Neck, Joint, Limb Pain

Pain in your head, neck, joints or from a body part you no longer have (known as phantom pain) can be caused by a wide range issues, including dental problems, structural abnormalities, injuries and illnesses.

Temporomandibular Joint Disorder
Head and facial pain may be the result of problems with teeth and gums, inflammation in the cranial nerves (trigeminal neuralgia ) or misalignment of the jaw (temporomandibular joint disorder, commonly known as TMJ) and should not be confused with a headache .

Symptoms may include pain or tenderness in the jaw, an aching pain in and around the ear, difficulty and discomfort when chewing and a locking of the jaw, making it difficult to open or close your mouth, which may also be accompanied by a clicking sound or grating sensation.

The temporomandibular joint is constructed with both a hinge action (opening and closing around a pivot point) and with sliding motions (a forward-back and side-to-side motion that helps teeth grind food). The bones that interact in the joint are covered with cartilage and are separated by a disk that keeps the movement smooth. Pain can result from the disk eroding or misaligning, the cartilage becoming damaged by arthritis or the joint suffering an injury.

TMJ disorders may happen at any age and to anyone, but they most commonly occur in women between the ages of 20 and 40. If there is no pain or limits to your ability to open and close your mouth or chew, you probably do not need medical treatment.

Neck and Joint Pain
Neck pain, as well as joint pain, may range in severity from a dull ache to a sharp stabbing or burning pain and be accompanied by numbness and muscle weakness. These common conditions may be caused by injuries, illnesses or conditions such as arthritis or arthralgia (joint pain). The associated pain usually only lasts a few hours or days and often responds to pain relievers, physical movement or massage. If pain lasts longer than several weeks, it is considered chronic or persistent. Most neck and joint pain does not need medical care.

Phantom Pain
When phantom pain occurs, an amputee can feel aches described as sharp, shooting, burning or cramping, or an uncomfortable sensation in the missing limb.

After an amputation, the local nerve cells remap their position in the brain and the new sensations that result create the feeling that the body part still exists and is experiencing sensory input. The sensations appear to originate in the spinal cord and brain; MRI scans have shown that the parts of the brain responsible for the nerve signals from the missing limbs still show activity when a person is experiencing phantom pain.

For some people, phantom pain resolves itself. Phantom pain may appear within a few days of amputation, can come and go or be continuous, is more likely to affect the part of the limb the farthest from the body and may feel like the limb is forced into an uncomfortable position. It can be triggered by emotional stress or by pressure on the remaining part of the limb.

Sometimes pain is a medical emergency
Neck pain may be a medical emergency. Call 911
if neck pain is severe and accompanied by these critical conditions:
  • An automobile accident or fall occurred right before the pain started
  • A high fever
  • Pain that radiates down the arms and legs
  • Loss of bladder or bowel control
  • Initial, less severe pain persists for several weeks or gets worse

Joint pain may also be a medical emergency. Call 911 if any serious joint conditions occur:
  • Sudden and severe joint pain
  • Joint pain accompanied by fever but not other flu symptoms
  • Severe, unexplained joint pain and swelling
  • Sudden appearance of a new joint deformity
  • Unable to use a joint

Diagnosis of Head, Neck, Joint and Phantom Limb Pain

Temporomandibular Joint Disorder
The team at Houston Methodist will take your medical history and perform a physical exam, during which the doctor will listen to and feel your jaw when you open and close your mouth to observe the range of motion; they may also press on the jaw to identify painful spots.

At Houston Methodist we refer patients with teeth pain to a dentist, who may recommend X-rays . Other potentially helpful imaging may include a computed tomography CT scan to capture detailed images of the bones involved in the joint or a magnetic resonance imaging (MRI) to expose problems in the joint's disk.

Neck and Joint Pain

To determine the potential underlying causes, our team of physicians will take your medical history and perform a physical exam, after which imaging, blood, urine and neurological tests may be recommended.

Phantom Pain
To identify whether it is phantom pain or pain in the tissue surrounding the amputation site, our team of physicians will take your medical history and perform a physical exam.

Treatment Options for Head, Neck, Joint and Phantom Limb Pain
A regimen of self-care, moderating activities, learning to relax, managing stress and establishing a healthy pattern of exercise, sleep and eating can help negate the need for medical treatment of these disorders.

Temporomandibular Joint Disorder

Although the symptoms of TMJ do sometimes go away on their own, those that persist may be treated with a variety of medication-, therapy- and procedure-based methods.

Medications known to help treat the symptoms of TMJ include pain relievers, antidepressants, muscle relaxants and sedatives to help relax and aid sleep.

Other nonpharmaceutical therapies may include exercises to stretch and strengthen the jaw muscles, using oral splints (bite guards) while sleeping, as well as counseling to help understand and avoid behaviors that typically worsen the pain.

If these methods prove unsuccessful, the doctors may explore other options such as injecting corticosteroids directly into the joint, arthrocentesis (inserting needles in the joint to push fluids, removing inflammatory byproducts) and, as a last resort, surgery to repair or replace the joint .

Neck and Joint Pain
The symptoms of neck and joint pain may also go away without treatment, but if they do not, physical therapy techniques may be recommended in addition to medication, such as pain relievers or antidepressants.

Phantom Pain
As a first step to relieving phantom pain, which can be difficult, the care team may initially suggest medications and then explore noninvasive therapies.

Despite the fact that no drugs exist specifically to treat phantom pain, some that have been found to relieve nerve pain include antidepressants (amitriptyline), anticonvulsants (gabapentin), opioids (codeine) and anesthetics (N-methyl-d-aspartate receptor antagonists or NMDA, such as dextromethoraphan).

Nerve stimulation (with a transcutaneous electrical nerve stimulation device or TENS), acupuncture, injections of anesthetics and steroids into the stump, electrical stimulation of the spinal cord and injections of nerve blocks can each offer relief from phantom pain.

Therapies that involve creating a virtual image of the lost limb (and then exercising it) can help reduce the feeling of the syndrome. Mirror box therapy involves a box with two holes in which the patient inserts both their remaining limb and the stump; mirrors in the box make it look as if the missing limb has reappeared; and the patient performs symmetrical exercises (both limbs together).

If other treatments do not help relieve the symptoms, such surgical options as brain stimulation and stump revision may be recommended. In brain stimulation, a surgeon delivers electric current stimulation through electrodes placed in the brain. In stump revision (neurectomy), a surgeon resects some of the nerves in the tissues around the amputation site.


Our physicians at Houston Methodist specialize in managing pain conditions at the following convenient locations.