Management of Chronic Pain Secondary to Temporomandibular Disorders

Jaw issues and TMJ pain are common, and can be a primary driver of chronic pain, or a comorbidity for many patients with other painful conditions.

Temporomandibular disorders (TMD) comprise a group of more than 30 painful conditions that affect the muscles of mastication, the temporomandibular joint (TMJ), and associated structures. TMD is a very common type of chronic musculoskeletal pain disorder that affects 6% to 9% of adults worldwide and is second only to low back pain.

Twelve subtypes of TMD have been proposed, including: myalgia, arthralgia, four types of disc displacement disorders, degenerative joint disease, subluxation, TMD related headache, and others. Thus, various conservative and invasive interventions are available to treat chronic TMD pain.
 
Some of the conservative therapies include: jaw exercises, jaw mobilization, cognitive behavioral therapy, self management (such as relaxation strategies), medication (such as anti-inflammatory drugs, analgesics, muscle relaxants), removable oral splints, low level laser therapy, and acupuncture.
 
Invasive therapies, some of which are irreversible, include: arthrocentesis, joint injection of local anesthetic and steroids, injection of regenerative substances, joint surgery, prosthodontics, orthodontics, and oral splints.

While numerous network meta-analyses (NMAs) have been performed on the efficacy and safety of interventions for chronic TMD pain, they all have limitations. Therefore, this systematic review and NMA attempted to deal with these limitations by comparing all known interventions for chronic TMD pain.

From Dr. Thistle:

Managing TMJ issues is often a secondary issue for chiropractors, who are often consulted primarily for spinal conditions. As we know, neck pain and many types of headaches are often accompanied by some form of TMD, so having a few tools at your disposal to manage this area is always helpful. In my experience, TMD symptoms track closely with stress levels, sleep quantity and quality and other non-biomechanical factors, so be sure to employ a holistic approach for these patients. With that said, skilled manual therapy in the form of soft tissue therapies, TMJ traction, mobilization or even manipulation can work wonders in combination with chiropractic care for spinal structures. Based on the results of this study, this remains an evidence-based approach to TMD pain.

RESEARCH REVIEW: Management of Chronic Pain Secondary to Temporomandibular Disorders

This paper was published in the British Medical Journal (2023)

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