Jaw muscle pain: How to get relief
Since TMD pain is not a serious condition, conservative management such as prescribing pain medications should be considered as the first line of treatment. File photo
A patient walks in and has jaw pain. Her jaw aches when she wakes up or when she yawns or when she wolfs down a burger at 8 Cuts. A thorough TMD exam tells me she has myogenous TMD, (the scientific term for jaw muscle pain) but the joint itself is not painful. Since TMD pain is not a serious condition, conservative management such as prescribing pain medications should be considered as the first line of treatment. But what type of pain medication to give? Well, it will depend on the specific TMD diagnosis and this is why pain medications sometimes don’t work, because of misdiagnosis. The other reasons are improper dosing and lack of patient compliance.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) have been successful in alleviating common dental pains. It is most e?ective where there is inflammation. Jaw muscles are rarely ever inflamed even when painful which is why NSAIDs sometimes don’t work for patients with non-inflammatory TMD. Some patients are allergic to NSAIDs and this can cause serious or life-threatening reactions. A more common adverse e?ect is tummy irritation and a possible remedy for this is to take the medication with some food.
In many cases, I find that Paracetamol/Acetaminophen is a rational first choice for pain control. I’ve read many studies that show Paracetamol to be a comparatively good pain reliever and, many times, their ine?ectiveness stems from insu?cient dosing rather than the drug itself being ine?ective. Paracetamol has a fairly wide margin of safety and given properly, can relieve most mild to moderate non-inflammatory TMD muscle pain and related headaches, with low risk of adverse e?ects.
My personal experience in prescribing Muscle Relaxants (MR) for TMD has been inconsistent. They work by “relaxing” muscles—of course—mainly by decreasing muscle tone, spasm and contraction. The lack of e?cacy in TMD may have to do with the fact that in most cases, jaw muscles do not undergo spasm (sudden, involuntary contraction). However, MR’s have shown good e?cacy in other medical applications. Some side e?ects of MR’s are drowsiness and muscle weakness and should be prescribed with caution in patients who operate heavy machinery.
There are other drugs that have o?-label use for TMD pain which modify the body’s inherent pain control system. Next installment will be about oral splints, the most abused oral device used in treating TMD.
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Dr. Ricardo Boncan received his training in TMD and Orofacial Pain at the University of Rochester, Eastman Institute of Oral Health in Rochester NY. He is the current president of the Orofacial Pain Association of the Philippines and the program director of the University of the Philippines College of Dentistry TMD and Orofacial Pain Program.
