From the Guidelines
Management of both myofascial pain syndrome (MPS) and temporomandibular joint disorder (TMJD) should prioritize cognitive behavioral therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care. This approach is based on the strongest and most recent evidence from a clinical practice guideline published in the BMJ in 2023 1. The guideline provides strong recommendations in favor of these interventions for patients living with chronic pain associated with TMD.
Key Interventions
- Cognitive behavioral therapy (CBT) with or without biofeedback or relaxation therapy
- Therapist-assisted mobilisation
- Manual trigger point therapy
- Supervised postural exercise
- Supervised jaw exercise and stretching with or without manual trigger point therapy
- Usual care, such as home exercises, stretching, reassurance, and education
Additional Considerations
- Conditional recommendations are made in favor of manipulation, supervised jaw exercise with mobilisation, CBT with non-steroidal anti-inflammatory drugs (NSAIDS), manipulation with postural exercise, and acupuncture 1.
- Conditional recommendations are made against reversible occlusal splints, arthrocentesis, cartilage supplement with or without hyaluronic acid injection, low level laser therapy, transcutaneous electrical nerve stimulation, gabapentin, botulinum toxin injection, hyaluronic acid injection, relaxation therapy, trigger point injection, acetaminophen, topical capsaicin, biofeedback, corticosteroid injection, benzodiazepines, and β blockers 1.
- Strong recommendations are made against irreversible oral splints, discectomy, and NSAIDS with opioids 1.
Lifestyle Modifications
- Patients should avoid hard or chewy foods
- Maintain proper posture
- Practice jaw relaxation techniques
- Stress management techniques, including meditation and deep breathing exercises, are important as stress often exacerbates both conditions 1.
From the Research
Management for Myofascial Pain Syndrome (MPS) and Temporomandibular Joint Disorder (TMJD)
- The management of MPS and TMJD can involve a combination of treatment modalities, including trigger point injection therapy, stabilization splint therapy, and biopsychosocial profile modulation 2, 3.
- Trigger point injection therapy combined with splint therapy has been shown to be effective in reducing pain and improving overall signs and symptoms in patients with myofascial temporomandibular disorder (TMD) 2.
- A holistic approach to treatment is recommended, taking into account the complex interplay between the limbic, autonomic, endocrine, somatic, nociceptive, and immune systems 3.
- Conservative modalities such as home care regimens, pharmacotherapy, intraoral appliance therapy, local anesthetic trigger point injections, physiotherapy, and complementary modalities may be beneficial in patients with MPS and TMJD 4.
- A multimodal approach to management is recommended, involving patient education, exercise, behavior modification, pharmacotherapy, and procedural interventions 5.
- Non-pharmacologic treatment modalities such as acupuncture, massage, transcutaneous electrical stimulation, and interferential current therapy may offer relief to some patients with MPS 6.
Treatment Options
- Trigger point injections
- Stabilization splint therapy
- Biopsychosocial profile modulation
- Pharmacotherapy (e.g. topical analgesics, nonsteroidal anti-inflammatory drugs, muscle relaxants)
- Procedural interventions (e.g. manual therapy, dry needling, onabotulinumtoxinA injections, acupuncture)
- Non-pharmacologic treatment modalities (e.g. acupuncture, massage, transcutaneous electrical stimulation, interferential current therapy)
Key Considerations
- Early intervention is important to prevent chronicity and improve treatment outcomes 5.
- A thorough history and clinical examination are essential for accurate diagnosis and effective treatment 4.
- Treatment should be tailored to the individual patient's needs and may involve a combination of different modalities 2, 3, 4, 5, 6.