From the Guidelines
Muscle relaxants are not recommended as a first-line treatment for Temporomandibular Joint (TMJ) disorders, as the current evidence suggests conditional recommendations against their use, especially when combined with acetaminophen or NSAIDS 1. When considering treatment options for TMJ disorders, it's essential to prioritize conservative, reversible, and evidence-based approaches. The most recent guidelines recommend cognitive behavioral therapy, therapist-assisted mobilization, manual trigger point therapy, supervised postural exercise, and supervised jaw exercise and stretching as strong recommendations for managing chronic pain associated with TMD 1. Some key points to consider when treating TMJ disorders include:
- Conservative approaches, such as reassurance and education, avoidance of wide mouth opening or aggravating activities, soft diet, jaw exercises, massage, non-steroidal anti-inflammatory drugs (NSAIDs), heat and/or cold, bite plate in the presence of bruxism, physiotherapy, mindfulness, yoga, meditation, acupuncture, splint therapy, cognitive behavioral therapy, paracetamol, and neuromodulatory medications (eg, amitriptyline, gabapentin) should be pursued first 1.
- Surgery should be considered only after non-response to conservative therapy, including arthrocentesis, arthroscopy, or open surgery of the temporomandular joint 1.
- The use of muscle relaxants, such as cyclobenzaprine (Flexeril), methocarbamol (Robaxin), and baclofen, may be considered in specific cases, but their effectiveness and safety should be carefully evaluated, and they should be used for short-term periods (2-3 weeks) due to potential side effects and dependence 1. It's crucial to weigh the potential benefits and risks of each treatment option and to prioritize the most effective and safest approaches for managing TMJ disorders, focusing on improving morbidity, mortality, and quality of life outcomes.
From the Research
Temporomandibular Joint (TMJ) Disorders and Muscle Relaxants
- Temporomandibular disorder (TMD) is a collective term that includes disorders of the temporomandibular joint (TMJ) and of the masticatory muscles and their associated structures 2.
- TMDs are characterized by pain, joint sounds, and restricted mandibular movement, and drugs are widely used in the management of that pain 2.
- Pharmacological agents commonly used for the treatment of TMDs include non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, muscle relaxants, antidepressants, anticonvulsants, and benzodiazepines 2, 3, 4.
Efficacy of Muscle Relaxants in TMJ Disorders
- There is evidence to suggest that muscle relaxants can be used as a supportive therapy in the treatment of patients with temporomandibular joint disorders 5, 6.
- Progressive muscle relaxation can be successfully used as a supportive therapy treatment of patients with dysfunction 5.
- A systematic review, including a network meta-analysis, found evidence for the use of muscle relaxants in the treatment of TMD-M (temporomandibular disorders with a focus on the masticatory muscles) 6.
Treatment Approaches for TMJ Disorders
- Treatment is directed toward reducing pain and improving function, and many non-invasive therapies, such as self-care, physical therapy, and appliance therapy, are commonly used for the treatment of TMD 2.
- Pharmacological intervention has been used for many years, and the most effective pharmacological agents for the treatment of TMD include analgesics, NSAIDs, opioids, corticosteroids, anxiolytics, muscle relaxants, antidepressants, anticonvulsants, and benzodiazepines 2, 3, 4.
- The evidence clearly indicates that the pharmacological treatment approaches differ between TMD-M and TMD-J (temporomandibular disorders with a focus on the temporomandibular joint), and it is of great importance to first try to uncover each patient's individual and multifactorial etiology and then employ a multifaceted treatment strategy, including pharmacological treatment approaches 6.