[KoK! Health] How to Treat Chronic Temporomandibular Joint Pain That Lowers Quality of Life

Easily Mistaken for Simple Fatigue or Muscle Pain
Suspect Chronic Condition if Symptoms Persist Over 3 Months
Diverse Treatments Including Medication, Stabilizers, and Injections
Rest and Lifestyle Improvements Also Crucial

Temporomandibular joint pain.
Photo by Asia Economy DB

[Asia Economy Reporter Lee Gwanju] Temporomandibular joint (TMJ) pain is one of the representative conditions that lowers quality of life. Especially, it often accompanies other symptoms such as tinnitus, headaches, shoulder and neck pain, not just pain in the TMJ itself, so people often mistake it for simple fatigue or muscle pain and visit the hospital only after a long time. In such cases, TMJ pain can become chronic.

Chronic TMJ pain does not easily disappear in a short period. The causes are also diverse. Changes in the plasticity of the pain nervous system, emotional stress, genetic issues, malocclusion, teeth grinding, and associations with other chronic diseases can all be causes of TMJ pain, so efforts to control complex symptoms are necessary. Chronicity can be suspected when continuous pain lasts for more than three months in the jaw and surrounding tissues. Although the pain intensity weakens compared to the initial stage, a dullness and stiffness of unknown cause persist, and the pain spreads from part of the jaw to the molars on the same side, head, and neck, accompanied by referred pain symptoms. Emotional stress such as sleep disorders, depression, and anxiety also adds to the distress.

Various treatment methods can be attempted for appropriate pain control. First, symptoms can be controlled through proper medication, and gradually reducing the dosage can lead to a better state than before without major side effects. In chronic pain management, in addition to widely known analgesics, anti-inflammatory drugs, and muscle relaxants, central nervous system drugs such as antidepressants and anticonvulsants are also used. Patients sometimes protest, saying, "I don't have depression or epilepsy, so why am I taking these drugs?" but this is a misconception. Professor Park Hyeji of the Department of Oral Medicine at Kangdong Kyung Hee University Hospital explained, "Low-dose antidepressants and neuropathic drugs are known to be effective in controlling chronic pain regardless of the symptoms of the specific disease," adding, "Especially with medications, since they do not have only one indication and dosages and methods vary depending on the disease, there is no need to worry."

Professor Hyeji Park from the Department of Oral Medicine at Gangdong Kyung Hee University Hospital is examining a patient.
[Photo by Gangdong Kyung Hee University Hospital]

Use of occlusal stabilization devices such as splints, mouthpieces, and mouthguards can also be considered. They reproduce the most stable position of the lower jaw and are mainly worn at night. Usually, continuous use for about 6 months to 2 years can help improve symptoms. Using similar devices easily available on the market may cause more pain due to poor fit, so it is better to have them custom-made at a dental clinic and continue to receive management afterward.

If medication is burdensome, injection therapy is another option. It is performed on the masticatory muscles or TMJ cavity, using botox, steroids, hyaluronic acid, etc. Appropriate injection therapy can help patients who have gastrointestinal issues that make taking medication difficult and can also reduce the amount of existing pain control medication. Botulinum toxin, often thought of as a cosmetic injection, is actually used in various clinical fields. In the TMJ, it helps control symptoms by not only relaxing muscles but also blocking the pain itself.

Along with treatment, improving lifestyle habits is important. Professor Park emphasized, “Although it is basic, patients often ignore how their lifestyle patterns contribute to pain,” and added, “It is important to check lifestyle patterns and take appropriate rest and relaxation.” She continued, “Improvement of accompanying symptoms such as tinnitus, neck pain, shoulder pain, headaches, sleep disorders, psychological anxiety, and depression is also an important variable,” explaining, “In many cases, when comorbid conditions improve, TMJ symptoms also get better.”