The Overlooked Source of Pain: TMJ Dysfunction and Chronic Pain Management
For over 50 years, the biopsychosocial model of pain management has been the gold standard for treating chronic pain. This holistic approach integrates biological, psychological, and social factors to provide a comprehensive treatment of pain that addresses not just the physical aspects of pain, but its emotional and social impacts as well. Yet, even within this model, certain conditions and sources of pain may be overlooked. One of the most commonly missed causes is temporal mandibular joint (TMJ) dysfunction, which is a source of dental pain that often flies under the radar, even in the best pain management programs.
In a Tedx talk given by by Suzie Bergman, DDS, FTMJF that I recently watched, an important spotlight is placed on the TMJ as a critical source of pain that’s often ignored. Dr. Bergman outlines how dental pain, particularly pain stemming from just TMJ dysfunction, can contribute to widespread chronic pain in ways that are frequently misunderstood or dismissed.
TMJ and the Biopsychosocial Approach
The temporal mandibular joint, located near the ear where the jawbone meets the skull, is responsible for a wide range of movements involved in chewing, talking, and swallowing. When this joint becomes misaligned or dysfunctional, it can result in a painful condition called TMJ disorder (or TMD) which can lead to headaches, jaw pain, and neck pain. It can even radiate discomfort through the face and shoulders.
While chronic pain patients often seek relief through established pain management programs, the focus tends to be on conditions like arthritis, fibromyalgia, or nerve damage. In these programs, the biopsychosocial model emphasizes treating the whole person: mind and body. Yet the intricate connection between TMJ and the other areas of the body is frequently missed. This oversight is a major gap in pain treatment, because TMJ dysfunction can mimic or contribute to other chronic pain conditions.
Why TMJ Is Often Overlooked?
There are a few reasons why TMJ dysfunction may be ignored or overlooked in chronic pain treatment:
- Specialized Nature of Dental Pain: Unlike other sources of chronic pain, TMJ dysfunction falls into a gray area between dentistry and pain management. Many chronic pain patients don’t seek a dental consultation unless they experience acute issues like toothaches or cavities. However, the jaw’s alignment, and the function of the temporal mandibular joint, are critical to overall body mechanics and pain perception.
- Symptoms That Overlap With Chronic Conditions: TMJ dysfunction can present with symptoms that overlap with other pain conditions such as migraines, tension headaches, and neck pain. Because so many clinicians fail to consider TMJ as a potential source, many patients are misdiagnosed or left untreated for the actual cause of their pain.
- Lack of Awareness: Both patients and some healthcare professionals might not fully understand how TMJ dysfunction can lead to systemic pain issues. This lack of awareness can contribute to underdiagnosis and ineffective treatment strategies, even in interdisciplinary pain programs.
The Call to Action
Dr. Bergman’s Tedx Talk brings an essential message to the forefront. We must not overlook TMJ when treating chronic pain. Ignoring the potential role of TMJ dysfunction in chronic pain syndromes can lead to prolonged suffering and inadequate treatment.
It’s crucial to spread the word about the impact of dental health on overall pain and advocate for a more integrated approach to pain management. Chronic pain patients should consider consulting with a dental specialist or TMJ expert as part of their pain management journey, ensuring that all possible sources of pain are thoroughly explored.
By incorporating TMJ evaluations into the biopsychosocial model, healthcare providers can offer more comprehensive care that addresses every facet of the patient’s pain experience. As Dr. Bergman emphasizes in the Ted Talk, understanding the connections between dental structures and chronic pain is a key to helping patients find relief and improving their quality of life.
Watch the TEDx Talk
I recommend watching this insightful Tedx talk to learn more about TMJ dysfunction and its role in chronic pain. Together, we can advocate for better awareness and improve treatment strategies in the field of pain management. Watch it here.
By sharing this information and spreading awareness, we can take a significant step forward in ensuring that TMJ dysfunction is no longer an overlooked source of chronic pain in treatment programs.
Dr. Suzie Bergman is a Visiting Research Scholar at Oregon Health Sciences University in the department of Neurological Surgery. Her most recent faculty appointment is with Pacific Northwest University School of Dental Medicine as an Adjunct Associate Professor. Her private practice is Dentistry on Officers Row in Vancouver, WA.
Some reports of of TMj having positive pro-inflammatory cytokine elevations along with generalized joint inflammation. i believe is nearly pathognomic for systemic inflammatory response syndrome R65.10 the real “chronic pain” syndrome with sub variants of rare painful diseases: CRPS, adhesive arachnoiditis, etc And at this point I think also the autoimmune disease group which are not that far off from the 25 rare painful disease group which we also include under the rubric of R65.10. Point being we have classified TMJ as also a rare painful disease under R65.10. We believe opiate analgesia is the drug of choice for the majority of the R65.10 CPPS due to the dual nature of opiates as the only FDA approved agent for severe pain plus it’s marked anti-inflammatory properties.