When myofascial pain (muscular TMJ) is a component of the pain problem, a trigger point injection (TPI) is helpful in treatment along with home stretching protocol. These injections are used to treat extremely painful areas of muscle that do not respond to stretching. A trigger point is a knot or tight, ropy band of muscle that forms when a muscle fails to relax. The knot often can be felt under the skin by palpating the painful area.
How It Works
Usually a small needle is inserted into the trigger point and a local anesthetic is used usually lidocaine. This injection inactivates the trigger point and thus alleviates pain. Numbness from the anesthetic may last about an hour, and a bruise may form at the injection site but this is not common. Pain can be relieved by alternately applying moist heat and ice for a day or two. In all cases, stretching exercises are performed following TPIs.
Indications For Lidocaine Trigger Point injections
- Myofascial pain (MFP) with an “active” trigger point: Active trigger point is defined as a pain site within a taut muscle band with referred pain on palpation
- Limited mouth opening due to painful muscles of mastication (chewing muscles)
- Referred TMJ from neck muscles
Steroid Injections For The TMJ
A TMJ joint injection is not the first approach for joint pain and swelling because it is logical to first try NSAIDs for a couple of weeks. However, if this medication or self-treatment approach fails to yield an improvement in two weeks, the next procedure to be considered would be a local anesthetic/corticosteroid assisted mobilization of the TM joint. This procedure can be done at an outpatient office visit, when a combination anesthetic and steroid injection is administered to the joint, the jaw is manually mobilized (stretched open gently) to increase mobility or the patient is taught self-stretching exercises to be performed at home. Intra-articular injections are occasionally used as a both diagnostic and therapeutic purposes of TM Joint pain. The primary indication for this procedure is substantial tenderness of the joint capsule. Usually, a corticosteroid injection in a small joint such as the TMJ is not performed more frequently than 10 times total and no more than once every three months (maximum of four injections a year).
Indications For Steroid TMJ Injections
- An arthritis/capsulitis flare-up of the TMJ with pain being generated on function
- TMJ capsule palpation should reveal substantial tenderness that has not responded to NSAIDs
Botox Injections For TMJ
Botox® can be injected into muscular structures around the TMJ to decrease spasms and improve overall muscle flexibility that can help to restore function. Since Botox® temporarily gets rid of the signals between your nerves and muscles, this means it can decrease the forces exerted on the jaw joint and relive your pain. Studies have shown that Botox® injections not only work to relieve muscle tension but it also helps by blocking pain signals to the brain thus providing pain relief. Botox® inactivates the nerve endings that cause muscles to contract, eliminating involuntary contractions in the jaw. For many patients, Botox® provides a minimally invasive and fast acting solution for symptoms that might otherwise require extensive treatment or even surgery. Botox® can be used to ease painful muscle cramping and spasms, a side effect of clenching and grinding of patients’ teeth, which are often symptoms associated with TMJ/TMD. Therefore, botulinum toxin is used as a treatment for persistent taut bands in myofascially altered muscles.
Is It Safe to Use Botox® For Jaw Pain?
Though not FDA approved for management for TMJ pain, Botox® is safe and effective treatment for managing complex jaw/facial pain. Botox® has been researched and used clinically for over 20 years, and the research has allowed for the fine-tuning of dosages and injection sites. There is always, of course, the potential for side effects including pain or swelling at the injection site, but these are usually mild and subside within a few hours. Also, the doses recommended for clinical treatment are well below doses that could cause human botulism.
The disadvantage of this method is that the use of local anesthetic injections into trigger points is actually a more substantial, but shorter acting way of relieving the trigger point pain than botulinum toxin. Thus, the first line therapy for a trigger point is stretch and thermal therapy. The second approach is local anesthetic trigger point injections. The third is botulinum toxin trigger point injections.
Indications for Botox TMJ injections
- Myofascial pain with an “active” trigger point that is unresponsive to trigger point injection treatment
- Active trigger point is defined as a pain site within a taut muscle band with referred pain on palpation
The pain felt by TMJ sufferers can be agonizing and keep you from living your life to the fullest. Since every TMJ disorder patient has different needs, it is important for Dr Virk to evaluate you to determine which unique treatment plan can maximize results for you. If you think you may have TMJ disorder, or if you just have questions, please feel free to contact us to make an appointment!
Note: The content of this blog is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.