Can Botox Help TMJ Pain?

  • Can Botox Help TMJ Pain
    Can Botox Help TMJ Pain?
    • Ann C McCulloch
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    Can Botox help TMJ pain? The answer is yes! Because temporomandibular joint (TMJ) pain is frequently associated with jaw muscle tension, Botox injections for TMJ pain makes logical sense. Further, Botox may help more than just muscle tension, interrupting the neurobiological processes that perpetuate chronic pain. Botox for TMJ pain is considered a safe and effective treatment option when conservative treatments fail.

    Here’s what you need to know about Botox for TMJ pain and how to maximize your chances of a successful outcome.

    How Does Botox Relieve Pain?

    What is Botox? Botox is a neurotoxic protein produced by clostridium bacteria. While it doesn’t sound very nice, the medical applications of this toxin have exploded. Its main function is to stop muscle contraction by preventing the release of acetylcholine. Stopping muscle contraction can be a powerful intervention for chronic pain conditions that are related to chronic muscle tension. This is because chronic muscle tension causes inflammation, muscle fatigue, and poor oxygenation of the involved muscles.

    But Botox has another powerful effect when used for chronic pain conditions, unrelated to its tension relieving effect on muscles. To understand how, it’s important to understand the neurobiology of chronic pain as a bidirectional phenomenon between peripheral sensory nerves and the pain processing areas of the brain.

    Peripheral sensitization is when sensory neurons amplify pain signals to the brain. A simple example is when a limb is injured, a simple brush against the skin can be interpreted as painful. In acute injuries, this is mostly because of inflammation, but in chronic pain scenarios, the neurotransmitter receptors in sensory nerves become upregulated.

    Central sensitization is when there is an increased responsiveness of pain neurons in the brain. The result is hypersensitivity, registry of pain to normal touch, and an expansion of the pain field beyond the original area.

    The dynamics of peripheral and central sensitization are mutually reinforcing. Here’s how it works:

    • Initial injury increases pain signals to the brain.
    • If untreated in the acute phase, the prolonged pain signaling in the periphery causes central nervous system hyperexcitability.
    • Hyperexcitability in turn causes reflex guarding, muscle tension, and spasm in the peripheral limbs.
    • Muscle tension and fatigue from guarding and spasm then create more pain signals up to the brain.

    This vicious cycle of bidirectional reinforcement is the neurobiological basis for chronic pain.

    By causing a partial and temporary paralysis of the muscles of mastication, Botox significantly reduces jaw muscle tension and halts the cycle of chronic TMJ pain. The effect is much more powerful than that of muscle relaxants or other pharmacologic therapies.

    Botox also has a mitigating effect on both peripheral and central sensitization, beyond its effect on muscle contraction. Neurotransmitter release of sensory neurons is decreased after Botox treatment, thereby reducing peripheral sensitization. Botox also decreases central sensitization, although the mechanism for this is unclear. For instance, some preclinical studies have shown that when Botox is injected on one side of the body, both sides experience a reduction in pain. The important thing is that the pain cycle is interrupted at both sources, both peripheral and central.

    Can Botox Help TMJ Pain?

    While there are over 30 different types of temporomandibular disorders (TMDs), a subgroup of these relate primarily to jaw muscle tension, as opposed to degeneration or derangement of the joint itself. Most studies that have investigated Botox for TMJ pain treat those conditions that are directly or indirectly related to chronic jaw muscle tension.

    Multiple studies to date have shown that Botox is an effective treatment for chronic TMJ pain of muscular origin. Outcomes of these studies look primarily at reduction in reported pain levels, with a response rate as high as 70%. The decreased use of pain medications after Botox has been reported as a positive outcome. Additionally, some studies have documented improvement in functional outcomes after Botox injection, such as increased range of motion of the jaw.

    Jaw muscle tension is also associated with both tension type and migraine headaches. In fact, “headache associated with TMD” represents its own class in the diagnostic criteria for TMJ disorders because the pathophysiology of headaches and TMJ disorders are closely interlinked.

    “Numerous studies have documented the effectiveness of Botox for headaches. Interestingly, one of the main injection sites for treating both migraine and tension headaches is the temporalis muscle, a primary TMJ muscle. Orofacial pain specialists have appreciated the close association between headaches and jaw muscle tension for years”, explains Bradly Eli, DMD, MS, a specialist in TMJ disorders.

    Side Effects of Botox for Jaw Pain

    Because most practitioners use low doses of Botox in their protocols, side effects and complications are rare. These are some of the potential complications that can occur with Botox for TMJ pain:

    • Flu-like symptoms.
    • Bruising or local tenderness at the injection site.
    • Difficulty chewing (the most reported side effect).
    • Diffusion of the toxin to related structures, resulting in temporary paralysis of eye, brow, or smile muscles.
    • Accidental injection of the salivary gland, resulting in dry mouth.
    • Atrophy of the facial muscles, resulting in cosmetic changes.

    Jaw Pain Relief

    The effect of Botox on muscles lasts for around 90 days, giving you a narrow window to maximize your chances for a positive outcome. This is an excellent time to implement a multimodal approach for jaw pain relief. The primary methods of a comprehensive strategy for jaw pain relief include:

    • Jaw rest
    • Jaw Physical Therapy
    • Thermo/Cryotherapy
    • Behavioral Therapy
    • Intraoral Splinting

    All these components are included in the Speed2Treat Home Healing Kit. This includes the QuickSplint anterior bite guard, a neoprene jaw wrap with reusable hot/cold packs, jaw exercise instructions, self-guided behavioral therapy techniques for pain management, and more. If you are planning on getting Botox for TMJ pain, consider using the Home Healing Kit to improve your chances of a successful outcome.

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