TMJ and stress are closely related. There is a bidirectional relationship between temporomandibular joint (TMJ) pain and the state of emotional and physical tension we call “stress”. Jaw pain from stress can lead to changes in the brain responsible for pain signaling. When pain pathways are triggered, stress hormones are released, leading to more emotional and physical tension. If untreated, this cycle of jaw pain and stress is a risk factor for developing chronic TMJ pain disorders.
Here’s what you need to know about TMJ and stress.
Psychological stress occurs when a person perceives that the demands of their current situation exceed their resources to deal with it. It can overlap many other psychological states, such as fear, anxiety, depression, catastrophizing, and despair. Stress can be triggered by life events, personality factors, and physical trauma.
Stress is not just a state of mind, it’s a state of body. The autonomic nervous system regulates your heart rate, breathing, vision, muscle tone, and other bodily functions in response to real or perceived threats. This is the so-called “fight or flight” response.
When situations in our lives trigger this response in a sustained way (i.e. chronic stress), our bodies can become negatively impacted. Once the biological mechanisms of stress become activated, stress can become a self-perpetuating cycle. Proven biomarkers of stress include cortisol levels, acute phase proteins, and inflammatory mediators.
Chronic stress and the sustained autonomic response can lead to serious illness. Systemic diseases associated with chronic stress include:
The association between stress and TMJ disorders was first proposed in the late 1960s. Since then, this association has been repeatedly supported using standardized measures of psychological stress. Most recently, researchers have found increased biomarkers of stress (such as salivary cortisol) in patients with TMJ pain, further demonstrating the link between stress and TMJ disorders.
Stress is not only coincident with TMJ disorders, but it also often precedes these disorders, suggesting that in some cases, stress initiates the pathological process that leads to chronic TMJ pain.
There is also a connection between stress and bruxism, which is repetitive activation of the jaw muscles in the form of jaw tension, jaw clenching, or teeth grinding. The medical literature indicates that there is a strong association between stress and bruxism. Bruxism itself is an independent risk factor for the development of chronic jaw pain and headaches.
Both stress and bruxism facilitate the development of chronic TMJ pain. “When stress causes chronic jaw tension and clenching, the jaw muscles start to fatigue and register pain. Neural pain pathways in the brain become hyperexcitable, amplifying these pain signals. Through parallel neural mechanisms, stress further compounds this phenomenon of pain amplification. This creates a ‘perfect storm’ for the development of TMJ pain disorders”, explains Bradley Eli, an Orofacial Pain Specialist.
Because stress and TMJ symptoms are so intertwined, the best strategy for TMJ stress relief is to independently address the psychological aspects of stress and the physical symptoms of jaw pain.
The key to stress management is to develop a sense of self-efficacy. If you start to feel empowered to deal with whatever situation you are in, you are well on your way towards stress relief. To de-stress your life, you can use your own resources and methods, or you can use formal stress management techniques. Here are some evidence-based methods of stress management to choose from:
The second prong of a TMJ stress relief strategy is to treat the physical symptom of jaw pain. When the bi-directional cycle of stress and jaw pain are established, it is often not enough to only focus on stress management. Instead, jaw pain should be addressed independently and concurrently with a stress management program.
A multi-modal approach to jaw pain relief is optimal. Such an approach typically includes:
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