As a TMJ specialist, there are times when medications are an important part of the treatment strategy. Though side effects must be kept in mind, there are medications that are often extremely helpful for short periods of time. So, for many TMJ sufferers, I have found that there are some medications that work rather well to address pain, muscle tension, and jaw motion restrictions.
However, it’s the way that these medications are used that differentiates their effectiveness. The following information should be very helpful to those considering (or currently) taking medications for a TMJ problem.
1. Advil (Ibuprophen) and Aleve (Naproxen): For pain, particularly when inflammation is present. Very important! Advil and Aleve are not muscle relaxants, in spite of what many people believe. They are classified as non-steroidal anti-inflammatory drugs and designed to reduce inflammation in joints and muscles. Most important: For individuals who have had jaw problems for an extended period of time, these medications must be taken for 2-4 weeks in order to be maximally beneficial. At the same time, the factors that caused the inflammation must be addressed or the medications will have limited benefit.
For some inflammatory problems associated with the temporomandibular joints specifically, these medications may be necessary for 8-12 weeks just like they would be required for this duration for inflamed and painful knees. Because Advil and Aleve can upset the stomach and kidneys, care must be taken when extended use is prescribed. Alleve has been recently recommended to be the anti-inflammatory of choice for those at risk for a heart attack or have a history of heart problems .
2. Tylenol (Acetaminophen): For pain when inflammation is not present. Acetaminophen is a different class of drug than Advil and Aleve and is not an anti-inflammatory medication. It is an analgesic that is effective to relieve pain when inflammation is not present. Your doctor must monitor long-term use of Acetaminophen as it can induce headaches and can compromise liver function (particularly in individuals that consume alcohol daily).
3. Muscle Relaxants: Commonly known muscle relaxants are Flexeril, Soma, Skelaxin, Zanaflex and Robaxin. This class of drug can only be obtained with a prescription. Muscle relaxants can be used both during the day and at night before going to bed. Because some people experience fatigue when using them particularly during the day, we often need to try several types to get the right one.
Muscle relaxants can also be used while taking other products such as Aleve, Advil and other prescription anti-inflammatory options. The time frame over which these medications are taken is variable but can be used for many months (particularly when taken only at bedtime).
An added bonus for patients taking muscle relaxants is that they promote restful sleep and can often reduce the intensity of nighttime grinding and clenching of the teeth.
4. Anti-Anxiety Medication: When anxiety and worry are driving muscle tension and pain in the face and jaw it is not uncommon to prescribe small doses of anti-anxiety medications for a short period of time to be taken during the day, at bedtime, or both. These medications work in the brain and help reduce the ability of muscles to “brace” as a consequence of life events, thoughts, and or emotions.
The commonly known medications in this category are Valium, Xanax, Klonopin, and Ativan. These are controlled substances, available by prescription only, and registered in a national data bank to help prevent overuse and abuse.
When taken at bedtime they are very effective (in short term periods) in reducing tooth grinding and clenching and the consequent symptoms of pain and muscle tension in the morning. My patients often report that anti-anxiety medication “takes the edge of my pain and muscle tension.”
So, for TMJ sufferers, medications have proven to be very helpful in breaking the “pain cycle” and allowing other therapies to begin to work for long-term relief. The key is using the right one, careful monitoring, and short-term use.
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