Medical Questions > Conditions and Diseases > TMJ Forum

Do These Work - Tens, Trigger Point Injections, Etc???


i'm a newbie on this board, but my tmj isn't new (already 4 years) :(. Finally found this board and i'm hoping I can get help here.

My symptom is at a mild (but lasting and annoying) level. Usually have pain around my cheek after every meal and I have to take a nap for half an hour or so to force my muscles to relax.

I saw a dentist (also diplomate, american board of orofacial pain) in the bay area, california. His diagnosis was bilateral capsulitis of the tmj joint, facial/cervical myositis, and headache/facial pain. The treatment plan includes: 1) a splint, 2) soft tissue mobilization, 3) transcutaneous electro-neuro stimulation (tens), and 4) trigger point injections.

My questions are:

1) I wonder if there's anybody on this board who has received these treatments?

2) also wonder what side effects and what long-term (say 5-10 years) effects of these treatments would be? Anybody had similar treatment before? Would appreciate it if you'd like to share your experience. How long would the positive effects of the treatment will last? (i have some physical therapy before - the pain was relieved but came back after a couple of weeks.)

3) I also would like to know much you paid in the long run. My insurance told me it would be covered - but when I looked their detailed policy, it's stated only surgical treatments for tmj would be coverd.

Any comments or suggestions will be greatly appreciated. Many thanks in advance!

wayne :)
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First Helper 2netta

replied March 20th, 2006
Tmj Therapies Do They Work?
Hi :lol: ,
i have had tmj problems all my life. I had radical orthodontic treatment that was absolutely necessary, but the negative side effect was severe tmj disfunction. And it turned into a messy osteo arthritis problem in the joint.
In 1996 I had arthriscopic surgery to reseat the tmj ligament, clean bone fragments and lubricate the joint with sinovial fluid. The surgery was a success. In the healing phase I still had facial pain, but it did subside. If you have facial pain as you heal or pre surgery you should contact an arthritis support group in your area. Their knowledge of joint problems is significant. You can make lifestyle and diet changes to aid in your recovery.
I recovered nicely.
But it is 2006 now. In 2005 I started to suffer from headaches, shoulder pain, and migraines. It took a year but I was diagnosed with cervical headache. This is a result of the numerous joint and muscle problems associated with tmj.
My last mri shows both joints are good, yet the muscles are enlarged around the joints and in the neck causing problems with the trigeminal nerve.
I am in a combo therapy and it works! :lol:
a drug cocktail at bed of nortriptyline and zanaflex, physiotherapy with tens and anesthetic trigger-point injections.
The combo has taken me from a level 6 headache 24/7 with breakthrough migrains at level 10 with nausea and vertigo 3 times a week, plus muscle spasms in mouth, neck, shoulders, upper back and head.......To pain free days!
There is no need to suffer.
Wouldnt you like to get back to normal activity?

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replied March 20th, 2006
Opps Forgot One Thing
Hi again,

i just wanted to address one last question.
The splint.

I am also a past dental technologist and I can explain the splint.

I did have a splint too.

It is called a bite opening applience.
It is used to create what is called a freeway space in your mouth.

Often if the tmj is subluxated ( sort of dislocated a bit) from its ill position, it forces the mouth to overclose.
You may wonder how a mouth can close more than your teeth will allow....
Well it isnt exactly that kinda close that is addressed.
Think about when you watch tv or are almost asleep. Your mouth is slightly open in the resting body. That is the freeway space.
To keep that resting space the right size the splint is used.
It is cool.
It is like a retainer with acrylic over your top teeth
so when you are resting your teeth dont come together.

For an average tmj problem the splint is a necessary applience pre and post surgically, or if you dont want surgery it is a must.

Your front teeth will meet when you take the applience out to eat.

Also this applience helps with night grinding of teeth. People who are in pain often grind their teeth in their sleep. Wearing down the enamel edges of the teeth. The plastic cant wear down the edges of your teeth cuz it is softer than enamel.

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replied March 20th, 2006
Tmj Therapies Do They Work?

I noticed this site changed a word I put in before the drug names.
I am writing the word now as cocktail.
If it changes it again it now looks effensive.
Sorry, I did not mean it to be.
Seeing it changes the word I will choose to say that the word I put referred to a "mixed drink" .
Um the word is used to describe a mixture of drugs that are taken together and work well mixed.

I hope that clarifies things.
Sorry again.

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replied March 21st, 2006
Hi wayne,
a bite splint is usually used to take pressure off the tmjoint(s) or balancing out a bite that isn't perfect. Flat acrylic splints for either the top or bottom teeth are used for this. There are also repositioning bite splints as many dentists believe that the lower jaw needs to be brought forward to fix the tmj. It is the repositioning splints that can cause open bites, and this particular splint usage almost always has a phase ii where the bite is adjusted (braces, etc.)

the tens and trigger point injections seem a little extreme for a person just diagnosed. Are you on a soft food/no chew diet? Just by your posting about eating I can tell that chewing sets off your spasms.

I know this will sound like a strange question, but what is your posture like? Are you on the computer a lot? If you are a sloucher or your head is frequently forward towards a computer screen, this can all contribute greatly to tmj. You need to keep your shoulder back and down with neck and head over your body with the chin down (not sticking out). It has taken me years to finally work on my posture and it has made a big difference already.

Basically, tmj is the result of an imbalanced bite/jaw. Clenching and/or grinding teeth at night is a big contributor to causing the pain. Bite splints are great for this problem, but not the cure-all. Sometimes a muscle relaxant or valium is needed at night-time to help relax the muscles. Stress is also another big problem. Do everything you can to reduce any stress you might have in your life. I just recently had to change my job position because of stress. It's amazing the difference it has made.

To answer your questions:
1. Yes, i've had various bites for 25 years and though I still have tmj, I do believe that most of the splints have been helpful. Remember that bite splints are only as good as the bite splint maker and adjuster. Bite splints almost always have to be adjusted several times for the first time you get one. This is normal. If your dentist doesn't mention adjustments - ask.

Tens feels good when I am in severe pain. I don't use it when in milder pain. The only trigger point injections i've had were directly into the jaw joint and they didn't help me. I do know several people with severe tmj and face pain that have had these injections that say they help. I think it's going to depend on your pain level on what you decide.

2. Side effects, I don't know, but the tens and tp injections are only temporary. That's why I mentioned about the severity of your pain, which I don't know what it is.

3. Tmj insurance varies by states. My state of michigan does cover almost everything I need for tmj - bite splint, injections, office visits, medications. Pt is only covered if the diagnosis is tmj and cervical (can't just be tmj). Massage therapy, which I have found most helpful, is not covered. Bite splints usually have to have a letter from the doctor saying why it is medically necessary; not always though. Because of co-pays and deductibles and things not covered (mt), I have pain a lot of out-of-pocket money, but i've also had tmj for 25 years.

There is a good possibility that you will not have tmj forever like me, so don't get worried yet. It's difficult to write too much since I don't your pain and symptoms. If the worst problem you have is after eating, you really should try a soft food diet as mentioned above and/or muscle relaxants (some are better than others) for a few months to see how you respond. Use moist heat and/or ice frequently. I do almost every night before bed even if I am pain-free. Look at your posture (go to nismat.Org/ptcor/tmj/ for pictures and descriptions of exercises, etc.) and stress. Bite splints (especially flat plane ones) are considered conservative and may stop your night-time bruxism.

What is your bite like? Not how straight are your teeth, but does each and every tooth come together evenly? If you change your head position, does your bite coming together change (posture)?

I hope this has helped. I recently had a conversation with a co-worker who claimed he had tmj for years and surgery was planned to remove the deteriorated discs. One day while driving around at work he noticed that he was clenching his teeth. He put his tongue between his teeth and kept it there all the time. He had to consciously think about doing this. Anyway, one day just before the surgery, he woke up with no pain and he has remained that way (years now). Stressful job? Yes, a police officer. Tmj can be "cured" or at least managed.

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replied April 5th, 2010
Do people ever recover from tmj if the cause wasn''t from injury? I know I''ve got a long road ahead of me with this but I do know that mine wasn''t caused by any injury to the jaw joints I know that mine has something to do with the stress over the months I was working at a job( that I ended up quoting thank god) and night clenching I think what really messed me up was when I went to the dentist he had my mouth open for a while and that''s when everything happened all at once sad
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replied April 5th, 2010
Extremely eHealthy
I''ve known a lot of people sufferring from TMJ. I''ve never known anyone who has been "Cured". Most people who pursue treatment get a much more managable level of comfort with rare flare-ups of pain that they manage with medicaiton. However treatment is advancing every year on this disorder. I wouldn''t lose hope.
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replied December 16th, 2010
I have just started getting trigger point massages after my current nm dentist advised me to do this. It hurts a lot but I feel this combined with my orthotic will help.
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replied January 10th, 2011
I finally broke down and used my Tens machine on the jaw area and the relief was amazing. I have not felt this great in months.
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replied January 10th, 2011
Very low freq. I am shocked by the results.
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