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Muscle-facial pain syndrome.
Last reviewed: 04.07.2025
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Myofacial pain syndrome may be seen in patients without temporomandibular joint pathology. It may be caused by tension, fatigue, or spasm of the masticatory muscles (medial and lateral pterygomandibular, temporalis, and masseter). Symptoms include bruxism, pain and tenderness in and around the masticatory apparatus or radiating to adjacent areas of the head and neck, and often abnormal jaw mobility. Diagnosis is based on the patient's history and clinical examination. Conservative treatment, including analgesics, muscle relaxation, habit modification, and splinting, is usually effective.
This syndrome is the most common condition localized in the temporomandibular region. It is most often observed in women in their 20s or during menopause. Muscle spasm is a consequence of nocturnal bruxism (clenching and grinding of teeth). The cause of bruxism is controversial (incorrect contact of teeth, emotional stress or sleep disturbance). Bruxism has several etiologic factors. Musculofacial pain syndrome is not limited to the masticatory muscles. It can be observed in other parts of the body, usually involving the muscles of the neck and back.
Symptoms of myofacial pain syndrome
Symptoms include pain and tenderness of the chewing muscles, usually pain and limitation of mouth opening. Nocturnal bruxism may cause headaches that improve during the day. Daytime symptoms, including headaches, may be worse if bruxism occurs during the day.
The jaw moves when the mouth opens, but usually not as suddenly and always at a given point as is observed with internal joint damage. When pressing on the jaw, the doctor can open the mouth 1-3 mm more than the maximum opening on its own.
A simple test can help make the diagnosis: the tongue surface is placed on the inner surfaces of the molars and the patient is asked to gently close the jaws. Pain in one spot is the symptom. X-ray examination does not provide data, but allows to exclude arthritis. If arteritis is suspected, ESR measurement is necessary.
Where does it hurt?
How to examine?
Treatment of myofacial pain syndrome
A bite guard made by a dentist can protect the teeth from contact with each other and prevent bruxism. A mouth guard that becomes pliable when heated is convenient. They are available at many sporting goods and drug stores. Low doses of a benzodiazepine at night are often effective during flare-ups to reduce symptoms. Mild pain relievers such as NSAIDs or acetaminophen may be prescribed. Because the disease is chronic, opiates should not be used except in acute flare-ups. Clenching of the jaw and grinding of the teeth should be controlled. Coarse foods and chewing gum should be avoided. Some patients may benefit from physical therapy and psychotherapy to relax the muscles. Physical therapy includes transcutaneous electrical stimulation of the nerve or cooling of the skin at the painful point with ice or skin sprays such as ethyl chloride when opening the mouth. Botulinum toxin can be used to reduce muscle spasm in myofacial pain syndrome. In most patients, even if they have not received treatment, the main signs of the disease disappear within 2-3 years.