TMJsurgeon.com…A Picture of TMJ Pain

We have all heard the expression that a picture is worth a 1,000 words. The above photograph is a real picture of pain. What you are seeing is an intense inflammatory infiltration of the lateral disc/capsule complex of the TMJ of a 17 year old patient, who has had chronic pain in all jaw movements, difficulty loading the jaw joint with forces required to eat properly without pain, and especially on attempted mouth opening. The jaw joint pops, locks variably, and pain is now refractory to all medications. The patient, though 17, has had daily pain and progressing symptoms for greater than 3 years. Dental therapies including bite plates (splints, orthotics etc.) and other treatments of the teeth and muscles have not been effective. The ” redness ” is inflammation. Much like the redness one would see surrounding a burn of skin or what surrounds any frank tissue damage that one can easily see after several days. Only, this inflammation is progressing and now involving the entire fibrous disc/capsule tissue of the TMJ. Such inflammation can irreversibly effect tissue quality and character if not properly diagnosed properly and early. Without proper imaging, it can not be appreciated ( Please refer to previous blogs to see the anatomy of the Disc/Capsule of the TMJ).

In confronting the problems of defining what “TMJ” is, my surgical experiences and visual observations refute much of what I was taught as a student in training to become a health care professional. It also challenges many theories of “TMJ”, “TMD” and other paradigms that have supported the sustaining of a poorly defined “syndrome” that effects millions of people. Those paradigms are strong on theories that “TMJ” is primarily a neuro-muscular pain syndrome, much like fibromyalgia. The only problem with many of these theories which influence on how these issues are clinically managed is that they are theories…and many of the theories concerning the jaw muscles as being the culprits is that they conflict with one another. (1-4) If one reads the extensive literature of the past 50 years in this field, you will not see a picture of an actual painful process….just a theory,written summaries, charts and diagrams of muscles, the nervous system and connections between muscles, connective tissues and the centers in the brain which monitor head and neck pain….and so on. No, you will not see these real pictures…..only different published studies, some with examples of experiments which create different ideas which promote more theories. A theory does not create a picture. One of the problems in this field is that theories predominate the mindset….which creates preferences in choice of which theory to follow (Bias)….which creates selective methodolgy in the education model as many of the theorists are professional educators/researchers/writers…..who instruct the students of today who become the clinicians of tomorrow.

In true science, a visual observation traditionally led to a cause/effect hypothesis, which led to a controlled experiment designed with multiple tested variations to try to explain the observation, confirm or refute the hypothesis….all this before a theory was generated. In this field, the theory is generated first. Accurate observations of what is actually happening within the joint itself are often ignored by the neuromuscular pain theorists. This is unfortunate and poor science. Think about it. For many years, we have had a poorly described syndrome “TMJ/TMD” which will look at any number of parameters before any consideration of what actually is orthopedically wrong with in the joint itself.

The paradigm of TMJ management that ignores well localized joint pain, and neglects to consider intra articular pathology, regardless of the age of the patient, is an enigma. Were one to to have pain in your kinee,( elbow, shoulder or any other joint in the body for that matter ) with all ranges of motion and could not normally function as you would need to…..would even a non surgical provider or researcher who could not walk well because of pain in the knee first consider that the source of the pain was actually in the muscles and the muscles were causing the pain in the joint …would that individual elect to change their shoes first to see if the knee pain got better (maybe) before seeing a competent orthopedist about what might be the cause of the problem of pain and instability within the knee ? Of course not.

That said, why do the theorists of neuromuscular “TMJ/TMD” pain continue to create new theories of muscular pain as the primary source of human jaw joint pain, and joint dysfunction….dysfunction and pain that doesn’t get better with reasonable clinical management and time…. that eventually leads to progressing and sustained chronic misery….all of which can start very early is one’s life (?). You tell me. Seriously.

There is another old saying….”If it looks like a duck, walks like a duck, quacks and flies like a duck…it just might be a duck ……To spend untold hours and money to try to consider and create a theory that it might not be a duck or something else in disquise creates a possibility of creating an explanation that it is not a duck….but that is a risk…..and a diversion that defies the senses and powers of observation. ….. once in a while you may be right…..but not with a high level of confidence in the rhelm of statistical life probabilities and engagement with reality.

The neuro-muscular theories of “TMJ/TMD” pain conflict with one another. (1-4) The nice thing about pictures, particularly clinical pictures….they are not in conflict. They are the real thing.

BIBLIOGRAPHY

1. Murray, GM and Peck CC: Orofacial Pain and Jaw Muscle Activity: A New Model. Journal of Orofacial Pain. Vol 21, No. 4, 2007. PP 263-278.

2. Mense, S : Critical Commentary 1: Orofacial Pan and Jaw Muscle Activity: A New Model. Journal of Orofacial Pain. Vol 21, No.4, 2007, pp: 279-281.

3. Lund, JP and Stohler, CS: Critical Commentary 2: Orofacial Pain and Jaw Muscle Activity: A New Model. Journal of Orofacial Pain. Vol 21, No. 4, 2007, pp: 282-283.

4. Svensson, P: Critical Commentary 3: Orofacial Pain and Jaw Muscle Activity: A New Model. Journal of Orofacial Pain. Vol 21, No. 4, 2007, pp: 284-286.

Tags: Add new tag, Jaw Pain, tmj, TMJ Derangement, TMJ Pain, TMJ Surgery