Medications

Your temporomandibular joint disorder (TMD) management program should include the following:

• Control the factors that make your TMD worse
• Decrease harmful pressure or “loading” on your jaw joints
• Restore your jaw function
• Help you resume regular daily activities
• Pain reduction techniques

In many cases, TMD signs and symptoms are temporary without serious long-term effects. Even when TMD symptoms are chronic and severe, most people with TMD do not need irreversible treatments. If your health care provider recommends an irreversible treatment, get a second opinion from another TMD expert. Most people with TMD get long-term relief with conservative therapy. Therapies such as behavior modification, physical therapy, medication, jaw exercise and orthotics help most people. Research studies show that more than 50% of people with TMD who use conservative techniques have few or no ongoing symptoms of TMD.  The most effective drugs for managing pain related to TMD include:

• Pain relievers – Acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) may help relieve milder TMD pain and inflammation. Examples of NSAIDs include aspirin, Trilisate, ibuprofen (Advil, Motrin), and naproxen (Naprosyn, Anaprox, Aleve). These medicines can be bought OTC (over-the-counter) or with a prescription at a local grocery store or pharmacy.
   
• Anti-convulsants – This class of medicine was originally used to treat seizure disorders but is also used to treat neuropathic (nerve damage) pain. Neuropathic pain can be part of the cause of chronic TMD pain. Examples include pregabalin (Lyrica), gabapentin (Neurontin), carbamazepine (Tegretol), oxcarbazepine (Trileptal) and lamotrigine (Lamictal).
   
• Anxiolytics and benzodiazepines – These classes of medicine are also referred to as anti-anxiety drugs or sedatives. Your health care provider may give you this medicine to treat anxiety and/or sleep problems. In addition, they may help to decrease bruxism and jaw clenching. Examples include clonazepam (Klonopin), diazepam (Valium), alprazolam  (Xanax) and lorazepam (Ativan).
   
• Muscle relaxants – These medicines may help to relax your jaw and other affected muscles. This may, in turn, relieve muscle spasm, pain and tenderness and decrease bruxism. Examples of muscle relaxants include methocarbamol (Robazin), orphenadrine citrate (Norflex), metaxalone (Skelaxin) and cyclobenzaprine (Flexeril).
   
• Opioids – Opioids are also called “narcotics.” This is a stronger class of medicine that may be given if OTC and prescription pain relievers do not relieve your pain. Examples of opioids used to treat TMD are tramadol (Ultram), codeine, propoxyphene (Darvon), oxycodone or hydrocodone. Avoid taking OTC medications with opioids unless you have talked with your doctor about it first.
   
• Tricyclic anti-depressants (TCAs) – This class of medicine was originally used to treat depression and other related disorders. Now some of them are given in lower doses to treat chronic TMD pain. TCAs may help in four ways: relieve pain, improve sleep, reduce bruxism and decrease depression in people who have it. Examples include amitriptyline (Elavil), nortriptyline (Pamelor) and doxepin (Sinequan).
   
• Topical medications – Many medications are available in topical form as a gel or a patch. These medications can be delivered directly to the site of muscle or joint pain with minimal effect on your overall health. Examples include Flector Patch and Voltaren Gel (NSAIDs), Lidoderm Patch (pain reliever). Many gels that can be made by a compounding pharmacy to include medications that your TMD care provider feels could help you.

All medications have specific benefits and side effects. Opioids and stronger sedatives such as Klonopin, Valium, Xanax, and Ativan should not be taken long-term, as they often only give temporary relief of pain. Long-term use of these medications can lead to depression, drug tolerance and addiction, although addiction is rare.