In the United States, temporomandibular disorder (TMD) affects about 10 million people. It is marked by pain in the muscles of the temporomandibular joint (TMJ).
Myofascial pain is distinguished by hypersensitivity of certain spots in tight muscle fibers (myofascial trigger points). Those trigger points can be caused by muscle overload from repetitive activities or trauma that result in increased stress on certain muscle groups. Symptoms experienced by TMD sufferers include weakness, muscle stiffness, limited range of movement of the jaws, headaches, and tenderness.
Each year millions of Americans with chronic pain avail themselves of acupuncture treatment; however, many mainstream doctors are still questioning its therapeutic value and they argue that the treatment in nothing more than placebo. But studies in TCM or traditional Chinese medicine have proven otherwise – acupuncture has proven to work and work well in the resolution of myofascial pain and temporomandibular disorders.
How Does Acupuncture TMD Treatment Work?
Although there is still no clear cut answer as to how acupuncture relieves TMD pain, traditional Chinese medicine practitioners believe that the ability of acupuncture to restore the balanced flow of energy or Qi has something to do with it.
Recent clinical studies have yielded scientific explanations as to why acupuncture has proved successful as treatment for a lot of painful conditions. Western medical records in the 1970s indicate that acupuncture lessens the sensation of pain through the direct stimulation of the nerve and this alters the quality of signaling in nerve cells.
Research efforts actually show that acupuncture has the ability to inhibit the spinal dorsal horn and nociceptive trigeminal nucleus caudalis neurons by regulating the release of neurotransmitters and neuropeptides.
Additional studies provide credence to the idea that acupuncture directly activates the release of neurotransmitters and endorphins and other biological actions. Neurotransmitters and endorphins are the body’s own substances that help block and dampen the brain’s perception of pain. More studies are required to further analyze the workings behind acupuncture since many of its effects still are difficult to explain.
What may be more important is simply the proof that acupuncture does work regardless if it is through the quality of Qi flow or through body chemicals. The NCCIH (National Center for Complementary and Integrative Health) states, “The outcomes from several studies imply that acupuncture is able to relieve knee pain/osteoarthritis, neck pain, and chronic low-back pain. It may also prevent migraine headaches and aid in the lessening of tension headache frequency”.
Western medicine is now only starting to understand how effective acupuncture is. The NCCIH noted “Recent data suggests that several factors such as belief and expectation that are not associated with traditional acupuncture may be one of the factors that bring about the beneficial effects of acupuncture pain treatment”.
TMD and Acupuncture
A treatment that constantly produce positive results, acupuncture for the treatment of TMJ and TMD is a long term plan of treatment, in which studies have revealed the most optimal treatment protocol for the treatment of TMD symptoms: treatment sessions lasting 30 minutes each one session per week. Acupuncturists treating TMD usually diagnose excess in the GB (gallbladder) meridian and a deficiency in the liver (Lv) meridian.
The site of the pain may be stuck with needles. This may include the area around the jaw and ear. But due to the interconnecting channels between the meridians, the needles can also be applied on the big toe, knees, and near the elbows. These are called distal acupoints and they as well, can change the flow of Qi through the jaw to alleviate inflammation and pain. To address identified disharmonies in the body, additional acupoints may be used. Rectifying the overall energy circulation in the body can help alleviate stress and other factors that contribute to TMJ disorders.
Researchers in Portland, Oregon and Tucson, Arizona performed a study in 2012 that involved 168 adults all suffering from TMD. At first, all the subjects attended a class on TMD. At the second week of the study, the researchers assigned a self-care or traditional Chinese medicine therapy to patients who had the worst TMD pain. The traditional Chinese medicine therapy required 20 visits within a year. Treatment was customized based on the needs of the patient and included lifestyle guidance, massage, Chinese herbs, and acupuncture. The self-care group was given cognitive behavioral therapy, stress management, relaxation therapy, jaw-stretching exercises and patient education as well as a self-help manual.
It was discovered that is traditional Chinese medicine (TCM) provided short-term pain relief that was significantly greater than self-care. Furthermore, the TCM group experienced a greater decrease in social activity interference. The researchers concluded that this type of community-based, stepped-care approach using TCM is safe and could lead to a better quality of life and short-term relief of pain for TMD patients. In terms of long-term results, more studies are forthcoming that will provide a clearer picture of the effect of this treatment approach.
For the management of TMD, medical interventions currently utilized by doctors include home self-care, physiotherapy (massage), drugs, jaw appliance therapy (bite guard or stabilization splint), and surgery. Acupuncture can be used as a complementary treatment to the other approaches or as a standalone treatment. Drugs for TMJ disorders may include muscle relaxants, antidepressants, opioids (painkillers), and NSAIDs (non-steroidal anti-inflammatory drugs). For extreme cases, local injections of corticosteroid injections may be prescribed. Acupuncture is often used often as a replacement to these modalities without the risks of side effects. Furthermore, it doesn’t interact with those current medical therapies.
Pharmaceutical therapies unfortunately are only able to provide temporal relief of TMD symptoms unlike acupuncture that zooms in on the root cause of the problem and thereby can potentially cure the condition completely. Acupuncture addresses the underlying cause of a condition by restoring balance to the body and mind through stimulation of energy pathways called meridians. This results in the relaxing of the neuromuscular tension in the jaw. TMD is oftentimes caused by muscle contraction in the face and jaw or too much stress in the jaw. Acupuncture relieves TMD discomfort by relaxing those muscles and lowering the overall levels of stress in the body.
Lifestyle changes are also important for the long-term care of TMD. Depending on any underlying disharmony the acupuncturist may identify, dietary changes may be also required. When there is an issue with teeth clenching or teeth grinding, the patient may need to wear a mouth night guard prescribed by a dentist to prevent them from occurring during sleep. Any misalignment can be rectified with bite plates.
All these behavioral approaches (altering chewing habits, jaw stretching exercises, relaxation methods, and stress reduction) have been proven to work very well. To treat TMJ discomfort, your acupuncturist can instruct you with these lifestyle changes.
For the management of TMD, you can use acupuncture either as part of an integrated plan of treatment or as a stand-alone therapy. It can provide you with an effective and really substantial alternative to occlusal splint treatment, which most probably is more preferable for patients who aren’t able to tolerate these splints very well. One study revealed TMD symptoms were significantly decreased with the use of both occlusal splints and acupuncture.
For people who don’t respond well to splint treatment, they could include acupuncture as an additional part of their treatment. When bruxism at night continues to be a problem, one option is to use acupuncture initially to get much better hold of the symptoms then use an occlusal splint to control symptoms on a long-term basis later on. Acute and chronic types of TMD can be very well addressed with acupuncture. How well the patient responds depends on how long the patient has had the condition. Normally, for acute TMD, the length of treatment would be much shorter than chronic cases.
Acupuncturists who have treated lots of cases of neuromusculoskeletal pain and TMD conditions have found these acupuncture points to work very well in the treatment of neck, head, and facial pain: GB 20, Yangbai (GB 14), Bl 10, Neiting (St 44), St 8, Li 4, , ST-6, and ST-7. These acupoints are typically stimulated for 10 to 20 minutes along with needling of Li 4 and some other acupoints, bilaterally, depending on the area affected and the severity of the pain. Electrical stimulation is added onto the needles to augment stimulation. Proof of this method’s effectiveness requires the close observation of the change in the pain perception of the patient.
The following is a list of precautions and guidelines when considering the use of acupuncture treatment:
1. If there is a strong possibility of getting an infection at the site intended for needle insertion, then acupuncture treatment should not be used
2. Acupuncture treatment would not be advisable for patients who cannot remain still during the entire treatment session.
3. If the needle insertion causes intolerable pain or discomfort for the patient, then the needle should be removed
It’s very important to follow safety precautions in an acupuncture treatment. They include only using disposable sterilized needles; utilizing aseptic methods for insertion of needles; closely monitoring the patient for any signs of bleeding; counting needles prior to and post treatment; needling the patient in supine position; and instructing the patient not to drive after treatment.
Acupuncture in general, is a very useful mode of treatment for the management of TMD symptoms. It can be used as a useful, simple, efficacious and quite safe complementary and standalone therapy in the management of TMD.
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