Myofascial pain

This myofascial pain post is the sixth in a series of posts about orofacial pain with difficult to diagnosis or unusual origin.

1. Cracked tooth syndrome
2. Trigeminal neuralgia
3. Atypical odontalgia
4. Neuralgia-inducing cavitational osteonecrosis or NICO
5. Referred pain
6. Myofascial pain AGD article with my highlighted notes
7. Burning Mouth Syndrome
8. Oral dysesthesia
9. First bite syndrome
10. Barodontalgia

Myofascial pain Etiology and Symptoms

This pain goes hand in hand with the previous referred pain and in most dental cases is caused by the same thing.  It is pain coming from one or more overworked muscle groups in the facial region and accompanied by both local and referred pain.  There will be a knot(s) in the muscle and an identifiable trigger point (TP). Dr. Rich Hirschinger has a great website that explains some of this. The trigger point is an area that is excessively sensitive to pressure.  If the TP is very hypersensitive a referred pain will occur.  If palpated there may be a twitch and a report of pain in the referred pain sight. This pain is more of a dull ache and can come and go depending on how overworked the muscle is.  The location of the TP will determine where the patient typically “feels” the pain.  Again, this is an excellent article on how to palpate the muscles and where the referred pain tends to be for each muscle.

Myofascial pain Treatment

Palpation of the muscles and a little knowledge about where certain muscle’s trigger points are will result in referred pain, which allows for the identification of the sore muscle.  This can be confirmed with injection of anesthetic without epinephrine or a spray-and-stretch procedure at the TP.  Once located treatment is the same as for that recommended in referred pain and on the acute TMD blog.  Myofascial pain is usually a somewhat continually recurring condition and a nightguard of some sort may be helpful.  The best “fix” is Botox. For more on chronic pain check out my TMD and chronic pain blog.

Temporal tendonitis

Temporal tendonitis is a particular myofascial pain resulting from inflammation of the temporal muscle. It results in a restriction of mouth opening and is very painful upon palpation of the temporalis. Typical triggers include excessive opening, bruxism, trauma and emotional stress. Treatment options start with simple self care and progress depending on severity.

Palpation of temporalis muscle to check for pain and thus temporal tendonitis

Temporal tendonitis treatment options are similar to acute TMJ options Duffin JOE 2020

Very rare but want to rule out temporal arteritis since left untreated can lead to blindness in affected side.  Difference is will have a burning pain feeling in addition to classic myofascial pain symptoms.