For Chronic Jaw Pain, Acupuncture May Provide Relief

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You are out of ideas. Your favorite TMD patient is continuing to suffer even though you have tried everything…and I mean everything. But wait. Has your patient tried acupuncture? It's proving itself to be an effective treatment option you should consider for your TMD patients.

Recently, I interviewed Suzie Husami, MSTOM, LAC, FABORM, an acupuncturist in Cleveland, Ohio, to learn about how this modality can benefit TMD sufferers. It was eye-opening to say the least! She discussed the huge increase in patients diagnosed with TMD since the onset of the pandemic, how it works, and why you might consider referring out for it. We all know that the pandemic has wreaked havoc in our patient’s lives - particularly for TMD patients. The incidence of complaints such as clicking, popping and pain have surged. Dentists are looking for innovative treatments to help patients get relief. But perhaps a look into the ancient past is just what your patient needs. This is why I reached out to Suzie to learn more and to share it with all of you.

How it works

Acupuncture, a treatment modality between about 2500-3000 years old, can help with a constellation of issues TMD patients experience, first by blocking pain and second by relieving tension in targeted muscle groups. When a patient has TMD pain, acupuncture creates a competing pain impulse. This overwhelms a pain- modulating gate at the dorsal horn, blocking it completely, while simultaneously suppressing the nociceptive trigeminal nucleus caudalis - thereby blocking pain. On top of addressing central nervous system (CNS) dysfunction, it helps reduce clicking and popping by relaxing the lateral pterygoid – often a major culprit involved in the displacing force found working against the TMJ in many cases. Similarly, acupuncture can relax muscles in the neck and head – relieving not only some primary muscles involved – but helping to prevent and relieve tension and migraine headaches secondary to TMD. Finally, acupuncture appears to help push patients out of a chronic sympathetic state and into parasympathetic regulation – and could even ease the incidence of bruxism as a result.

The specifics

1. The effects of acupuncture tend to be cumulative. The more your patient receives it, the better the outcomes and the longer the relief lasts.
2. For every year of symptoms, it could take 1 month of treatment, as a general rule.
3. One-hour sessions are typical. Initially, 1x/week for 4-6 weeks is standard. Then, you taper down depending on the individual patient’s needs.
4. The session starts with an intake, general assessment and then the patient will be on the table for 20-40 minutes. The patient lays comfortably on a treatment table, remaining still yet relaxed, and needles are inserted into the jaw, neck, head, ankles, feet, hands, and arms. The needles stay in during the session.
5. Some patients fall asleep on the table as they find it so relaxing.
6. Some patients prefer to have the room to themselves, and will be checked on by the acupuncturist throughout the treatment. Other patients prefer to have her in the room the entire time. Anywhere from 4-30 needles might be used, with 20 being about average-depending on the comfort of the patient, and the issue being treated.

Payment

Many insurance plans now cover acupuncture due to its comparatively low cost and good success rate for pain specifically. Medicare is beginning to cover 12 sessions/ year in many states. Suzie charges $135 for an initial session then $95 for returning visits. Packages are offered which can lower the cost. 

What if the patient is afraid of needles?

The key to success is for the needle-phobic patient to feel in control. They can stop the treatment at any time. Suzie goes “low and slow” with these patients: using a small number of needles for a shorter treatment duration at first, incrementally increasing as her patient feels ready. She finds it important to “let the patient decide what they can tolerate.” This works wonders, and she reports that she hasn’t had a patient yet who discontinues care due to their needle-phobia. 

What are the benefits of acupuncture?

1. It has been shown to provide both initial and sustained relief from pain in around the TMJ.
2. It can reduce clicking and popping by relaxing tense, target muscle groups and reducing the displacing force at play.
3. It helps relieve upper back, neck tension and pain, and can relieve secondary tension and migraine headaches.
4. Stress plays a significant role in bruxism and in many cases of TMD. Acupuncture is an excellent way to decrease stress by increasing the time spent in parasympathetic regulation, therefore providing some opportunity to break the cycle of pain.
5. A minimally invasive procedure, acupuncture has few to no side effects (with minor bruising and slight pain at the site being most reported) and patients can undergo treatment in conjunction with most other treatments and medications they might be undergoing or taking.

An example of a TMD patient

Serena is a 39-yo single mother of two teenage boys. She had terrible TMD and for years at the time she sought care. She tried everything her dentist recommended with some moderate success with the introduction of a splint – but her compliance with her night guard was not great. She was referred to Suzie who began a typical treatment plan of twice/ weekly sessions for 1 month. At her 1-month evaluation, she reported improvements of about 60-70%. Then, in 2 months, and after tapering to once weekly sessions, the pain was minimal. After month 3 she graduated from care. She returns for acupuncture on occasion for stress management but her TMD hasn’t returned.

Conclusion

Acupuncture can be a truly effective modality for any patient going through TMD. Whether this is new diagnosis or a chronic problem, it’s worth consideration for your patient. Acupuncture is one of the complementary modalities that western providers now commonly refer out for – as more and more patients are beginning to experience positive outcomes. Talk to your patient about acupuncture- and see if it’s right for them. A referral might just make the difference in a stubborn case. You can find board certified acupuncturists in your area by going to the NCCAOM ‘find a practitioner tool’ at https://www.nccaom.org/find-a-practitioner-directory/

If you have had success with TMD patients who sought treatment with acupuncture, email me at diana2@discussdirectives.com. I’d love to hear your stories.If you have questions, thoughts, or a referral for Suzie, contact her at: Husami Integrative Acupuncture Beachwood, OH 619-302-7589 www.husamiacupuncture.com.