About facial pain
Facial pain commonly results from temporomandibular joint (TMJ) disorder. Many practitioners refer to TMJ disorder, or syndrome, as a single disorder but there are various sub-diagnoses (e.g. myofascial pain, temporomandibular joint inflammation). The disorder is common and most often occurs in people aged between 20 and 40 years (NICE 2009). Around 33% of the population has at least one temperomandibular symptom and 3.6% to 7% of the population has TMJ disorder with sufficient severity to cause them to seek treatment (Wright 2009).
TMJ disorder is an umbrella term covering acute or chronic pain, especially in the muscles of mastication, or inflammation of the temporomandibular joint (Zakrzewska 2007). The temporomandibular joint is susceptible to many of the conditions that affect other joints in the body, including ankylosis, arthritis, trauma, dislocations, developmental anomalies, neoplasia and reactive lesions. Symptoms usually involve more than one of the numerous TMJ components: muscles, nerves, tendons, ligaments, bones, connective tissue, and the teeth. Symptoms can include difficulty in biting or chewing, jaw pain or tenderness of the jaw, clicking, popping, or grating sound when opening or closing the mouth, reduced ability to open or close the mouth, a dull, aching pain in the face, dizziness, headache or migraine (particularly in the morning), neck and shoulder pain, blinking, ear pain, hearing loss and tinnitus.
Treatment of a patient with chronic facial pain includes analgesics, NSAIDs, an occlusal splint (bite guard), cognitive behavioural therapy, physiotherapy and surgery (Al-Jundi 2008)
Al-Jundi MA, John MT, Setz JM et al. Meta-analysis of treatment need for temporomandibular disorders in adult nonpatients. Journal of Orofacial Pain 2008; 22(2): 97-107.
NICE (2009) Interventional procedure overview of total prosthetic replacement of the temporomandibular joint (IP 419). National Institute for Health and Clinical Excellence. www.nice.org.uk
Wright EF, North SL. Management and Treatment of Temporomandibular Disorders: A Clinical Perspective. J Man Manip Ther. 2009; 17(4): 247–54
Zakrzewska JM. Facial pain: neurological and non-neurological. J Neurol Neurosurg Psychiatry 2002;72:ii27-ii32 doi:10.1136/jnnp.72.suppl_2.ii27.
How acupuncture can help
This Factsheet focuses on the evidence for acupuncture in the management of facial pain resulting from musculoskeletal conditions such as temporomandibular joint (TMJ) disorder. There are also factsheets on Bell’s palsy, dentistry pain, headache, migraine, neuropathic pain (including trigeminal neuralgia) and sinusitis.
There have been 4 systematic reviews on the management of facial pain in TMJ disorder (Jung 2011, La Touche 2010a, Cho 2010, La Touche 2010b). All found evidence that acupuncture may be effective, but all stated that more (and larger, longer) high quality studies are needed to confirm acupuncture’s effect in TMJ disorder. Many of the reviewed trials used sham acupuncture control groups (and some reviews analysed only this sort) despite the fact that ‘sham’ acupuncture interventions are not inert placebos, hence potentially underestimating the effect of ‘real’ acupuncture (Lundeberg 2011). So far the indications are that acupuncture is superior to sham, to physical therapy and to no treatment, and similar to splinting. Also it is effective for both acute and chronic pain
One randomised controlled trial (RCT) published since these systematic reviews found that acupuncture is an effective complement or an acceptable alternative to decompression splints in the treatment of myofascial pain and temporomandibular joint pain-dysfunction syndrome (Vicente-Barrero 2012). Another found that it reduced pain in TMJ disorder more than sham acupuncture (Itoh 2012). However, both of these trials are very small, so the systematic review caveats still hold.
A sample of RCTs from 2007-9 (i.e. prior to the systematic reviews) is included in the table below, to give further examples of the research in this area (Shen 2009,Sima 2009,Shen 2007,Wang 2009).
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.
Research has shown that acupuncture treatment may specifically help in the management of facial pain by:
- acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009)
- increasing the release of adenosine, which has antinociceptive properties (Goldman 2010)
- inducing antinociception by activating the opioid pathway (Almeida 2008a) or the L-arg/NO/cGMP pathway (Almeida 2008b)
- exciting or inhibiting the anterior temporalis muscle via reflex pathways and thus smoothing jaw opening and closing (Wang 2007)
About traditional acupuncture
Acupuncture is a tried and tested system of traditional medicine, which has been used in China and other eastern cultures for thousands of years to restore, promote and maintain good health. Its benefits are now widely acknowledged all over the world, and in the past decade traditional acupuncture has begun to feature more prominently in mainstream healthcare in the UK. In conjunction with needling, the practitioner may use techniques such as moxibustion, cupping, massage or electroacupuncture. They may also suggest dietary or lifestyle changes.
Traditional acupuncture takes a holistic approach to health and regards illness as a sign that the body is out of balance. The exact pattern and degree of imbalance is unique to each individual. The traditional acupuncturist’s skill lies in identifying the precise nature of the underlying disharmony and selecting the most effective treatment.
The choice of acupuncture points will be specific to each patient’s needs. Traditional acupuncture can also be used as a preventive measure to strengthen the constitution and promote general wellbeing.
An increasing weight of evidence from Western scientific research (see overleaf) is demonstrating the effectiveness of acupuncture for treating a wide variety of conditions. From a biomedical viewpoint, acupuncture is believed to stimulate the nervous system, influencing the production of the body’s communication substances – hormones and neurotransmitters. The resulting biochemical changes activate the body's self- regulating homeostatic systems, stimulating its natural healing abilities and promoting physical and emotional wellbeing
About the British Acupuncture Council
With over 3000 members, the British Acupuncture Council (BAcC) is the UK’s largest professional body for traditional acupuncturists. Membership of the BAcC guarantees excellence in training, safe practice and professional conduct. To find a qualified traditional acupuncturist, contact the BAcC on 020 8735 0400 or visit www.acupuncture.org.uk