Pain Treatment in Temporomandibular Disorders and Orofacial Pain: LESS IS MORE   November 25th, 2016

​Temporomandibular Disorders (TMD) and orofacial pain are conditions that have been drawing more attention from Physical Therapists (PTs) in the recent years. Although regarded as a very complex kind of pain, mostly due to the great number of comorbidities that might be involved, clinical practice has proved to be more beneficial when we keep the treatment simple.

Unfortunately, some PTs insist on using all kinds of techniques and modalities they have learned to treat a patient. It is understandable and also could be a good thing to have such a wide kind of knowledge.

But try to see it as if you were the patient. What is this professional doing? Why every time I come to PT session they use some different kind of treatment? Do they really know what they are doing?

Try to see it from PT perspective: my patient is getting better, very good!! Do I know what exactly, from all I’ve been doing, is working for my patient? If I had to replicate, would I know which technique I should use? How can I apply Evidence Based Practice if I resort to every possible modality I have in hands? It is not acceptable to use trial and error when dealing with chronic pain patients, independent of how minimum invasive the treatment could be.

Why, instead of using the session hours for an unnecessary variety of techniques, PTs do not try to get cutting edge information to complement treatment? For example, pain neuroscience education, biopsychosocial assessment and approach, to name a few. There’s already reliable scientific evidence from remarkable PT groups around the globe showing how well those can help our patients to get better.

The fact is that delivering good health care takes more than few years at graduation. It is essential to keep up-to-date in order not to lose track of the best means available to manage our patients’ suffering. It might not be easy or smooth; it requires a lot of studying and practice, lots of time of dedication and mostly, willingness to gather good information so we can offer the best tools available to achieve good results.

It’s really important that PTs in general mix good evidence available, clinical practice and patients’ autonomy to the best function of treatment and pain management.

If it fits for you, very good. If it doesn’t, very good as well.


Cesar Waisberg

TMJ and orofacial pain PT - Craniomandibular and neck disorders
University visiting teacher at Universidade do Sagrado Coração 
IASP member

2016  Pain in Motion

References and further reading:

Wijma AJ, van Wilgen CP, Meeus M, Nijs J. Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education. Physiother Theory Pract. 2016 Jul;32(5):368-84.

Jacobs CM, Guildford BJ, Travers W, Davies M, McCracken LM. Brief psychologically informed physiotherapy training is associated with changes in physiotherapists' attitudes and beliefs towards working with people with chronic pain. Br J Pain. 2016 Feb;10(1):38-45.

Calixtre LB, Moreira RF, Franchini GH, Alburquerque-Sendín F, Oliveira AB. Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials. J Oral Rehabil. 2015 Nov;42(11):847-61.

Harrison AL, Thorp JN, Ritzline PD. A proposed diagnostic classification of patients with temporomandibular disorders: implications for physical therapists. J Orthop Sports Phys Ther. 2014 Mar;44(3):182-97.