Temporomandibular disorders and neuropathic pain

Neuropathic pain is a common concomitant complaint in patients with temporomandibular disorders (TMDs). Careful analysis of the often diverse complex of symptoms is crucial to the correct diagnosis of these cases. Definition of the individual elements of the clinical picture, classification of the nature of the pain (acute, persistent or chronic) as well as decision-making regarding the choice of rehabilitative modalities, the respective therapeutic targets, and the type of specialists to consult for co-treatment are also key elements of successful treatment. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II screening instruments are used to assess the prognosis of the individual symptoms. The treatment goals should be reassessed at predetermined times over the course of treatment to modify the treatment path as needed in the event of failure. This article describes the case of a 61-year-old woman who presented with pain in the left maxilla region. The pain had persisted for the previous 5 years and was classified as a combination of persistent myogenic pain and neuropathic pain. Despite a poor initial prognosis (pain of > 5 years' duration, multiple surgeries in the painful region, multilocular pain), her pain, including her neuropathic pain, disappeared over the course of TMD treatment, and the outcome has been stable for 4 years. This case report invites critical discussion on the course of patient management. Keywords: temporomandibular disorders, TMD, myalgia, neuropathic pain, persistent pain