Review of Oral Muscle Relaxants Used for Chronic Temporomandibular Disorder Pain.

Abstract

Temporomandibular disorders (TMDs) comprise a group of multifactorial conditions involving the masticatory muscles, temporomandibular joint, and associated structures influenced by biomechanical, neuromuscular, and biopsychosocial factors. Myogenous TMDs may involve muscle hyperactivity, parafunction, and central sensitization, contributing to chronic pain and functional limitation. Oral skeletal muscle relaxants (SMRs) are commonly used as adjunctive pharmacologic therapy; however, these agents vary considerably in mechanism, efficacy, and safety. This review summarizes the pharmacology, clinical evidence, and risk profiles of commonly prescribed SMRs-including cyclobenzaprine, baclofen, tizanidine, and others-within the context of chronic TMD management. Evidence supports short-term benefit for select agents, though data for chronic daily use remain limited. Given concerns regarding sedation, dependence, hepatotoxicity, and interactions with polypharmacy, clinicians should employ these medications judiciously and primarily for acute exacerbations rather than long-term therapy. An evidence-based, multimodal approach remains essential for optimizing care in patients with chronic TMDs.