Background and Objectives: Although intra-articular injection is considered one of the therapeutic options for temporomandibular joint (TMJ) pain, it is not well understood whether in combination with local anesthetics, it is effective for TMJ pain. The objective of this study is to determine the efficacy of intra-articular injections of corticosteroids combined with local anesthetics in patients with TMJ pain and identify predictors for pain improvement.
Methods: Charts of patients with persistent TMJ pain and a diagnosis of TMJ disorders who underwent intra-articular injections of 1.5 ml containing 20 mg triamcinolone and 10 or 20 mg lidocaine were retrospectively analyzed. The TMJ pain intensity on palpation before treatment, immediately after injection, and at follow-up was assessed using a verbal Numerical Rating Scale (NRS).
Results: Thirty-seven injections of 31 patients were identified. The pre-treatment pain NRS score (median=7, interquartile range: 5–8) was significantly reduced immediately after injection (median=0, interquartile range: 0–0, p<0.001) and at follow-up (median=3, interquartile range: 0–6, p<0.001). Although transient facial palsy (2 cases) and bite change (1 case) were found after injection, no significant complications were reported. Greater pain improvement at follow-up was associated with cases without osteoarthritis (p=0.004). In addition, pain improvement was modestly correlated with the pre-treatment pain score (Spearman’s rho=0.328, p=0.048) and immediate pain relief after injection (Spearman’s rho=0.375, p=0.022).
Conclusion: Intra-articular injections of corticosteroids in combination with local anesthetics may contribute to favorable prognosis of TMJ pain, with the absence of osteoarthritis serving as one of the predictors of TMJ pain improvement. The results highlight that pre-treatment conditions and diagnoses play a relevant role in the prognosis of TMJ pain after intra-articular injection.
Keywords: temporomandibular joint disorders, orofacial pain, intra-articular injections, corticosteroids, local anesthetics, pain measurement.