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For pain medicine

When pain has long become independent – and still has an entry point

You see these people late. After years, after many previous practitioners, with pain that has become detached from its cause. That is precisely why asking about the jaw system here is neither naive nor too late.

You know these patients

Chronic head and facial pain without a tangible correlate. Widespread tenderness far beyond the original region. Poor sleep, a strong tendency to catastrophise, a long journey through the specialties – and a history in which “the jaw” was mentioned at some point without anyone examining it.

The connection

What has been measured

  1. 01Measured / described

    Chronic CMD is a nociplastic pain condition

    Chronic craniomandibular dysfunction is now classified as nociplastic pain with central sensitisation . This puts it in the same category you already work in – and not in the dental pigeonhole of “mechanical joint problem”.

  2. 02Measured / described

    The predictors of chronification are the same

    Pain catastrophising and depressive symptoms are the most consistent predictors of pain persistence in CMD. The DC/TMD reference standard therefore includes a second axis: psychosocial distress, grading via the GCPS, jaw function via the JFLS. A CMD finding without Axis II is half a finding.

  3. 03Measured / described

    Psychological methods work as well as standard treatment here

    In painful CMD, psychological treatments reduce pain intensity to a similar extent as standard dental treatment. This is not an argument against functional assessment – it is the argument for running both side by side rather than one after the other.

  4. 04Where the evidence ends

    Where the evidence ends

    The aetiology of CMD is considered multifactorial and biopsychosocial; the purely occlusal explanation is outdated. We do not claim that the bite is the cause of a chronified pain condition. We claim that it can be an accessible, measurable and modifiable component of it – and that this can be established rather than assumed.

Indication

When a referral is worthwhile

First, and without exception: red flags and unclear findings belong in specialist work-up, before any functional diagnostics. The CMD perspective complements, it does not replace.

Worthwhile

  • Head and facial pain with jaw signs – clicking, bruxism, restricted mouth opening, tender jaw muscles
  • Persistence beyond three months despite guideline-based first-line treatment
  • High GCPS grade with unclear peripheral component
  • Before escalating drug therapy – to clarify whether a functional component has remained untreated

Not worthwhile

  • As a replacement for pain medicine care – we do not take it over
  • With unresolved red flags; specialist work-up comes first
  • With the expectation of reversing central sensitisation with a splint

Division of roles

The patient remains in your care. We take on the functional part, measure it, report back – and refer back. Further treatment only at your explicit request.

Next steps

Three routes – your choice

  • 01

    I want to know more

    DC/TMD Axis II instruments, our measurement protocols and the sources in full text.

    Request documents
  • 02

    I have a question about a case

    Call-back from the CMD specialist, not from reception.

    Ask a question
  • 03

    I would like to refer

    By phone, email or letter – whatever suits you.

    Referral

Other specialties

To the overview