Amitriptyline for jaw/facial pain

[ATrueBlue]

Have a mixed diagnosis of tmjd/myofascial pain. Gp wants me to start on 10mg of amitriptyline as quality of life is affected by not being able to eat solid food. Jusy wondering has anyone else been prescribed amitriptyline for the same thing and did they find it helpful? BIt worried about sleepiness on them as have young DC that still wake up during the night, plus I clench a lot a night abd worried ill do it moreso if I'm in a deeper sleep

I was prescribed it for atypical facial pain. It actually kept me awake all night.
Seemingly it has the opposite effect for the majority of people. I tried it for several nights but, aside for the lack of sleep, it left me feeling like a zombie the next day.

I have gabapentin instead now & a mouth guard.

Thanks for the reply @Herecomesanothernamechange. Funny you say it kept you awake, my DH was taking it for a while and it made him quite peppy also. I know for most people it tends to have a sedative effect though. What kind of mouthguard do you have? And do you find the gabapentin helpful? I know a lot of people who can't tolerate amitriptyline do well on gabapentin

I found half a tablet [5mg] at night was better than the 10mg which left me groggy and lethargic the next day.
It helped me with tmj pain and fibromyalgia pains. And I find
I get some quality sleep on it too.
I only take it when I'm desperate so I don't become used to it and that way I can keep at a low dose.

Hope you get some relief op. Has your dentist offered you a mouth guard? I found the soft ones best. The hard ones moved my teeth much
more than the soft ones.

That seems sensible @PollyPicket. I think I would be happier taking 5mg too. Sorry to hear you have fibromyalgia too. I know there's a link between tmj and fibro. Does your jaw pain affect both sides or just one? Yes I'm getting a hard splint made but not sure how well I will be able to tolerate it as I know they fit very tight and I don't like that kind of sensation. I did ask about a softer one but apparently they encourage clenching more. I would prefer a soft one though as would be more likely to wear it.

The dentist makes me soft mouth guards, I chew through it within 3-4 months generally. Being as they haven’t been seeing routine patients since the first lockdown I’ve resorted to ordering this which works well.
time2sleep.co.uk/product/mouth-guard-for-teeth-grinding/
The dentist tried me on a rigid mouth guard, it was agony. I couldn’t tolerate it as, when my teeth clenched together, it caused me more pain.
The gabapentin does help. I do have fibromyalgia also btw.

I read on another thread about a different guard, one that just fits over a couple of front teeth that a poster found success with, an NTI mouth guard but I doubt my nhs dentist would go for that -if I ever get to see them again!

Would GP consider nortryptaline instead? Same benefits, fewer side effects.

I had amitriptyline for nerve pain, it helped a bit but my body kept getting used to it and we had to increase the dose. I think I was on 25mgs when I came off it because it raised my heart rate too much and would make me sleep for a solid 12 hours after taking it.

I found gabapentin much better though still not ideal from a side effects POV

I had thought about ordering a mouthguard online @Herecomesanothernamechange, but I've heard that they can mess up the bite and cause more damage. I can definitely see the appeal in buying them though, especially when the dentist made ones are so expensive. I suspect I won't be able to tolerate the rigid mouthguard either. Incidentally, my dentist has made me an nti mouthguard to wear until the hard guard is made. Although it has stopped me clenching (well I still clench but my back teeth dont meet), it hasn't stopped the jaw pain. Nti devices are also quite controversial for long term use as they can cause bite changed too, but some dentists swear by them. Temporary ntis are cheap to make and can be made there and then in the dentists so they might make you one. If it helps you could look into getting a proper one then. I actually have gabapentin in the cupboard (DH used to take it), but will maybe try a very low dose of amitriptyline first to see how it goes. It's very interesting how many people have fibro and facial pain. Is your pain one sided or both?

I did ask about nortriptyline @WeKnowFrogsGoShaLaLaLaLa but GP advised I try the amitriptyline first. I suspect the nortriptyline is more expensive and that's why it's not so readily prescribed. Have you taken nortriptyline? I know it's seen as a "cleaner" drug than amitriptyline.
Sorry to hear you ended up having side effects @PinkPlantCase. I'm glad you find the gabapentin helpful though. Was it facial pain you were experiencing?

Yes I have tmj pain on both sides. I've been grinding my teeth since I was a teenager. It preceded the fibre by about 35 years in my case.
About 20 years ago I had an operation on one side of my jaw to supposedly cure the grinding but it made no difference. And the operation was brutal and has left me with an overbite.

Just recently I had botox jabs in my jaw privately at a local dentist.
I still grind when stressed but the dentist assures me it's not the powerful grinding I did before the botox jabs. So I'll hang fire on the results for a while.

I’ve been prescribed amitriptyline several times now for various things including TMJ and whilst I would probably agree that it’s a go to try this first drug, it worked really well for me. I am affected by the drowsiness to start with (but would take the tablet about 7/8pm which worked for me), but I got used to this. I’m not sure what the protocols are for how it works, but it wasn’t a there and then painkiller as such, so needed to take it for a few weeks before getting the full effect.
I have a bite guard as well, and I know a lot of the issue is stress/tension/anxiety related, so the drug wasn’t a cure all.

@PollyPicket that sounds horrible! Are you able to get braces for the overbite or would they not work? The botox sounds encouraging. Are you able to eat normally?
@Mbear that's great you found the amitriptyline helpful. It definitely seems like the go to drug for tmj issues. I've been taking diazepam which does help but obviously can't be ok it forever so need something more long term. What kind of bite guard do you have? I've just recently started hypnotherapy for stess/anxiety. Only had one session so far but the hypnotist says he sees many people with bruxism/tmj problems. There's some good hypnotherapy videos on YouTube also which you might find helpful.

The overbite is permanent because they shortened my jaw in the op.
Since botox eating is fine, just the same as it usually is really. Although
the dentist did say not to eat hard stuff and that the advice I was given after my jaw op too by the maxfax surgeon.

Can you still open your mouth fully, op? I just wondered because I remember my surgeon. telling me not to be bullied by future dentists in to straining to open my [tiny gap] mouth more than I can.

Ah that really does sound like a brutal op 😧That's good you're able to eat normally though. I can't eat anything that's not pureed as it sets off the pain but I'm hoping the amitriptyline will help with that. I can just about open my mouth enough to get 3 fingers in (according to my dentist everyone should be able to put in 3 fingers and it's a test I've had many dentists do), but I feel the strain on my jaw when I do it. I do have quite a tiny mouth naturally though and even before the jaw issues I would have struggled with dentists trying to put the plastic holder thing for x rays into my mouth. Yes definitely don't let dentists bully you or make you feel like you're being 'dramatic' with limited opening. Does your pain ever manifest as toothache?

Sorry, forgot to tag you @PollyPicket

@ATrueBlue I have a dentist mouth guard, which was about £65. It’s the one where they fill a sort of cage full of putty type stuff and ram it in! I’ve had an upper and lower mouth guard - no idea if one is better than the other. But they do need replacing as they wear out.
I’m not sure if the guard stops me grinding etc in my sleep or it’s there to protect my teeth because I grind (DH says I also clench my jar and clack my teeth together - I am a joy to live with!)
My dad went into hospital as an emergency earlier this week and I woke up the other morning and christ alive my jar was tense and stiff - I obviously hadn’t been grinding for a little while and had a night of it probably due to the worry!

A bite splint is first line treatment for TMJ. You haven't tried the most basic treatment for TMJd yet so I wouldn't go jumping in with amitryptiline. Amitryptiline can be effective but more for atypical facial pain and I wouldn't go trying it until you've tried conservative measures first

The majority of people tolerate a hard bite splint. Its made to your mouth and can be very effective at treating night time grinding which you do. Theres no evidence to suggest a soft bite splint is any less effective than a hard bite splint and so if you don't your dentist can make you a soft one. Different patients get on with different gaurds and if therefore one doesn't work its worth trying another. Night time clenching/grinding is the most common cause of myofascial tmj and you are already aware you do this so its this you need to stop

Buying a bite splint online will fuck up your bite, so yes do not do this.

Sorry to hear about your dad @Mbear. I hope he is OK. There definitely is a correlation between stress and clenching/grinding. My (limited) understanding is that the purpose of most mouthguards are to protect the teeth from the mechanical damage of clenching etc, however I think some (such as the nti device) have the added bonus of encouraging the user to break the habit. I could be wrong though.
Hey @OrangeSharked, I've been wearing an nti device for just over a month now but no real improvement as of yet. I feel there is less pain in the molars (as I can't clench them i guess) but the jaw pain has increased if anything. Dentist is on the fence about how to move forward, but he has suggested a michigan may be better. I'm concerned about compliance though as I think I'd struggle with the tightness. I agree completely about trying more conservative measures first but I've lost quite a bit of weight due to not being able to eat, so I think the GP feels the benefits outweigh the risks with the amitriptyline. I did query why it was prescribed for tmj as I know it's generally used for neuropathic pain but she said it can also dampen pain receptors so can be used for chronic pain too. She mentioned if it didn't work she would try me on baclofen instead, but hopefully the splint will help. Do you mind me asking if you're a dentist? I seem to recall you giving (very good) advice in another post and you mentioned your profession. If so, would you have any thoughts on ntis vs michigans? There seems to be holy wars on the subject in the field and the peer reviewed studies are extremely conflicting regarding their efficacy. I'm just wondering would you have any thoughts based on your own clinical experience?

@ATrueBlue how are you now ? Xx