TemporomandibularMyofascialPainSyndrome—AetiologyandBiopsychosocialModulation.ANarrativeReview

Myofascial pain syndrome (MPS) represents one of the most significant chronic health problems encountered in clinical dental practice and beyond. When it affects the temporomandibular region, it becomes a particular type of temporomandibular disorder (TMD) characterized by muscle-origin pain that can spread beyond the boundaries of the masticatory muscles, often accompanied by limitation in mandibular movement. The condition is defined by the development of trigger points—hyperirritable spots within muscles and connective tissue that are painful when pressured, stretched, overstrained, or contracted, and typically produce characteristic patterns of referred pain. MPS affects the majority of the general population and substantially impairs mobility, reduces overall sense of well-being, and hinders functioning in society.

Given its widespread impact and complex nature, understanding the full spectrum of factors contributing to temporomandibular MPS is essential for effective management.

This narrative review aimed to provide a comprehensive examination of the aetiology, diagnosis, and treatment of temporomandibular myofascial pain syndrome, with particular emphasis on psychosocial modulation. The authors conducted an electronic search across SCOPUS and PubMed digital databases using multiple keyword combinations related to myofascial pain syndrome, trigger points, relaxation techniques, meditation, treatment, occurrence, statistics, limbic system, diagnosis, bruxism, biopsychosocial profile modulation, cognitive behavioural therapy, biofeedback, sleep hygiene measures, and craniosacral therapy. Sources spanning 1970 to 2021 were included. After removing duplicates from an initial pool of 30,621 articles, 2,356 articles remained for consideration.

The review followed the recommendations of the Scale for the Assessment of Narrative Review Articles (SANRA). The authors synthesized evidence on the multifactorial aetiology of MPS, its relationship with various physiological systems, diagnostic approaches, and both directed and self-directed treatment modalities.

The review identified that MPS is mainly regulated by psychological and pathophysiological factors rather than morphological ones. Psychosocial factors—including stressful life events, emotional disturbances, psychological distress, and psychiatric disorders such as hypervigilance, depression, anxiety, post-traumatic stress disorder, and neurosis—contribute to arousal of the central nervous system, leading to excessive masticatory muscle activity. This muscle activity can manifest as sleep bruxism (rhythmic or non-rhythmic muscle activity during sleep) or awake bruxism (repeated or sustained tooth contact and bracing or thrusting of the mandible). The average bruxer's bite force reaches 54.43 kg (with some patients producing up to 113 kg), resulting in 26,126.92 kg/s per day—far exceeding the 7,801.8 kg/s per day from normal function.

As much as 75% of patients report stress as the main reason for a doctor visit.

The limbic system plays a central role in MPS through its connections to the emotional motor system, which generates emotion-particular changes in the body via stressor-triggered efferent pathways. Multiple systems are affected simultaneously: limbic, autonomic, endocrine, somatic, nociceptive, and immune. The endocannabinoid system, with receptors expressed in the limbic system, helps maintain physiological, emotional, and cognitive homeostasis.

Regarding prevalence, MPS affects as much as 85% of the general population as a general condition. Myofascial disorders affect about 50% of people suffering from chronic headaches and neck pain, and even 100% of patients diagnosed with chronic non-specific neck pain may suffer from MPS. The overall prevalence of myofascial TMD pain amounts to up to 45.3%. Among specific populations, 15.4% of Saudi Arabian children suffer from myofascial pain according to RDC/TMD, while 10.3% of Brazilian adolescents suffer from myofascial pain.

In the Polish population, myalgia occurs in 47.4% and myofascial pain in 14.1% according to DC/TMD protocol.

For treatment, behavioral treatment (biofeedback, cognitive-behavioural programs, and relaxation) caused a long-lasting 30–60% decrease in headaches. Cognitive behavioural therapy with hypnosis techniques yielded reduction in pain intensity, severity, frequency, and subjective pain index, with 70–90% of participants experiencing significant clinical change, and therapeutic effectiveness persisting after 9 months in 60–80% of patients. Other research reported reduction in MPS symptoms in 76.1% of participants after CBT. Biofeedback through an in-ear device reduced headaches and pain intensity during the night by 50% after three months and 80% after six months.

Mindfulness meditation decreased pain intensity averaged 27% during pain stimulation, with reduction in pain shown in about 44% of patients. Remarkably, 85% of patients undergoing physiotherapy, thermotherapy, and relaxation stopped using any medications.

This review underscores that temporomandibular MPS is not merely a local muscle problem but a complex disorder requiring holistic treatment approaches. The strong influence of psychosocial factors means that addressing stress, anxiety, depression, and other psychological components is essential for effective management. The biopsychosocial model, reflected in Axis II of the DC/TMD protocol, provides a framework for comprehensive assessment and treatment planning.

For patients, this means that lifestyle modifications and self-directed interventions can be powerful tools. Relaxation techniques, meditation, proper sleep hygiene, and stress reduction may be as important as—or more important than—purely physical treatments. Nutritional factors also matter: a fruit and vegetable diet contributes to reduction in chronic pain intensity through anti-inflammatory effects, while proper hydration supports musculoskeletal function.

For clinicians, the review suggests that treatment should extend beyond symptomatic approaches (occlusal splints, pharmacological therapy, physiotherapy) to include directed biopsychosocial profile modulation through cognitive behavioural therapy, biofeedback, and various relaxation techniques. The evidence supports integrating mind-body practices into standard care, given the shared neural pathways between physical pain and emotional states. Emerging approaches such as cannabidiol oils and craniosacral therapy may offer additional options, though more research is needed. Ultimately, patient education and increasing awareness of psychosocial factors can empower individuals to participate actively in their own recovery.