Understanding TMD-related pain

Key takeaways:

• Pain ≠ damage – TMD pain is influenced by your brain and nervous system, not just what's happening in your jaw muscles or joints.

• TMD pain can persist due to nervous system sensitisation, even when the original cause (like clenching or inflammation) has resolved.

• Pain is a warning system, not a damage detector — like an alarm that keeps ringing even after the danger has passed.

• Stress, emotions, and habits like clenching or avoiding movement can reinforce the pain cycle by keeping your body in high alert mode.

• Chronic TMD pain develops when the brain “learns” pain patterns and becomes more reactive to everyday jaw use.

• You can retrain your system – through gentle movement, awareness, and calming strategies, the brain can learn to turn pain sensitivity back down over time.

Introduction

If you’re experiencing ongoing jaw pain, painful clicking, or discomfort while chewing, talking, or yawning, you may have asked yourself:

👉 Is something wrong with my jaw?
👉 Why does it hurt so much?
👉 Why hasn’t the pain gone away? 

Many people assume pain is a sign of damage—that something in their joints, muscles, or teeth must be broken or worn down. But pain is much more complex than that.

TMD-related pain isn’t just about your jaw—it’s about how your brain and nervous system process signals from your body. This means that pain related to TMD can continue to persist even when no active injury remains. Understanding this can help you feel less afraid of pain, move with more confidence, and take better control of your symptoms.

What causes TMD pain?

TMD pain can come from different sources, and it’s rarely due to just one single cause:

1. Muscle tension, strain, or overwork:

• Your jaw muscles work hard when you chew, speak, and express emotions.

• Clenching, grinding, or holding tension can overwork these muscles, leading to soreness, tightness, and fatigue.

2. Joint inflammation or irritation:

• The Temporomandibular Joint (TMJ) allows your jaw to move, but if it becomes inflamed, irritated, or stiff, it can cause pain, clicking, or difficulty moving your mouth.

3. Nervous system sensitisation:

• If pain lasts for weeks or months, your nervous system can become overly sensitive, sending real pain signals even when whatever triggered the original signals has settled, healed or resolved.

4. Psychological and social factors

• Stress, anxiety, and emotions can influence how the brain processes pain, as nearly all facial pain signals pass through the brain's emotional centers before reaching their final destination.

• Your daily habits, posture, sleep quality, and workload all contribute to how pain is experienced and managed–for example, anxiety about an exam can increase muscle tension, affecting pain levels.

TMD pain may start in the jaw and surrounding structures, but it is often reinforced by how the brain and nervous system respond to ongoing pain signals.

Pain is a protective mechanism—not just a sign of damage.

Pain is often thought of as a direct signal of injury—but in reality, pain is about perceived danger, not just physical harm or damage. You can have an injury without pain (e.g., a small cut you don’t notice). You can have pain without ongoing injury or damage (e.g., phantom limb pain in amputees whose amputation has healed).

Pain is essentially a warning system—like an alarm designed to protect you, but like an alarm it can continue after the threat has stopped or been removed.

Example: Biting into something hard.

Imagine you take a bite of food and accidentally hit something unexpectedly hard, like the stone in a fruit. Instantly, you feel pain in your teeth or jaw. Why? Your nervous system is telling you:

🚨 “Stop! Something might be wrong!” 🚨

Even if no actual damage occurs, the pain makes you cautious and protective. After a short time, when the brain realises the threat is gone, the pain disappears.

But what happens when pain continues to persist long after an injury has healed? That can happen when the alarm stays on.

Why does TMD pain persist? When the alarm system stays on

Short-term (acute) pain is useful—it helps us react to potential harm. But in chronic pain conditions like chronic TMD, the alarm system can become stuck in high alert mode, keeping real pain signals active even when no damage is happening or an initial injury has healed.

This happens due to sensitisation, where the nervous system becomes more reactive to pain signals over time.

A simplified explanation on how pain becomes chronic in TMD:

1. You experience jaw pain for any number of reasons for example: clenching, grinding, over working the jaw, an injury, prolonged mouth opening.

2. Your brain learns to associate specific activities with the pain (e.g., chewing, talking, yawning, going to the dentist for a long appointment).

3. The nervous system becomes more sensitive, sending pain signals even when the jaw is no longer injured.

4. You start avoiding movement, reinforcing pain sensitivity.

🚨 Pain persists not because of continued damage—but because the nervous system stays “stuck” in protection mode and the alarm is ongoing even though whatever triggered the original signals has settled, healed or resolved.

Pain and fear: The role of stress and emotions in TMD

Ever noticed your jaw pain worsens when you're stressed? That’s because pain isn’t just physical—it’s influenced by emotions, thoughts, and nervous system sensitivity.

When you're anxious or tense, for example:
 • Your jaw muscles tighten, increasing discomfort.
 • Your nervous system becomes more sensitive, making pain feel stronger.
 • You may clench more, reinforcing the pain cycle.

This doesn’t mean pain is “all in your head”—it means that stress and emotions directly impact how much pain you feel. 

🔹 Example: Ever had a one-off headache after a stressful and long day? There’s no injury, but tension makes pain feel worse. The same happens with TMD pain—your brain amplifies pain based on stress, habits, and emotions.

How to start retraining your brain and jaw:

Understanding why TMD pain persists is the first step in learning how to reduce it. The good news? The brain and nervous system are changeable—they can learn to turn pain sensitivity down just as they learned to turn it up.

By gently moving, calming your nervous system, and reframing pain, you can reduce sensitivity over time. In the following series, we’ll explore ways to retrain your nervous system, brain and reduce the impact persistent TMD pain has on you.
 

Final takeaway: Understanding pain gives you control

✔ TMD pain isn’t just about your jaw—it’s influenced by your brain and nervous system.
✔ Pain can persist even when no damage is present—because the nervous system has become overprotective.
✔ By gently moving, calming your nervous system, and reframing pain, you can reduce sensitivity over time.

References:

1. National Academies of Sciences, Engineering, and Medicine. Temporomandibular Disorders: Priorities for Research and Care. The National Academies Press, 2020. https://doi.org/10.17226/25652.

2. Woolf, Clifford J. "Central Sensitization: Implications for the Diagnosis and Treatment of Pain." Pain, vol. 152, no. 3 Suppl, 2011, pp. S2–S15. https://doi.org/10.1016/j.pain.2010.09.030.

3. Gatchel, Robert J., et al. "The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions." Psychological Bulletin, vol. 133, no. 4, 2007, pp. 581–624. https://doi.org/10.1037/0033-2909.133.4.581.

4. Sessle, Barry J. "The Pain of Orofacial Disorders – Biological and Psychosocial Mechanisms." Pain, vol. 129, no. 3, 2007, pp. 244–246. https://doi.org/10.1016/j.pain.2007.02.005.

5. Moseley, G. Lorimer. Explain Pain. Noigroup Publications, 2003.

6. Harper, David E., et al. "Clustering of Pain Conditions in Patients with Temporomandibular Disorders: A Cross-Sectional Study." Journal of Pain, vol. 17, no. 9, 2016, pp. 951–960. https://doi.org/10.1016/j.jpain.2016.05.001.