Diagnosis and management of persistent post-operative pain following temporomandibular joint surgery: a survey-based study of oral and maxillofacial surgeons.

Chronic pain is an under-recognised but common and significant complication following temporomandibular joint (TMJ) surgery. This study aimed to investigate how oral and maxillofacial (OMF) surgeons diagnose and manage persistent post-operative pain and to assess collaboration with pain specialists. A 21-item anonymous online questionnaire was distributed to 130 OMF surgeons with expertise in TMJ surgery. The survey addressed clinical practice demographics, diagnostic and management strategies for persistent post-operative pain, awareness of risk factors for chronic pain, and interdisciplinary collaboration. Descriptive statistics were used to analyse responses. Of 39 responses, 30 complete responses were analysed (response rate: 23%). Respondents reported that 30% of their patients with TMD underwent minimally invasive procedures and 24% underwent open joint surgery. Although 24 surgeons routinely discussed the risk of chronic pain, six did not or only did so selectively. Common diagnoses of pain following TMJ surgery included persistent myofascial pain, neuropathic pain, and progression of arthropathy. Only 14 surgeons reported referring patients with persistent pain to a pain specialist. Barriers to referral included limited access, difficulty coordinating care, and perceptions of unnecessary use of resources. Although all respondents were aware of the orofacial pain (OFP) specialty, eight indicated that it was not recognised in their country. Persistent post-operative pain remains a complex, multifactorial issue in TMJ surgery. While most surgeons recognise its prevalence and approach management conservatively, gaps remain in interdisciplinary collaboration and risk factor awareness. Improved integration of OFP specialists and broader adoption of the biopsychosocial model of pain may enhance patient outcomes.