Lack of research has resulted in a paucity of evidence-based treatment approaches for TMJD (Antczak- Bouckoms 1995, List 2003). While NSAIDs are sometimes used, there is little evidence for their effectiveness for TMJD (Dionne 1997, Gordon et al 1990, 1991) except in frank joint involvement (Ta et al 2004), and gastrointestinal and renal toxicity limit their long-term use (Gabriel et al 1991, Allison et al 1992, Schafer et al 1995, Champion et al 1997) for treatment of chronic pain. Use of opioids has been discouraged for this chronic pain condition due to the limitations of long-term use for this drug class (DeNucci et al 1996, Dionne 1997). The most promising pharmacologic therapy for TMJD to date has been antidepressants, but it is important to note that indication for their clinical use has primarily been extrapolated from other chronic pain conditions (McQuay et al 1992, Onghena et al 1992). Only two randomized controlled trials have examined one of the tricyclic antidepressants (amitryptyline) for TMJD specifically (Sharav et all 1987, Rizzatti-Barbosa 2003). Amitryptyline for TMJD demonstrated an average response rate of 40% in these two studies, but its adverse effects result in a large percentage of patients discontinuing the drug before achieving pain relief (DeNucci et al 1996), resulting in an unfavorable risk to benefit ratio (Zitman et al 1990). Taken together, there has been insufficient evidence to adopt a pharmacologic standard of care for treatment of TMJD.