Abstract
The objective of this study will be to investigate the additional effect of pain neuroscience education program compared to a craniocervical manual therapy and exercises program for pain intensity and disability in patients with temporomandibular disorders (TMD). This study will be a randomized controlled trial comprising a sample of 148 participants. Subjects between 18 and 55 years, both genders, will undergo a screening process to confirm painful TMD by the Research Diagnostic Criteria (RDC/TMD), and then the volunteers will be randomized into two groups (G1: pain neuroscience education + craniocervical manual therapy and exercises vs. G2: craniocervical manual therapy and exercises). The volunteers will be recruited at the dentistry clinic. The intervention will be administered twice a week for 6 weeks by a single therapist lasting 1 h per session. The primary outcome will be pain intensity and disability and the secondary outcomes will be pain self-efficacy, kinesiophobia, and global perceived effect of improvement. The participants will be assessed immediately after the last session and at one- and three-month follow-ups. All statistical analyses will be conducted following intention-to-treat principles, and the treatment effects will be calculated using linear mixed models. The results of this study may contribute to understand the additional effect of pain neuroscience education intervention on TMD patients submitted to manual therapy and exercise.Trial registrationClinicalTrials.gov NCT03926767. Registered on April 29, 2019.
Highlights
Temporomandibular disorders (TMD) is a collective term that encompasses several clinical diagnoses involving the masticatory muscles, temporomandibular joints (TMJs), and associated structures [1]
A systematic review reported that the combination of Pain neuroscience education (PNE) with other interventions resulted in more favorable responses for pain intensity, disability and pain catastrophizing in patients with chronic musculoskeletal disorders [17]
This study will be the first randomized controlled trial in which the additional effect of PNE to Orofacial Manual Therapy/Orofacial exercises/Neck Motor Control exercises will be investigated in patients with chronic TMD pain for the outcomes of pain intensity and orofacial-related disability
Summary
Temporomandibular disorders (TMD) is a collective term that encompasses several clinical diagnoses involving the masticatory muscles, temporomandibular joints (TMJs), and associated structures [1]. Several studies have demonstrated the effectiveness of interventions like manual therapy associated or not to therapeutic exercise for pain intensity and disability for TMD [9,10,11]. A systematic review reported that the combination of PNE with other interventions resulted in more favorable responses for pain intensity, disability and pain catastrophizing in patients with chronic musculoskeletal disorders [17]. There is no previous study published in the literature investigating the additional effect of PNE to a protocol of craniocervical manual therapy and exercises for patients with TMD. The objective of our study will be to evaluate the additional effect of PNE to craniocervical manual therapy and exercises on pain intensity and orofacial disability immediately and after 1-month and 3-month follow-ups in patients with TMD. The hypothesis of this study is that patients submitted to both PNE and manual therapy and exercises will show better outcomes for pain intensity and orofacial-related disability than patients submitted to manual therapy and exercises alone
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