Abstract
To evaluate the effect of photobiomodulation therapy (PBMT) on painful temporomandibular disorders (TMD) patients in a randomized, double-blinded, placebo-controlled manner. Participants were divided into a masseter myalgia group (n = 88) and a temporomandibular joint (TMJ) arthralgia group (n = 87) according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Both groups randomly received PBMT or placebo treatment once a day for 7 consecutive days, one session. The PBMT was applied with a gallium-aluminum-arsenide (GaAlAs) laser (wavelength = 810 nm) at pre-determined points in the masseter muscle (6 J/cm2, 3 regions, 60 s) or TMJ region (6 J/cm2, 5 points, 30 s) according to their most painful site. Pain intensity was rated on a 0–10 numerical rating scale (NRS) and pressure pain thresholds (PPT) and mechanical sensitivity mapping were recorded before and after the treatment on day 1 and day 7. Jaw function was assessed by pain free jaw opening, maximum unassisted jaw opening, maximum assisted jaw opening, maximum protrusion and right and left excursion. Data were analyzed with a mixed model analysis of variance (ANOVA). Pain intensity in arthralgia patients decreased over time (P < 0.001) for both types of interventions, however, PBMT caused greater reduction in pain scores than placebo (P = 0.014). For myalgia patients, pain intensity decreased over time (P < 0.001) but without difference between interventions (P = 0.074). PPTs increased in both myalgia (P < 0.001) and TMJ arthralgia patients over time (P < 0.001) but without difference between interventions (P ≥ 0.614). Overall, PBMT was associated with marginally better improvements in range of motion compared to placebo in both myalgia and arthralgia patients. Pain intensity, sensory function and jaw movements improve after both PBMT and placebo treatments in myalgia and arthralgia patients indicating a substantial non-specific effect of PBMT.
Highlights
exercise[9], transcutaneous electrical stimulation, and photobiomodulation therapy (PBMT)[10]
A total of 175 participants were initially enrolled into the study, 28 of them were excluded due to the exclusion criteria. 147 participants were randomized into 4 groups, while 16 participants dropped out due to personal reasons or inability to cooperate
The increase of serotonin and endorphin levels is a further putative mechanism of pain relief[35]. These putative molecular and biological mechanisms underlying of PBMT is far from complete, it is commonly believed that Cytochrome c Oxidase (CCO) in the mitochondrial respiratory chain serves as the primary photoceptor[36]
Summary
exercise[9], transcutaneous electrical stimulation, and photobiomodulation therapy (PBMT)[10]. Patients with TMJ pain often involve disorders of the articular surfaces, articular disk, bilaminar zone, joint capsule and ligaments, manifested as sound, limited mandibular movement and pain in these areas, while patients with muscle disorders often present with pain in the related muscle region, reduction of mandibular mobility and “pulling” sensations such as feeling of fatigue and b racing[24]. In addition to these differences in clinical manifestations, the mechanism of TMJ pain and myalgia may be d ifferent[24]. The purpose of this study was to evaluate the effect of PBMT on myalgia and TMJ arthralgia patients by use of QST and pain sensitivity mapping techniques in a randomized, double-blinded, placebo-controlled manner
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