Intramuscular Injections and Dry Needling within Masticatory Muscles in Management of Myofascial Pain. Systematic Review of Clinical Trials.

Zuzanna Nowak,Sylwia Bulanda,Aleksandra Nitecka-Buchta,Maciej Chęciński,Danuta Ilczuk-Rypuła,Lidia Postek-Stefańska,Stefan Baron

doi:10.3390/ijerph18189552

Abstract

Background: Myofascial pain is an important cause of disability among the whole population, and it is a common symptom of temporomandibular joint disorders (TMDs). Its management techniques vary widely; however, in recent years, there has been a growing interest especially in needling therapies within masticatory muscles, due to their simplicity and effectiveness in pain reduction. Methods: The construction of the following study is based on PICOS and PRISMA protocols. A systematic literature search was conducted based on the PubMed and BASE search engines. Searching the abovementioned databases yielded a total of 367 articles. The screening procedure and analysis of full texts resulted in the inclusion of 28 articles for detailed analysis. Results: According to analyzed data, clinicians manage myofascial pain either with wet or dry needling therapies. The most thoroughly studied approach that prevails significantly within the clinical trials is injecting the botulinum toxin into the masseter and temporalis. Other common methods are the application of local anesthetics or dry needling; however, we notice the introduction of entirely new substances, such as platelet-rich plasma or collagen. In the analyzed articles, the target muscles for the needling therapies are most commonly localized by manual palpation although there are a variety of navigational support systems described: EMG, MRI or EIP electrotherapy equipment, which often aid the access to located deeper lateral and medial pterygoid muscle. Conclusions: Needling therapies within masticatory muscles provide satisfactory effects while being simple, safe and accessible procedures although there still is a need for high quality clinical trials investigating especially injections of non-Botox substances and needling within lateral and medial pterygoid muscles.

Highlights

Botox or local anesthetics in recent years, there has been an ongoing search for another substance that would turn out to be more beneficial in myofascial pain therapy
It is a promising tool for the assessment of masticatory muscles, especially the masseter as stated by Olchowy et al there still is a significant need for more studies on larger groups to determine the accuracy of elastography to characterize masticatory muscles and their disorders [68]. It is worth discussing the masticatory muscles as a primary needling treatment target in all the analyzed clinical trials, as the results indicate that needling therapies are most often carried out within the masseter and temporal muscle
The interest in needling therapies within masticatory muscles has clearly increased in recent years

Summary

Introduction

Myofascial pain is an important cause of disability among men and women of all ages and may affect up to 85% of the population [1,2]. It is a common symptom of temporomandibular disorder (TMD) [3]. The 2020 International Classification of Orofacial Pain (ICOP) allows for a more systematized and standardized look at myofascial pain [6]. It specifies definitions and diagnostic criteria for primary myofascial orofacial pain: acute and chronic, as well as secondary myofascial orofacial pain attributed to tendonitis, myositis

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Discussion

Conclusion