TMJ Arthrocentesis Alone and in Combination with Duloxetine in Temporomandibular Joint Pain.

Abstract

The purpose of the study was to compare the efficacy of arthrocentesis alone and arthrocentesis with duloxetine in patients with TMJ pain. This study comprised of 20 patients. Patients with TMJ pain as confirmed by RDC/TMD and with pain duration of at least 3months were included in the study. Patients were randomly divided into two groups, group A in which patients were treated with arthrocentesis alone and group B in which patients were treated with arthrocentesis followed by duloxetine 30mg twice daily for 12-week therapy. Patients were followed up at regular interval at day 1, day 5, day 7, week 4, week 6 and week 12. Outcome assessment of pain, swelling, maximal mouth opening, painful/pain-free lateral or protrusive jaw movement was done. Hospital anxiety and depression (HAD) scale was used to assess pre- and post-treatment anxiety and depression. Radiologic assessment was done based on OPG and CBCT. Biochemical assessment of IL-6 in lavage fluid between groups A and B was done pre-operatively and postoperatively. There was significant reduction of pain in both groups, but reduction of pain was more in group B than in group A at week 4, week 6 and week 12. Mouth opening was significantly higher in group B than in group A patients. Reduced painful lateral and protrusive movements were seen in group B than in group A patients. There was no significant difference in hospital anxiety and depression scale among the groups at pre-operative and at 4th week post-operative. Though a significant reduction of IL-6 levels was seen post-operatively, there was no significant difference between the two groups. Arthrocentesis is an effective procedure for relieving symptoms in patients with temporomandibular disorders. In this study, combination of duloxetine with arthrocentesis gave much better outcome than arthrocentesis alone. Further studies with large sample size required to evaluate the effect of arthrocentesis plain or in combination with duloxetine in providing permanent relief to the patient.