Myofascial Pain Dysfunction Syndrome Research Articles

Value of transcutaneous electric nerve stimulation in the treatment of myofascial pain dysfunction syndrome

Pain in facial region originating from both temporomandibular joint (TMJ) and jaw muscles is a common clinical problem and is a diagnostic dilemma till today. There are many synonyms for this condition including myofascial pain dysfunction syndrome, mandibular dysfunction syndrome, and the TMJ dysfunction syndrome. With change in time, advances and new diagnostic criteria have been made in the diagnosis of myofascial pain syndrome, its epidemiology, clinical characteristics, and etiopathogenesis, but many unknowns remain. An integrated hypothesis has provided a greater understanding of the physiopathology of trigger points, which may allow the development of new diagnostic criteria and treatment of this chronic disease and combined pharmacological as well as physical therapy for the management of the disease. The purpose of this paper is to describe the multidisciplinary approach highlighting the effect of transcutaneous electric nerve stimulation (TENS) for the treatment of a 60-year-old female who suffered from myofascial pain and 5-day TENS therapy for management of pain.

Evaluation of conventional therapy, transcutaneous electric nerve stimulation therapy, and placebo in management of myofascial pain-dysfunction syndrome: A comparative study

Evaluation of conventional therapy, transcutaneous electric nerve stimulation therapy, and placebo in management of myofascial pain-dysfunction syndrome: A comparative study

The Enigma of Myofascial Pain Dysfunction Syndrome

Introduction:Myofascial Pain Dysfunction Syndrome (MPDS) is one of the most common and important cause of the orofacial pain.Patients with temporomandibular joint and muscle pain gradually learn to live with the symptoms although they have been exposed to a variety of treatments. In some instances the symptoms have been aggravated by the treatment, while other patients have recovered without treatment.Masticatory muscle fatigue and spasm are responsible for the cardinal symptoms of pain, tenderness, clicking, and limited function that characterize the MPD Syndrome.The symptoms of a typical temporomandibular joint dysfunction is classified as (a) pain and its sequelae, (2) clicking and crepitus, and (3) irregularities of mandibular movement.The pain can be unilateral or bilateral with varying degree of pain.Mandibular deviation is a third characteristic often evident in temporomandibularjoint patients. Mandibular deviation, in this instance, refers to the deviation from rest position to mouth wide open is a result of joint malfunction and muscle pain. Various non- surgical and surgical methods are used for the treatment of myofascial pain dysfunction syndrome.Conclusion: Since MPDS consists of variable symptoms, it might be very difficult to provide any definite diagnosis and treatment. Therefore the more the specialists extend their knowledge and information about this disorder, the more they will make the best decision in this regard.

Short-term effects of self-massage combined with home exercise on pain, daily activity, and autonomic function in patients with myofascial pain dysfunction syndrome.

[Purpose] The aim of the present was to investigate the short-term effects of a program combining self-massage and home exercise for patients with myofascial pain dysfunction syndrome (MPDS). [Subjects and Methods] In this retrospective study, 63 patients were allocated to the experimental (n = 32) and control (n = 31) groups. Both groups received 6 sessions of treatment with physical modalities over the course of two weeks. The experimental group completed an additional program with a combination of self-massage and home exercise. The outcome measurements included a pain scale, pressure pain threshold (PPT), neck disability index (NDI), patient-specific functional scales (PSFS), and heart rate variability (HRV). The interactions between the groups and over time were analyzed using two-way repeated measures ANOVA. [Results] Only the experimental group demonstrated significant improvements in the pain scale with varying conditions. The PPTs of the trigger points increased significantly in the experimental group, and significant functional improvements in NDI and PSFS were observed in the same group. There were significant increases in high-frequency HRV and high-frequency % in the experimental group. [Conclusion] Treatment with physical modalities plus combination of self-massage and home exercise is more effective than the physical modalities treatment alone.

Evaluation of laser therapy and routine treatment modalities in the management of myofascial pain dysfunction syndrome

Objective: To evaluate the efficacy of laser as a monotherapy and in combination with exercise therapy in comparison to only exercise in the treatment of Myofascial Pain Dysfunction Syndrome (MPDS) or Temporomandibular Myofascial Pain. Materials and Methods: A total of 60 patients with MPDS were included in the study and were randomly divided into three groups: exercise, laser, and the combination of both (exercise and laser). Results: Significant reduction in pain at rest and pain on movement was observed with all three types of treatment modalities. Pain reduction was more in those patients who received combination of exercise and laser therapy. Similarly, decrease in the muscle tenderness was more when combination of exercise and laser therapy was used. Conclusion: The ideal therapy should be fast, cheap, and have a long-term effect. Laser (Helium Neon) as monotherapy or in combination with exercise had shown promising results and can be used as an effective treatment modality for the treatment of MPDS.

Evaluation of Salivary Cortisol and Anxiety Levels in Myofascial Pain Dysfunction Syndrome

BackgroundMyofascial pain dysfunction syndrome (MPDS), otherwise called myofascial pain is one of the most common temporomandibular disorders, which in turn is the most common cause of orofacial pain of non-dental origin. Its etiology is multifactorial and still poorly understood. Psychological factors have been shown to play a role in the etiology. The aim of the study was to evaluate the association between anxiety and salivary cortisol levels in patients with myofascial pain.MethodsTwenty patients suffering from myofascial pain were recruited as the study group. The same number of age and sex matched healthy individuals were taken as the control group. The salivary samples collected between 9-9:15 am from both groups were analyzed for cortisol levels with the competitive enzyme-linked immunosorbent assay method. Anxiety levels of 40 patients were measured using Hamilton's anxiety scale.ResultsThe mean serum cortisol level of the MPDS group showed a highly significant difference (p < 0.001) from the controls. The mean anxiety scores of the MPDS group showed a highly significant difference (p < 0.001) from the controls. A positive correlation was found between anxiety and the salivary cortisol levels in MPDS patients.ConclusionsThese findings suggest that anxiety plays a vital role in the etio-pathogenesis of MPDS; thus, besides pharmacological treatment, psychological support is also needed.

The Adjunct Therapeutic Effect of Lasers with Medication in the Management of Orofacial Pain: Double Blind Randomized Controlled Trial

This study aimed to evaluate the efficacy of laser therapy in conjunction with a pharmaceutical approach to alleviate myofascial pain dysfunction syndrome. A few clinical studies have evaluated the analgesic effect of laser therapy on orofacial pain, most of which reported controversial results. Myofascial pain dysfunction syndrome (MPDS), trigeminal neuralgia, and atypical facial pain are the most common facial pain. A double-blind randomized controlled trial was designed to evaluate the therapeutic effect of GaAs laser (peak power 10 W; pulse frequency 3000 Hz; average power 0.012 W; wavelength 980 nm; irradiation duration 300 sec; and dose 12.73 J/cm(2)) on the management of common orofacial pain. The laser group (n=30) received 10 sessions of treatment with GaAs laser. The control group (n=30) was treated identically with sham laser. All patients received the appropriate pharmaceutical treatment as well. Visual analog scale (VAS) was recorded for all patients at baseline, and immediately, 2, and 4 months after the final treatment session. The qualitative variables among the groups were compared using the χ(2) test. Both groups demonstrated a significant reduction in pain with the progression of time (p<0.05). The difference between the two groups was not significant (p>0.05). Whereas laser therapy in the present study failed to show any significance over the control group, the role of covariates such as radiation parameters (wave length, dose) should not be overlooked. We found no significant level of efficacy for the GaAs laser in the management of common orofacial pain. Further studies are suggested to evaluate the efficacy of other types of lasers with different parameters in the management of orofacial pains.

Therapeutic effect of combining muscle relaxant and posture correction in patients with myofascial pain dysfunction syndrome of temporomandibular disorder

Background: Many studies have shown that poor posture may lead to myofascial pain dysfunction syndrome (MPDS) of the trunk. Forward head posture is one of the most common forms of poor posture, and is related to neck pain. Hence, the aim of this study was to estimate the influence of body posture on MPDS of the temporomandibular joint (TMJ). Methods: Twenty-six otherwise healthy adults with MPDS of the TMJ were enrolled in this study. Clinical examination was performed at three time-points: prior to the treatment, at the 2-week follow-up, and at the 4-week follow-up. The subjects received a muscle relaxant drug and adjustment of body posture. Variables such as visual analogue scale (VAS) score, shoulder angle (SA), cervical spine angle-coronal (CSA-c), and cervical spine angle-sagittal (CSA-s) were evaluated at each stage. Generalized estimating equations (GEE) were used to control for non-independence among observations. Results: There were significant improvements in VAS score (p ＜ 0.001), SA (p ＜ 0.001), CSA-c (p ＜ 0.001), and CSA-s (p ＜ 0.001) after treatment compared to the corresponding values obtained before treatment. Conclusions: Correcting body posture in conjunction with use of a muscle relaxant had an extremely therapeutic effect on patients with MPDS of TMJ. The improvement of the angle of sagittal cervical spine may have reduced the pain score, and we speculate that it is important to correct forward head posture when treating patients with MPDS of TMJ.

Evaluation of Malocclusion in MPDS

Myofascial pain dysfunction syndrome (MPDS) is a disorder which is characterized by facial pain and limited mandibular function because of the complex nature of this disease. Malocclusion was never evaluated in MPDS patients to know its role. Electromyographic silent period durations of masseter were used for objective assessment of MPDS patients. To evaluation of role of malocclusion in MPDS patients and also to study the EMG masseteric silent period pattern in MPDS patients in different malocclusions. Two groups, groups I and II of 75 subjects each, were included in this study. Groups I and II constituted the normal subjects and MPDS patients respectively. All these subjects in both the groups were again subdivided based on Angle's class I, II and III malocclusion. Electromyographic (EMG) silent period of masseteric muscle on both sides was measured for all the subjects in both the groups to know whether it differs according to the type of malocclusion. The silent period was more in group II (MPDS patients). There was no signifcant difference in the silent periods in Angle's class I, II and III malocclusion in group I, whereas in group II, there was a signifcant difference in the silent period in Angle's class II compared to Angle's class I and III. There was no signifcant difference between males and females. MPDS patients are more in Angle's class I malocclusion. Silent period is more in Angle's class II malocclusion of MPDS group. CLINICAL SIGNIFCANCE: The EMG masseter silent period duration can be advantageously utilized as an adjunct to clinical examination for diagnosis of myofascial pain dysfunction syndrome. It is enough if one side masseter muscle is measured for silent period duration.

Therapeutic significance of guidance for masticatory patterns in patients with myofascial pain dysfunction syndrome and clinical studies on lifestyle related expressions of this disease

Therapeutic significance of guidance for masticatory patterns in patients with myofascial pain dysfunction syndrome and clinical studies on lifestyle related expressions of this disease

Observation of the guidance for masticatory patterns in patients with myofascial pain dysfunction syndrome

Observation of the guidance for masticatory patterns in patients with myofascial pain dysfunction syndrome

A Case of Myofascial Pain Dysfunction Syndrome improved by Guidance for Masticatory Patterns

A Case of Myofascial Pain Dysfunction Syndrome improved by Guidance for Masticatory Patterns

Clinical survey of the patients with temporomandibular joint disorders, using Research Diagnostic Criteria (Axis II) for TMD: Preliminary study

PurposeThe purpose of this study was to investigate the nonspecific physical and psychological symptoms in patients who suffered from temporomandibular joint disorder (TMD) using the Research Diagnosis Criteria (Axis II) for TMD diagnosis (RDC/TMD). Study designA total of 317 patients were included (M: 75, F: 242). The signs and symptoms of physical, psychological and behavioral factors were evaluated using questionnaires in the RDC/TMD. The patients were examined through clinical and radiological method and diagnosed by the same investigator. Patients were divided into 3 different groups such as: the osteoarthritis group (group 1), the internal derangement (group 2) and the myofascial pain dysfunction syndrome group (MPDS, group 3). ResultsIn the analysis of depression and vegetative symptoms, patients in the internal derangement group revealed a high ratio of ‘normal’. In patients with MPDS, they appeared to suffer highly. According to nonspecific physical symptoms, there have been tendencies of a higher ratio of ‘severe’ patients with MPDS. In subjects aged 25 years or younger, the internal derangement group was the greatest, while the osteoarthritis group was the greatest for subjects over 40-years old. In the evaluation of depression and vegetative symptoms, the internal derangement group showed a relative normal value while the MPDS group showed a serious extent in comparison. ConclusionAccording to the result of this study, MPDS group showed more severe depressive and nonspecific physical symptoms than internal derangement group. When making TMD diagnosis and treatment, it is thought to be important to analyze psychometric properties and nonspecific physical symptoms.

Management of Myofascial Pain

The present study was designed to compare the effects of low-level laser with occlusal splints in patients with signs and symptoms of myofascial pain (MP) dysfunction syndrome. A total of 40 (34 women and 6 men, with a mean age of 32.84 [SD, 10.70] years) were selected after the diagnosis of MP according to the Research Diagnostic Criteria for Temporomandibular Disorder. The patients were randomly divided into 2 groups: study group (n = 20) and control group (n = 20). Low-level laser was applied to patients in the study group 2 times per week, for a total of 10 sessions. Patients in the control group were instructed to wear occlusal splints 24 h/d for 3 months. The functional examination was based on Research Diagnostic Criteria for Temporomandibular Disorder and pressure pain threshold values were obtained with the aid of an algometer in both groups. Patients' self-report of pain was evaluated with visual analog scale. Comparisons were made within and between the groups before and after treatment. Vertical movements showed statistically significant improvements after the treatments in both groups (P < 0.01), but when the groups were compared with each other, there were no significant difference between the groups. In both groups, tenderness to palpation of the muscles decreased significantly. Pressure pain threshold evaluations and visual analog scale scores revealed similar results, too. This particular type of low-level laser therapy (820 nm, 3 J/cm2, 300-mW output power) is as effective as occlusal splint in pain release and mandibular movement improvement in MP.

Myofascial Pain Dysfunction Syndrome (MPDS)

Introduction: Myofascial Pain Dysfunction Syndrome (MPDS) is one of the most important causes of the orofacial pain. The main purpose of this study was to evaluate 40 related variables in this regard. Materials and Methods: Thirty nine patients with MPDS were evaluated in this study. Different factors including age, gender, occupation, marital status, sensitivity of masticatory muscles, maximum opening of the mouth, deviation, deflection, involvement of temporomandibular joint, habit, parafunction, malocclusion, neck pain, headache, earache and history of jaw involvement, etc were analyzed in this evaluation. Results: In our study, 39 patients (32 females and 7 males), 20-40 years old, with the average age of 35 ± 13.32 years were studied. 51% were housewives and 74.4% were married. The most common involvements were Clicking (74.4%), pain in temporomandibular joint (54%), headache (46.2%), earache (41%), neck-pain (35.9%), trouble in the mouth opening (71.8%), malocclusion Class I (74.4%), cross bite and deep bite (25%), clenching (64.1%) and involvement of masseter and lateral pterygoid muscle (84%).

Soft occlusal splint therapy in the management of myofascial pain dysfunction syndrome: A follow-up study

Myofascial Pain Dysfunction Syndrome (MPDS) has been recognized as the most common, nontooth-related chronic orofacial pain condition that confronts dentists. A variety of therapies has been described in literature for its management. The present study is a prospective study carried out to evaluate the efficacy of occlusal splint therapy and compare it with pharmacotherapy (using analgesics and muscle relaxants) in the management of Myofascial Pain Dysfunction Syndrome. Forty patients in the age range of 17-55 years were included in the study and randomly assigned to one of two equally sized groups, A and B. Group A patients received a combination of muscle relaxants and analgesics while Group B patients received soft occlusal splint therapy. All the patients were evaluated for GPI, VAS, maximum comfortable mouth opening, TMJ clicking and tenderness during rest and movement as well as for the number of tender muscles at the time of diagnosis, after the 1 st week of initiation of therapy and every month for three months of follow-up. There was a progressive decrease in GPI scores, number of tender muscles, TMJ clicking and tenderness with various jaw movements and significant improvement in mouth opening in patients on occlusal splint therapy during the follow-up period as compared to the pharmacotherapy group. Occlusal splint therapy has better long-term results in reducing the symptoms of MPDS. It has better patient compliance, fewer side effects, and is more cost-effective than pharmacotherapy; hence, it can be chosen for the treatment of patients with MPDS.

A device for diagnosing role of occlusion in myofascial pain dysfunction syndrome

Myofascial pain dysfunction syndrome is the most common temporomandibular joint disorder (TMD). It is a stress-related disorder and its incidence is on the rise in this present day stressful lifestyle. Temporomandibular joint kinematics requires strict harmony between the dentition and the muscle action for normal functioning of the masticatory apparatus to take place. An accurate diagnosis is the first step in the management of any TMDs and this process cannot be abridged. This paper highlights an easy method of designing and functioning of a device can be used for diagnosing the relationship of the noxious occlusion to tenderness in the lateral pterygoid muscle and other muscles of the mastication. Along with this it can be used to relieve the ischemic muscle tenderness, may be used as a positioning device for the registrations of physiologic interocclusal relations and to help eliminate the dysfunctional articular clicks.

Effects of Low-level Laser in the Treatment of Myofascial Pain Dysfunction Syndrome.

Background and aims Muscular pain in the facial region is the most common cause of facial pains. Myofascial pain dysfunction syndrome (MPDS) is one of the most important facial muscle disorders comprising of signs and symptoms including pain during function, tenderness in the muscles of mastication and restricted jaw movement. Due to the lack of an accepted therapeutic approach, the purpose of this paper was to find an effective treatment to decrease the pain of such patients. Considering the analgesic and anti-inflammatory action of laser therapy, the effects of low level laser (Ga-Al-As) in the treatment of MPDS patients referred to Tehran University of Medical Sciences Faculty of Dentistry, were investigated in the present study. Materials and methods This study was a quasi-experimental research. Twenty-two MPDS patients were selected from those referred to Department of Oral Medicine, Tehran University of Medical Sciences Faculty of Dentistry. Clinical examination was performed at six stages in the following order: prior to the treatment, at 2 and 4 weeks after treatment, and monthly thereafter for a 3-months follow-up. All patients underwent low-level laser therapy for 4 weeks (12 sessions). Variables such as pain severity, pain of cheek region, pain frequency, tenderness of masticatory muscles, click, and mouth opening were evaluated at each stage. Numerical variables were investigated using Analysis of Variance test for repeated measures whereas ranking variables were studied by non-parametric Kruskal-Wallis test. Results At the end of treatment period, pain severity, pain of cheek region, pain frequency, tenderness of masseter, temporalis, medial pterygoid, and lateral pterygoid muscles showed significant improvement as compared with the commencement of any treatment which continued during the 3-months post-treatment (p<0.05). Conclusion It was shown that low-level laser (Ga-Al-As) therapy had the efficacy to alleviate pain and decrease the tenderness of masticatory muscles among MPDS patients through a continuous and regular therapeutic program.

Combining Technologies: A Computerized Occlusal Analysis System Synchronized with a Computerized Electromyography System

Current advances in computer technologies have afforded dentists precision ways to examine occlusal contacts and muscle function. Recently, two separate computer technologies have been synchronized together, so that an operator can record their separate diagnostic data simultaneously. The two systems are: the T Scan II Occlusal Analysis System and the Biopak Electromyography Recording System. The simultaneous recording and playback capacity of these two computer systems allows the operator to analyze and correlate specific occlusal moments to specific electromyographic changes that result from these occlusal moments. This synchronization provides unparalleled evidence of the effect occlusal contact arrangement has on muscle function. Therefore, the occlusal condition of an inserted dental prosthesis or the occlusal scheme of the natural teeth (before and after corrective occlusal adjustments) can be readily evaluated, documented, and quantified for both, quality of occlusal parameters and muscle activity and the responses to the quality of the occlusal condition. This article describes their synchronization and illustrates their use in performing precision occlusal adjustment procedures on two patients: one who demonstrates occlusal disharmony while exhibiting the signs and symptoms of chronic myofascial pain dysfunction syndrome, and the other who had extensive restorative work accomplished but exhibits occlusal discomfort post-operatively.

‘Mice’ in the joint

Synovial chondromatosis of the temporomandibular joint (TMJ) is rare, and is characterised by the presence of loose bodies (joint mice). It can be confused clinically with myofascial pain dysfunction syndrome, and histologically with chondrosarcoma. Diagnosis involves clinical, radiographic, and histological examination. Arthroscopy is a useful, minimally-invasive adjunctive diagnostic investigation.