Myofascial Pain Of Jaw Muscles Research Articles

Efficacy of different combinations of physiotherapy techniques compared to exercise and patient education in temporomandibular disorders: A randomized controlled study

ABSTRACT Objective This study aims to investigate the efficacy of different types of physiotherapy approaches in individuals with cervical myofascial painful temporomandibular disorders (TMDs). Methods Seventy-five participants with myofascial pain of jaw muscles and cervical myofascial pain were randomized into three groups: exercise group (E), low-level laser therapy group (LLLT), and manual pressure release group (MPR). All patients were assessed before treatment and after 12 sessions of treatment. Results Significant improvement was seen in all groups’ pressure pain threshold (PPT) values (p < 0.01). Some masticatory and neck muscles’ PPT changes in MRP and LLLT groups were significantly higher than the exercise group (p < 0.05). Conclusion Exercise therapy is an effective approach for treatment of TMDs. Additionally, LLLT combined with exercise and MPR combined with exercise have better effects than only exercise therapy. Multimodal treatment approaches should include exercise to achieve better results in clinical practice.

A comparison trial between three treatment modalities for the management of myofascial pain of jaw muscles: A preliminary study

Objectives: To compare three treatment modalities for the management of myofascial pain of jaw muscles.Methods: Thirty (N = 30) patients with low pain-related impairment were randomly assigned to receive laser therapy (LST), oral appliance therapy (OA), or counseling (CSL). Visual Analog Scale (VAS) pain levels and the Muscular Index (MI) of the Craniomandibular Index were the outcome variables, which were assessed at baseline, at three weeks, three months, and six months.Results: At six months, improvement in the MI was maintained both in the LST (p = .025) and OA groups (p < .001). As for VAS values, positive changes were still shown for LST (p = .001), and were also shown for the OA (p = .002) and CSL groups (p = .048).Conclusions: Despite differences in the short-term effectiveness of LST and OA, with respect to CSL alone, all three treatment groups improved at six months. This suggests that active treatments should be directed to maximize the positive changes in the short-term period.

Therapeutic effectiveness of a combined counseling plus stabilization appliance treatment for myofascial pain of the jaw muscles: A pilot study

Objective: This study aims to assess changes over time in pain intensity (VAS) and in pressure pain threshold (PPT) of the anterior temporalis and masseter muscles with a treatment protocol combining counseling and stabilization appliance as well as its effects on psychosocial factors.Methods: Twenty individuals with myofascial pain of jaw muscles lasting from at least six months were selected for an uncontrolled before-after study. Counseling was performed by giving information on myofascial pain and advice on self-management. Stabilization appliances were delivered one week after the first counseling session. A number of outcome variables (i.e. visual analogue scale [VAS], pain pressure threshold [PPT] and Research Diagnostic Criteria for Temporomandibular Disorders axis II [RDC/TMD]) were assessed at different evaluation points during a six-month follow-up. ANOVA for repeated measures and Pearson’s correlation test were used to evaluate changes in the outcome variables over time.Results: Compared to baseline data, a significant positive change was found at the 1st week, 1st, 3rd, and 6th month evaluations for VAS values (P < 0.0001) and at the 1st week, 3rd, and 6th month evaluations for PPT values (P < 0.05). RDC/TMD axis II values were significantly different (P < 0.05) from baseline to all evaluations points.Conclusion: The association of counseling and stabilization appliance is effective in the management of chronic myofascial pain of jaw muscles. Future controlled studies are required to get deeper into the assessment of the relative effectiveness of counseling and stabilization appliances.

Myofascial Pain of the Jaw Muscles: Comparison of Short-Term Effectiveness of Botulinum Toxin Injections and Fascial Manipulation Technique

A randomized controlled trial was performed to compare the short-term effectiveness of botulinum toxin injections and physiatric treatment provided by means of Fascial Manipulation techniques in the management of myofascial pain of jaw muscles. Thirty patients with a Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) diagnosis of myofascial pain were randomized to receive either single-session botulinum toxin injections (Group A) or multiple-session Fascial Manipulation (Group B). Maximum pain levels (VAS ratings) and jaw range of motion in millimeters (maximum mouth opening, protrusion, right and left laterotrusion) were assessed at baseline, at the end of treatment, and at a three-month follow-up. Both treatment protocols provided significant improvement over time for pain symptoms. The two treatments seem to be almost equally effective, Fascial Manipulation being slightly superior to reduce subjective pain perception, and botulinum toxin injections being slightly superior to increase jaw range of motion. Differences between the two treatment protocols as to changes in the outcome parameters at the three-months follow-up were not relevant clinically. Findings from the present investigation are in line with literature data supporting the effectiveness of a wide spectrum of conservative treatment approaches to myofascial pain of the jaw muscles. Future studies on larger samples over a longer follow-up span are needed on the way to identify tailored treatment strategies.

Surface electromyography of jaw muscles and kinesiographic recordings: diagnostic accuracy for myofascial pain

The present investigations attempted to assess the diagnostic accuracy of commercially available surface electromyography (sEMG) and kinesiography (KG) devices for myofascial pain of jaw muscles. Thirty-six (n = 36) consecutive patients with a research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I diagnosis of myofascial pain and an age- and sex-matched group of 36 TMD-free asymptomatic subjects underwent sEMG and KG assessments to compare EMG parameters of the masseter and temporalis muscles as well as the jaw range of motion and the interarch freeway space. EMG data at rest were not significantly different between myofascial pain patients and asymptomatic subjects, while the latter achieved significantly higher levels of EMG activity during clenching tasks. Symmetry of muscle activity at rest and during clenching tasks, KG parameters of jaw range of motion and the measurement of the interarch vertical freeway did not differ between groups. Receiver operating characteristics curve analysis showed that, except EMG parameters during clenching tasks, all the other outcome sEMG and KG measures did not reach acceptable levels of sensitivity and specificity, with a 30·6-88·9% percentage of false-positive results. Therefore, clinicians should not use sEMG and KG devices as diagnostic tools for individual patients who might have myofascial pain in the jaw muscles. Whether intended as a stand-alone measurement or as an adjunct to making clinical decisions, such instruments do not meet the standard of reliability and validity required for such usage.

Power and Sample Size Calculations for Clinical Trials of Myofascial Pain of Jaw Muscles

When a clinical trial is planned, the approximate number of subjects needed for significant differences between/among groups to be detected must be estimated. Sample-size calculations provide the investigator with this information. This paper discusses the choice of outcome measures and describes the steps used to estimate the numbers of subjects necessary for a study that compares treatments for patients with chronic myofascial pain of jaw muscles. Within- and between-subject variances were estimated for the chosen variables, the subjects' pain ratings on visual analogue scales. Sample sizes were then calculated for theoretical differences between groups by pre-treatment means and overall standard deviations (Cohen, 1977). The results of this analysis can be used by other researchers when planning studies involving these types of patients.