Temporomandibular Myofascial Pain Research Articles

Effectiveness of low-level laser therapy and myofascial release technique on health-related outcomes of pregnant women with temporomandibular myofascial pain: A Randomized Controlled Trial

Effectiveness of low-level laser therapy and myofascial release technique on health-related outcomes of pregnant women with temporomandibular myofascial pain: A Randomized Controlled Trial

Pain Assessment during Gnathological Treatment of Temporomandibular Myofascial Pain through Mandibular Repositioning Splints Designed after a Posture-Stabilometric Evaluation

The aim of the study is to evaluate the effectiveness of two complementary mandibular repositioning splints (SVED and MORA) designed after a preliminary patients’ posture-stabilometric evaluation in treatment for temporomandibular myofascial pain (TMP) using the Pain-Intensity Numeric Rating Scale (PI-NRS) assessment. Eighty-six consecutive sportive non-agonistic subjects with TMP were randomly divided in two groups. Forty-two wear mandibular repositioning splints designed by a posture-stabilometric evaluation, thus constituting the test group. The other 44 subjects were not subjected to any treatment, thus represented the control group. To record pain intensity, subjects in both groups were asked to fill in a PI-NRS which ranged from 0 (no pain) to 10 (worst imaginable pain). In the test group, PI-NRS was assessed three times: before starting therapy (t0), after 4 months (t1) and after 8 months (t2) of treatment. Instead, in the control group PI-NRS was recorded during the first visit (t0) and after 8 months (t2). The Friedman test showed a statistically significant decrease in PI-NRS mean scores after 4 (t1) and 8 (t2) months from the start of the gnathological therapy with mandibular repositioning splints, (p < 0.001) in test group. There is enough evidence to assess that occlusal splint therapy for mandibular repositioning (MORA and SVED) designed through a posture-stabilometric evaluation could be considered in the treatment of temporomandibular myofascial pain.

Temporomandibular Myofascial Pain Syndrome-Aetiology and Biopsychosocial Modulation. A Narrative Review.

This review elaborates on the aetiology, diagnosis, and treatment of temporomandibular (TMD) myofascial pain syndrome (MPS) regulated by psychosocial factors. MPS impairs functioning in society due to the accompanying pain. Directed and self-directed biopsychosocial profile modulation may be beneficial in the treatment of MPS. Moreover, nutrition is also a considerable part of musculoskeletal system health. A fruit and vegetable diet contributes to a reduction in chronic pain intensity because of its anti-inflammatory influence. Cannabidiol (CBD) oils may also be used in the treatment as they reduce stress and anxiety. A promising alternative treatment may be craniosacral therapy which uses gentle fascia palpation techniques to decrease sympathetic arousal by regulating body rhythms and release fascial restrictions between the cranium and sacrum. MPS is affected by the combined action of the limbic, autonomic, endocrine, somatic, nociceptive, and immune systems. Therefore, the treatment of MPS should be deliberated holistically as it is a complex disorder.

ЛУЧЕВАЯ ДИАГНОСТИКА ПРИ ЛЕЧЕНИИ СМЕЩЕНИЯ СУСТАВНОГО ДИСКА ВИСОЧНО-НИЖНЕЧЕЛЮСТНОГО СУСТАВА И МИОФАСЦИАЛЬНЫХ РАССТРОЙСТВ

Purpose: Determination of the volume and sequence of radiation studies in the treatment of patients with displacement of the articular disc of the temporomandibular joint (TMJ)and myofascial pain disorders.
 Material and methods: The study included 48 patients with displacement of the articular disc of the TMJ and myofascial pain disorders. Clinical criteria for articular displacement were confirmed by MRI and CBCT. Studies of the function of the masticatory muscles were carried out at the Synapsis electromyograph. All patients underwent complex treatment, including relaxation of the masticatory muscles and relief of pain using injections of botulinum toxin in the actual masticatory, temporal and lateral pterygoid muscles (LPM), followed by repositioning split therapy. For the introduction of muscle relaxant in LPM, we have developed and applied external periarticular injection access to LPM. The method is based on reaching the zone of joint attachment of the upper and lower heads of the LPM with MRI navigation. Surveillance continued for up to 12 months with MRI monitoring of the position of the articular disc.
 Results: The stages of treatment of SJS of the TMJ with control use of MRI and CT, as well as a method for the administration of botulinum toxin under MRI navigation, have been developed. The first stage included CT and MRI of the temporomandibular joint, the second stage – injections of botulinum toxin into the masticatory muscles using the developed periarticular access to the LPM with MRI navigation, as well as CBCT with a splint to control the new (established) position of the lower jaw; the third and fourth stages included continuation of the reduction splint therapy, correction of the splint, observation for 3-6 months with control CBCT after 6 months to assess the position of the mandible without splint. Achieved an increase in the posterior and upper temporomandibular joint distances and the correct position of the lower jaw.
 Conclusion: Performing radiation studies on time at certain stages of treatment, differing in their content and volume, provided a complete diagnosis, planning treatment measures and monitoring the results.

Clinical evaluation of botulinum toxin A in the management of temporomandibular myofascial pain

Introduction: We completed a clinical service evaluation of patient-reported outcomes for pain and change in interincisal distance in patients treated with botulinum toxin A (BTX-A) for temporomandibular myofascial pain at nurse-led clinics.

A Facility-Based Study of Severity of Pain Among Patients with Temporomandibular Myofascial Pain Syndrome

Background: Myofascial pain syndrome is the most common temporomandibular joint (TMJ) disorder. Objective: To measure pain severity among patients with temporomandibular myofascial pain syndrome using the Visual Analogue Scale (VAS), and to relate pain severity to age and gender. Methods: A cross-sectional study of patients who presented with TMJ pain and were diagnosed with TMJ myofascial pain syndrome was conducted. Data were collected using a structured questionnaire and were statistically analyzed. Results: Out of a total of 603 patients, 18 (3.0%) had temporomandibular myofascial pain syndrome. They were aged 22-78 years with female preponderance (11; 61.1%) and a female-to-male ratio of 1.6:1. The majority of the patients had mild pain (7/18; 38.9%). The mean VAS score for the patients in this study was 5.8+2.6. The female patients experienced more severe pain (5/11; 45.4%), compared to males. Conclusion: There was a female preponderance in TMJ myofascial pain syndrome, with a mean VAS pain score of 5.8+2.6. Severe pain was mostly reported by female patients while the male patients often present with mild pain.

Efficacy of botulinum toxin in the management of temporomandibular myofascial pain and sleep bruxism

ObjectivesThis study sought to evaluate the efficacy of injecting botulinum toxin into the masseter and temporal muscles in patients with temporomandibular myofascial pain and sleep bruxism.Materials and MethodsThe study was conducted based on a clinical record review of 44 patients (36 females and eight males; mean age, 35.70±12.66 years). Patients who underwent the injection of botulinum toxin into the masseter and temporal muscles for the management of temporomandibular myofascial pain and sleep bruxism were included in the study. Patients were diagnosed based on the Diagnostic Criteria for Temporomandibular Disorders. Sleep bruxism was diagnosed according to the criteria defined by the American Academy of Sleep Medicine. The values of the visual analogue scale (VAS) and range of jaw motion, including unassisted maximum mouth opening (MMO), protrusion, and right and left laterotrusion, were observed preoperatively and postoperatively at one-, three-, and six-month follow-up visits.ResultsMMO, movements of the right and the left laterotrusion, and protrusion increased significantly (P<0.05), while VAS ratings decreased significantly at the three follow-up points relative to baseline values (P<0.05).ConclusionBotulinum toxin is an effective treatment for patients with temporomandibular myofascial pain and sleep bruxism.

A novel cortical biomarker signature for predicting pain sensitivity: protocol for the PREDICT longitudinal analytical validation study.

Temporomandibular disorder is a common musculoskeletal pain condition with development of chronic symptoms in 49% of patients. Although a number of biological factors have shown an association with chronic temporomandibular disorder in cross-sectional and case control studies, there are currently no biomarkers that can predict the development of chronic symptoms. The PREDICT study aims to undertake analytical validation of a novel peak alpha frequency (PAF) and corticomotor excitability (CME) biomarker signature using a human model of the transition to sustained myofascial temporomandibular pain (masseter intramuscular injection of nerve growth factor [NGF]). This article describes, a priori, the methods and analysis plan. This study uses a multisite longitudinal, experimental study to follow individuals for a period of 30 days as they progressively develop and experience complete resolution of NGF-induced muscle pain. One hundred fifty healthy participants will be recruited. Participants will complete twice daily electronic pain diaries from day 0 to day 30 and undergo assessment of pressure pain thresholds, and recording of PAF and CME on days 0, 2, and 5. Intramuscular injection of NGF will be given into the right masseter muscle on days 0 and 2. The primary outcome is pain sensitivity. PREDICT is the first study to undertake analytical validation of a PAF and CME biomarker signature. The study will determine the sensitivity, specificity, and accuracy of the biomarker signature to predict an individual's sensitivity to pain. ClinicalTrials.gov: NCT04241562 (prospective).

Clinical evaluation of botulinum toxin A in the management of temporomandibular myofascial pain.

We did a clinical service evaluation of patient-reported outcomes for pain and change in interincisal distance in patients treated with botulinum toxin A (BTX-A) for temporomandibular myofascial pain at nurse-led clinics. We retrospectively reviewed the clinical records of 100 patients and the prescribing patterns of two OMFS consultants. The mean starting pain score of 7.54 out of 10 was reduced by a mean (SD) of 2.48 (2.1) points after the intervention (p<0.001). The most common prescription was for 100 units (n=59 prescriptions). The change in the mean pain scores did not differ significantly whether 100 or 200 units were prescribed (p=0.19). Interincisal distance increased by a mean (SD) of 0.5 (5.24) mm after treatment with BTX-A, which was not significant (p=0.35). In most cases the treatment helped to manage and reduce the symptoms of temporomandibular myofascial pain. Considerable improvement in interincisal distance as a result of this treatment alone, however, is unlikely, but it may have a role in a multifaceted approach, particularly when other conservative methods have failed. The use of a pro forma may allow for more consistent record keeping and the detailed assessment of patient-reported pain scores in the weeks and months after treatment. Development of an electronic patient-reported outcome (ePRO) tool may facilitate this further.

Comparison of the efficacy of dry needling and trigger point injections with exercise in temporomandibular myofascial pain treatment.

We aimed to compare the efficacy of dry needling, trigger point injection, and protection methods through physical exercise on clinical symptoms and the pain threshold in patients with temporomandibular myofascial pain. Between March 2013 and September 2013, in a random consecutive manner, a total of 63 consecutive patients (10 males, 53 females; median age 39.4±14.9 years; range, 18 to 65 years) were randomly divided into three groups: Group 1 (only exercise and protection training), Group 2 (dry needling + exercise + protection training), and Group 3 (trigger point injection + exercise + protection training). Dry needling or trigger point injection was performed for three times to the patients in Group 2 and Group 3 on a weekly basis. All patients were followed on Day 10 and at one month. A statistically significant improvement in the assessment and response variables was found for all groups, particularly for pain and functional limitation status (p<0.001). All groups were similar in terms of the improvement degree (p<0.001). Although not statistically significant, the highest improvement in the facial pain was seen in Group 3 on Day 10 (p=0.235); however, on Day 30, no significant difference was observed. Our study results showed that improvement in the subjective and objective symptoms in all treatment groups. Particularly, only exercise therapy was found to be beneficial as invasive methods. We suggest that all these methods should be applied together to achieve long-term efficacy.

Botulinum toxin in the management of myofascial pain associated with temporomandibular dysfunction.

Critical evidence on the therapeutic efficacy of botulinum toxins (BTX) is still lacking for most pain conditions. The aim of this review was to evaluate the therapeutic efficacy of BTX in the management of temporomandibular myofascial pain. Electronic databases PubMed, EMBASE, Scopus, Web of Science, and gray literature were searched for randomized clinical trials until February 2018 to answer a focused question "What is the effectiveness of botulinum toxin in the management of temporomandibular myofascial pain?" Two independent reviewers performed the study selection according to eligibility criteria. A total of seven studies that met the eligibility criteria were included. Two studies showed a significant improvement in temporomandibular myofascial pain, and one study showed equal efficacy of BTX in comparison with facial manipulation, while the remaining studies did not report any significant difference between BTX and control group. Due to heterogeneity in the methodology and outcome assessment, a meta-analysis and recalculation of risk could not be performed. Based on our findings, the therapeutic efficacy of BTX was unclear. Randomized controlled trials with better methodological criteria need to be carried out to evaluate the real effectiveness of BTX.

In quest of the longest-lasting and most annoying pain for patients and for dentists. Quantitative and qualitative characteristics of temporomandibular myofascial pain dysfunction syndrome – a questionnaire study

BackgroundDysfunctions in the face, due to the psychological importance of the structures in the face and head, have long been a subject of interest for researchers exploring issues concerning health-related quality of life. The surprising results of previous clinical trials for myofascial pain dysfunction syndrome of the temporomandibular joints encouraged the present authors to plan a study focused on obtaining systematic knowledge of the issue.Participants and procedureThe study included 26 patients of the Masticatory System Disorders Laboratory of the Dental Prosthetic Clinic at the Jagiellonian University Medical College diagnosed with the painful form of muscle-related functional masticatory organ disorders. The study was part of a larger research project. The data to be analysed for this article was obtained in the course of a single questionnaire survey conducted prior to the start of the treatment process.ResultsThe results showed the quantitative characteristics of pain experiences in the clinical group, observed in the context of the circadian dynamics, psychophysical factors, and the location of pain, as well as their quality characteristics. The analyses showed negative covariances of the quality of life perceived by patients and the length of periods without pain, pain intensifying factors, and emotional image of pain. The strongest pain experienced by the patients negatively correlated with the quality of life related to the sphere of physical pain and mental distress, whereas the weakest pain correlated with the quality of life related to the social sphere. The lower quality of life occurred together with the frontal, zygomatic, mental, parotideomasseteric, and occipital region.ConclusionsIt is necessary to further analyse the issue on a larger sample in order to explain and clarify the obtained results.

Efficacy of Low-Level Laser Therapy in the Treatment of Temporomandibular Myofascial Pain: A Systematic Review and Meta-Analysis.

To conduct a systematic review and meta-analysis to determine the efficacy of low-level laser therapy (LLLT) in treating temporomandibular myofascial pain in adults compared to laser placebo. Randomized, placebo-controlled studies were identified by a search on March 2, 2016 and updated on February 9, 2017 in the PubMed, Web of Science, and Cochrane Library databases. Three of the authors assessed the studies for risk of bias. Outcomes included pain reduction on a visual analog scale (VAS) and interincisal opening. The initial search strategy yielded 142 unduplicated references assessed independently by three review authors. After evaluation, this number was reduced to eight relevant studies for inclusion in this review. Of these eight studies, four were at unclear risk of bias and four were at high risk. In a meta-analysis, pain intensity was significantly reduced after treatment in the group that received LLLT as compared to laser placebo (an average of 2.2 units on a scale of 0 to 10) (P = .005) and an average of 2.4 units 3 to 4 weeks later (P = .022). Pooled results showed a significant increase in interincisal opening at 1 month after treatment (P = .012), but not when the treatment was completed (P = .079). The findings from this systematic review showed that LLLT seems to be effective in reducing pain in patients with temporomandibular myofascial pain with moderate-quality evidence. However, due to the high heterogeneity, small number, and high risk of bias of the included studies, the results are not definitive, and further well-designed studies are needed.

Interactive group therapy for the management of myofascial temporomandibular pain.

Background and aim To evaluate the outcome of a group therapy approach in the management of myofascial temporomandibular pain (TMD) through promotion of self-care.Methods A group based interactive session was introduced for those patients who, at initial consultation, were diagnosed with myalgic TMD. Feedback forms and telephone interviews were used to record patient reported outcome measures to assess patient satisfaction with the service.Results Fifty-five patients attended 17 group sessions over ten months. Feedback revealed a high level of satisfaction immediately after the session with 71% (n = 39) of patients opting for discharge, reporting confidence to self-manage in primary care. This effect appears to be sustainable up to 11 months.Conclusions This approach benefits patients with myofascial TMD through promotion of self-management while utilising health care resources efficiently.

Use of buspirone in selective serotonin reuptake inhibitor-induced sleep bruxism

Sleep bruxism is characterized by the involuntary clenching or grinding of the teeth during sleep and can cause severe health problems, including the destruction of tooth structure, temporo-mandibular joint dysfunction, myofascial pain, and severe sleep disturbances. Iatrogenic sleep bruxism may be common during treatment with psychotropic medications, such as anti-psychotics and antidepressants, especially selective serotonin reuptake inhibitors (SSRIs). Bruxism is a common movement disorder that affects 8–21% of the population. The majority of bruxism symptoms are mild or moderate, although rare but severe cases may lead to serious periodontal damage, temporo-mandibular dysfunction, sleep disturbances, jaw pain, and stiffness. As a result, such cases must be treated with medication. It has been hypothesized that the mechanism of SSRI-induced bruxism may involve excessive serotonergic action on the meso-cortical neurons arising from the ventral tegmental area. It has been argued that,the addition of buspirone, was necessitated by the high level of residual anxiety. As a result, these symptoms may have been prevented through the use of buspirone alone. Buspirone, is an agonist of the 5-HT1A receptor that increases dopaminergic neuron, firing in the ventral tegmental area and increases the synaptic release of dopamine in the prefrontal cortex. These effects ameliorate drug-induced bruxism. Buspirone can also ameliorate extrapyramidal side effects, such as akathisia and tardive dyskinesia, and this property may be an additional explanation for the bruxism-related effects of the drug. Furthermore, buspirone may be an effective treatment for the bruxism associated with the use of these medications.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Clinical results after deep dry needling versus intratissue percutaneous electrolysis technique for the treatment of temporomandibular myofascial pain

Clinical results after deep dry needling versus intratissue percutaneous electrolysis technique for the treatment of temporomandibular myofascial pain

The influence of cranio-cervical rehabilitation in patients with myofascial temporomandibular pain disorders.

The aim of the study was to prove the causality between the craniocervical dysfunction and myofascial pain in the head and neck and to demonstrate the clinical value and usefulness of physiotherapy as one of the therapeutic options for myofascial pain. The group of patients diagnosed with myofascial dysfunctional pain syndrome contained 98 patients out of which 79 patients (81 %) were females and 19 patients (19 %) were males. The majority of the patients were aged between 26 and 35 years; the total age range was 14-77 years with the average of 38 years. Observed patients were subdivided into three groups. Standard therapeutic methods aimed at the temporomandibular joint were provided to the patients of the first group. The second group of the patients received therapy aimed at cervical muscles only. Complex rehabilitation was applied in the third group of patients. The most frequent method used in the evaluation of chronic musculoskeletal pain in clinical studies is the visual analogue scale (VAS). According to our results, all three groups of patients saw an improvement in pain perception, but the overall subjective remission of painful sensations in the third group took place in as many as 88 % of patients. In this group, there was a significant decrease in the tenderness of trigger points in the trapezius and sternocleidomastoid muscles. It was proved that a combination of simple relaxing and stretching exercises of cervical muscles with a standard method used in the therapy of masticatory muscles is significantly more efficient (Fig. 5, Ref. 18).

Thermal temporal summation and decay of after-sensations in temporomandibular myofascial pain patients with and without comorbid fibromyalgia

IntroductionChronic myofascial temporomandibular disorders (TMD) may have multiple etiological and maintenance factors. One potential factor, central pain sensitization, was quantified here as the response to the temporal summation (TS) paradigm, and that response was compared between case and control groups.ObjectivesAs previous research has shown that fibromyalgia (FM) is diagnosed iñ20% of TMD patients, Aim 1 determined whether central sensitization is found preferentially in myofascial TMD cases that have orofacial pain as a regional manifestation of FM. Aim 2 determined if the report of after-sensations (AS) following TS varied depending on whether repeated stimuli were rated as increasingly painful.MethodsOne hundred sixty-eight women, 43 controls, 100 myofascial TMD-only cases, and 25 myofascial TMD + FM cases, were compared on thermal warmth and pain thresholds, thermal TS, and decay of thermal AS. All cases met Research Diagnostic Criteria for TMD; comorbid cases also met the 1990 American College of Rheumatology criteria for FM.ResultsPain thresholds and TS were similar in all groups. When TS was achieved (~60%), significantly higher levels of AS were reported in the first poststimulus interval, and AS decayed more slowly over time, in myofascial TMD cases than controls. By contrast, groups showed similar AS decay patterns following steady state or decreasing responses to repetitive stimulation.ConclusionIn this case–control study, all myofascial TMD cases were characterized by a similar delay in the decay of AS. Thus, this indicator of central sensitization failed to suggest different pain maintenance factors in myofascial TMD cases with and without FM.

Immediate effects of manual therapy targeting the cervical or orofacial region in neck symptoms in patients with myofascial temporomandibular pain

Immediate effects of manual therapy targeting the cervical or orofacial region in neck symptoms in patients with myofascial temporomandibular pain

Effectiveness of Percutaneous Intratissue Electrolysis (PIE) technique in the temporomandibular myofascial pain syndrome

Effectiveness of Percutaneous Intratissue Electrolysis (PIE) technique in the temporomandibular myofascial pain syndrome