1
|
Torres D, Zaror C, Iturriaga V, Tobias A, Brignardello-Petersen R. Corticosteroids for the Treatment of Internal Temporomandibular Joint Disorders: A Systematic Review and Network Meta-Analysis. J Clin Med 2024; 13:4557. [PMID: 39124823 PMCID: PMC11313177 DOI: 10.3390/jcm13154557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
Background: We evaluated the comparative effectiveness of all intra-articular injection corticosteroids for treating internal temporomandibular joint (TMJ) disorders. Methods: We searched MEDLINE, CENTRAL, EMBASE, SCOPUS, and LILACS through December 2023. We included randomized clinical trials (RCTs) enrolling patients with symptomatic internal disorders of the TMJ comparing any type of intra-articular corticosteroid therapy against another or to another minimally invasive therapy. The outcomes of interest were pain, range of mandibular motion (RoM), quality of life (QoL) and adverse effects at 1, 3, 6, and 12 months. We assessed the risk of bias using the Cochrane Collaboration's tool. We conducted a frequentist network meta-analysis and assessed the certainty of the evidence (CoE) using GRADE. Results: We included 20 RCTs enrolling 810 participants, which assessed five corticosteroids alone or combined with arthrocentesis or hyaluronic acid. Based on moderate CoE, betamethasone is among the most effective corticosteroids for reducing pain at one (mean difference compared to arthrocentesis [MD], -3.80; 95% confidence interval [CI], -4.55 to -3.05) and three months (MD, -2.74; 95%CI, -3.42 to -2.06), and arthrocentesis plus dexamethasone at six months (MD, -0.80; 95%CI, -1.57 to -0.03). There was no convincing evidence that any intervention was better than arthrocentesis for improving the RoM and QoL at any follow-up time. Methylprednisolone may be more harmful than arthrocentesis for adverse effects. Discussion: Betamethasone and arthrocentesis plus dexamethasone are the most effective in managing pain in the short and medium term compared to arthrocentesis (moderate CoE). Decisions about their use should consider other factors, such as costs, feasibility, and acceptability. Future research should consider QoL as an outcome and assess participants at longer follow-up periods.
Collapse
Affiliation(s)
- Daniela Torres
- Magíster en Odontología, Facultad de Odontología, Universidad de La Frontera, Temuco 4781176, Chile;
- Temporomandibular Disorder and Orofacial Pain Program, Sleep & Pain Research Group, Faculty of Dentistry, Universidad de La Frontera, Temuco 4781176, Chile;
| | - Carlos Zaror
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco 4781176, Chile
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Verónica Iturriaga
- Temporomandibular Disorder and Orofacial Pain Program, Sleep & Pain Research Group, Faculty of Dentistry, Universidad de La Frontera, Temuco 4781176, Chile;
- Department of Integral Adult Care Dentistry, Faculty of Dentistry, Universidad de La Frontera, Temuco 4781176, Chile
| | - Aurelio Tobias
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK;
| | | |
Collapse
|
2
|
Bouloux GF, Chou J, DiFabio V, Ness G, Perez D, Mercuri L, Chung W, Klasser GD, Bender SD, Kraus S, Crago CA. Guidelines for the Management of Patients With Orofacial Pain and Temporomandibular Disorders. J Oral Maxillofac Surg 2024:S0278-2391(24)00200-3. [PMID: 38643965 DOI: 10.1016/j.joms.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Gary F Bouloux
- Family Professor, Division Chief, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Joli Chou
- Associate Professor, Department Of Oral and Maxillofacial Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Vince DiFabio
- Associate Clinical Professor, Oral and Maxillofacial Surgery, University of Maryland School of Dentistry, University of Maryland Medical Center, Baltimore, MD
| | - Greg Ness
- Emeritus Professor-Clinical, The Ohio State University, Private Practice, Oral and Facial Surgery for Adults and Children, Columbus, OH
| | - Daniel Perez
- Associate Professor and Program Director, Oral and Maxillofacial Surgery, University Texas Health Sciences San Antonio, San Antonio, TX
| | - Louis Mercuri
- Visiting Professor, Department of Orthopedic Surgery, Rush University Medical Center, Adjunct Professor, Department of Bioengineering, University of Illinois Chicago, Chicago, IL
| | - William Chung
- Clinical Professor, Residency Program Director, Indiana University School of Dentistry and Hospital Medicine, Indianapolis, IN
| | - Gary D Klasser
- Certificate Orofacial Pain, Professor, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans, LA
| | - Steven D Bender
- Clinical Associate Professor, Director, Clinical Center for Facial Pain and Sleep Medicine, Department of Oral and Maxillofacial Surgery, Texas A&M School of Dentistry, Dallas, TX
| | | | | |
Collapse
|
3
|
Zanelatto FB, Vieira WF, Nishijima CM, Zanotto TM, Magalhães SFD, Sartori CR, Parada CA, Tambeli CH. Effect of propranolol on temporomandibular joint pain in repeatedly stressed rats. Eur J Oral Sci 2024; 132:e12957. [PMID: 37908149 DOI: 10.1111/eos.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023]
Abstract
Stress substantially increases the risk of developing painful temporomandibular disorders (TMDs) by influencing the release of endogenous catecholamines. Propranolol, an antagonist of β-adrenergic receptors, has shown potential in alleviating TMD-associated pain, particularly when the level of catecholamines is elevated. The aim of this study was to explore whether intra-articular propranolol administration is effective in diminishing temporomandibular joint (TMJ) pain during repeated stress situations. Additionally, we investigated the effect of repeated stress on the expression of genes encoding β-adrenoceptors in the trigeminal ganglion. In the present study, rats were exposed to a stress protocol induced by sound, then to the administration of formalin in the TMJ (to elicit a nociceptive response), followed immediately afterward by different doses of propranolol, after which the analgesic response to propranolol was evaluated. We also assessed the levels of beta-1 and beta-2 adrenergic receptor mRNAs (Adrb1 and Adrb2, respectively) using reverse transcription-quantitative PCR (RT-qPCR). Our findings revealed that propranolol administration reduces formalin-induced TMJ nociception more effectively in stressed rats than in non-stressed rats. Furthermore, repeated stress decreases the expression of the Adrb2 gene within the trigeminal ganglion. The findings of this study are noteworthy as they suggest that individuals with a chronic stress history might find potential benefits from β-blockers in TMD treatment.
Collapse
Affiliation(s)
- Fernanda Barchesi Zanelatto
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | | | - Catarine Massucato Nishijima
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Tamires Marques Zanotto
- Department of Internal Medicine, School of Medical Science, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Silviane Fernandes de Magalhães
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - César Renato Sartori
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Carlos Amilcar Parada
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Claudia Herrera Tambeli
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| |
Collapse
|
4
|
Minervini G, Franco R, Crimi S, Di Blasio M, D'Amico C, Ronsivalle V, Cervino G, Bianchi A, Cicciù M. Pharmacological therapy in the management of temporomandibular disorders and orofacial pain: a systematic review and meta-analysis. BMC Oral Health 2024; 24:78. [PMID: 38218874 PMCID: PMC10787959 DOI: 10.1186/s12903-023-03524-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/10/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Temporomandibular disorders (TMD) are manifested by soreness in the jaw joint area and jaw muscles, clicks or creaks when opening or closing the mouth. All these symptoms can be disabling and occur during chewing and when the patient yawns or speaks. Several classes of drugs are used to treat symptoms. This review aims to assess which drug suits the different signs. METHODS Pubmed, Web of Science and Lilacs were systematically searched until 01/02/2023. Clinical trials were selected that dealt with drugs used in temporomandibular dysfunction RESULTS: Out of 830 papers, eight studies were included. The Meta-Analysis with Continuous Outcomes with Pre-Calculated Effect Sizes resulted in the rejection that there is intergroup variability (p.0.74). CONCLUSIONS Treatment of orofacial pain is still a significant challenge for dentistry. We can conclude that there is no drug of first choice in the treatment of temporomandibular pain. However, the clinician must distinguish the type of pain and the aetioloic cause of the pain so that the patient can be treated and managed pharmacologically.
Collapse
Affiliation(s)
- Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India.
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio 6, 80138, Naples, Italy.
| | - Rocco Franco
- Department of Biomedicine and Prevention, University of University of Rome "Tor Vergata", 00100, Rome, Italy
| | - Salvatore Crimi
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123, Catania, CT, Italy
| | - Marco Di Blasio
- Department of Medicine and Surgery, University Center of Dentistry, University of Parma, 43126, Parma, Italy.
| | - Cesare D'Amico
- School of Dentistry Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Vincenzo Ronsivalle
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123, Catania, CT, Italy
| | - Gabriele Cervino
- School of Dentistry Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Alberto Bianchi
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123, Catania, CT, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123, Catania, CT, Italy
| |
Collapse
|
5
|
Temporomandibular Joint Surgery. J Oral Maxillofac Surg 2023; 81:E195-E220. [PMID: 37833023 DOI: 10.1016/j.joms.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
|
6
|
Burris BJ, Bavarian R, Shaefer JR. Nonsurgical Management of Temporomandibular Joint Arthropathy. Dent Clin North Am 2023; 67:27-47. [PMID: 36404079 DOI: 10.1016/j.cden.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Arthropathy is a broad diagnostic term for any pathologic condition afflicting one or more joints of the body. Temporomandibular joint (TMJ) arthropathy is an umbrella term that may be applied to mechanical dysfunction or disease of one or both TMJs. This article provides evidence-based recommendations for conducting a patient evaluation, initiating a diagnostic workup, formulating an assessment, and instituting various nonsurgical modalities for the treatment of TMJ arthropathies.
Collapse
Affiliation(s)
- Briana J Burris
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA; Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115, USA; Department of Oral and Maxillofacial Surgery, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Roxanne Bavarian
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA; Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115, USA.
| | - Jeffry R Shaefer
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA; Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115, USA
| |
Collapse
|
7
|
Myogenous Temporomandibular Disorders: Diagnostic Concepts and Prospective Pilot Study on Extracorporeal Shockwave Therapy. Diagnostics (Basel) 2022; 13:diagnostics13010051. [PMID: 36611343 PMCID: PMC9818132 DOI: 10.3390/diagnostics13010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
The aims of this article are to discuss the current, and potential future directions, in the diagnosis of myogenous temporomandibular disorders (M-TMD), as well as to report a pilot study to investigate the feasibility and clinical outcomes of extracorporeal shockwave therapy (ESWT) in the treatment of M-TMD. Forty-one adult patients presented with M-TMD were recruited into the study and randomized into two groups: Group 1 received ESWT treatment, whereas Group 2 received placebo treatment. The variables investigated were pain, measured by a numerical rating scale (NRS) and mouth opening. Twenty-six patients (Group 1: n = 14, mean age = 45.3 (16.7) years; Group 2: n = 12, mean age = 46.8 (19.7) years) completed 1-year follow up and were included into the final analysis. In both groups, reduction in pain and increase in MO (unassisted maximum, assisted maximum, and pain-free) were seen at post-treatment 1 year. There were more reduction in pain and increase in all MO in Group 1 than Group 2, but statistical significance was not detected. No major complications were encountered in this study. Although significant differences were not seen between groups, this prospective pilot study provided preliminary evidence that ESWT is safe and potentially beneficial in the treatment of M-TMD.
Collapse
|
8
|
Diagnosis and Treatment of Myogenous Temporomandibular Disorders: A Clinical Update. Diagnostics (Basel) 2022; 12:diagnostics12122914. [PMID: 36552921 PMCID: PMC9776546 DOI: 10.3390/diagnostics12122914] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022] Open
Abstract
Myogenous temporomandibular disorders (M-TMDs) are the most common chronic orofacial pain, affecting the masticatory muscles and, thus, jaw movement. While a concise diagnosis is crucial to formulate a rational treatment plan, the similarities in clinical presentations that M-TMDs share with other neuromuscular disorders affecting the temporomandibular joint (TMJ) could easily confuse physicians. In addition to the basics, such as thorough history taking and meticulous clinical examinations, different imaging techniques are useful adjuncts to facilitate the diagnostic process. This review presents an overview of the current understanding on a variety of diagnostic and treatment modalities for M-TMD patients. It is essential to highlight that there is not a single treatment for all, and the benefits of multidisciplinary strategies have been noted for the effective management of myogenous TMD pain. Treatment modalities ranging from conservative to minimally invasive options are discussed in this review.
Collapse
|
9
|
Javed F, Ahmed HB, Zafar MS, Shaikh MS, Rossouw PE, Michelogiannakis D, Alstergren P. "Testosterone decreases temporomandibular joint nociception"- A systematic review of studies on animal models. Arch Oral Biol 2022; 139:105430. [PMID: 35461068 DOI: 10.1016/j.archoralbio.2022.105430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/17/2022] [Accepted: 04/10/2022] [Indexed: 12/09/2022]
Abstract
OBJECTIVE The aim of the present systematic review was to assess the effect of testosterone on temporomandibular joint (TMJ) nociception. DESIGN A systematic review of pertinent indexed literature was performed. The focused question addressed was "Is there a connection between testosterone and TMJ nociception?" Original studies were included. In-vitro and ex-vivo studies, case-reports/series, letters to the Editor and commentaries were not sought. Indexed databases were searched without time and language restrictions up to and including September 2021 using different free text key words: testosterone OR "male sex hormones" OR "gonadal hormones" AND "temporomandibular joint" OR "temporomandibular dysfunction" AND nociception AND males. The literature search was performed in accordance with the preferred reporting outcomes of systematic reviews and meta-analysis guidelines. The risk of bias (RoB) was assessed using the SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) tool. RESULTS Out of the 406 studies identified, seven studies on animal-models were included. All studies were performed in rats with age and weight ranging between 21 and 90 days and 200-300 g, respectively. Testosterone was administered in concentrations ranging between 1 and 10 mg/Kg. Results from all studies showed that testosterone administration in gonadectomized male rats reduces induced TMJ nociception. The RoB was high in 3 and unclear in 4 studies. CONCLUSION Testosterone offers protection against TMJ nociception in male rats; however, from a clinical perspective, potential contribution of testosterone therapy towards the management of TMD remains indeterminate.
Collapse
Affiliation(s)
- Fawad Javed
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, NY 14620, United States.
| | | | - Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah Al Munawwarah 41311, Saudi Arabia; Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan
| | - Muhammad Saad Shaikh
- Department of Oral Biology, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi 75510, Pakistan
| | - P Emile Rossouw
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, NY 14620, United States
| | - Dimitrios Michelogiannakis
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, NY 14620, United States
| | - Per Alstergren
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö, Sweden; Scandinavian Center for Orofacial Neurosciences (SCON), Malmö, Sweden; Specialized Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
10
|
Dadjoo S, Michelogiannakis D, Rossouw PE, Javed F. Potential adjunct therapies for the management of temporomandibular disorders: An evidence-based review. Cranio 2022:1-11. [PMID: 35156534 DOI: 10.1080/08869634.2022.2036437] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim was to review the role of adjuvant therapies that may potentially contribute toward the management of temporomandibular disorders (TMD). METHODS The addressed focused question was, "Are there any adjuvant therapies that may contribute toward the management of TMD?". Indexed databases were searched up to June 2021. The eligibility criteria were the following: (a) original clinical studies and (b) randomized controlled clinical trials (RCTs). RESULTS Adjuvant therapies were comprised of acupuncture, manual therapy, jaw exercises, dietary modifications, botulinum toxin therapy, and photobiomodulation. Short-term follow-up results from each of these RCTs showed beneficial effects in terms of pain reduction and improvements in jaw movement among patients with TMD. There are no long-term follow-up results in this regard. CONCLUSION The most effective adjunct treatment for managing TMD remains unknown, primarily due to a lack of sufficient scientific evidence.
Collapse
Affiliation(s)
- Shaahin Dadjoo
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Dimitrios Michelogiannakis
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - P Emile Rossouw
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Fawad Javed
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| |
Collapse
|
11
|
Andre A, Kang J, Dym H. Pharmacologic Treatment for Temporomandibular and Temporomandibular Joint Disorders. Oral Maxillofac Surg Clin North Am 2021; 34:49-59. [PMID: 34598856 DOI: 10.1016/j.coms.2021.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Temporomandibular joint disorder is defined by pain and/or loss of function of the temporomandibular joint and its associated muscles and structures. Treatments include noninvasive pharmacologic therapies, minimally invasive muscular and articular injections, and surgery. Conservative therapies include nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants. Minimally invasive injections include botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose. With many pharmacologic treatment options and modalities available to the oral and maxillofacial surgeon, mild to moderate temporomandibular joint disorder can be managed safely and effectively to improve symptoms of pain and function of the temporomandibular joint.
Collapse
Affiliation(s)
- Amanda Andre
- The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA.
| | - Joseph Kang
- The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA
| | - Harry Dym
- The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA
| |
Collapse
|
12
|
Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet 2021; 397:2082-2097. [PMID: 34062143 DOI: 10.1016/s0140-6736(21)00393-7] [Citation(s) in RCA: 817] [Impact Index Per Article: 272.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/08/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022]
Abstract
Chronic pain exerts an enormous personal and economic burden, affecting more than 30% of people worldwide according to some studies. Unlike acute pain, which carries survival value, chronic pain might be best considered to be a disease, with treatment (eg, to be active despite the pain) and psychological (eg, pain acceptance and optimism as goals) implications. Pain can be categorised as nociceptive (from tissue injury), neuropathic (from nerve injury), or nociplastic (from a sensitised nervous system), all of which affect work-up and treatment decisions at every level; however, in practice there is considerable overlap in the different types of pain mechanisms within and between patients, so many experts consider pain classification as a continuum. The biopsychosocial model of pain presents physical symptoms as the denouement of a dynamic interaction between biological, psychological, and social factors. Although it is widely known that pain can cause psychological distress and sleep problems, many medical practitioners do not realise that these associations are bidirectional. While predisposing factors and consequences of chronic pain are well known, the flipside is that factors promoting resilience, such as emotional support systems and good health, can promote healing and reduce pain chronification. Quality of life indicators and neuroplastic changes might also be reversible with adequate pain management. Clinical trials and guidelines typically recommend a personalised multimodal, interdisciplinary treatment approach, which might include pharmacotherapy, psychotherapy, integrative treatments, and invasive procedures.
Collapse
Affiliation(s)
- Steven P Cohen
- Johns Hopkins School of Medicine, Baltimore, MD, USA; Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Lene Vase
- Neuroscientific Division, Department of Psychology and Behavioural Sciences, Aarhus University Hospital, Aarhus, Denmark
| | | |
Collapse
|
13
|
Efficacy and safety of propranolol for treatment of temporomandibular disorder pain: a randomized, placebo-controlled clinical trial. Pain 2021; 161:1755-1767. [PMID: 32701836 DOI: 10.1097/j.pain.0000000000001882] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Propranolol is a nonselective beta-adrenergic receptor antagonist. A multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 2b trial enrolled participants aged 18 to 65 years with temporomandibular disorder myalgia to evaluate efficacy and safety of propranolol compared with placebo in reducing facial pain. Participants were randomized 1:1 to either extended-release propranolol hydrochloride (60 mg, BID) or placebo. The primary endpoint was change in facial pain index (FPI = facial pain intensity multiplied by facial pain duration, divided by 100). Efficacy was analyzed as a mean change in FPI from randomization to week 9 and as the proportion of participants with ≥30% or ≥50% reductions in FPI at week 9. Regression models tested for treatment-group differences adjusting for study site, sex, race, and FPI at randomization. Of 299 participants screened, 200 were randomized; 199 had at least one postrandomization FPI measurement and were included in intention-to-treat analysis. At week 9, model-adjusted reductions in mean FPI did not differ significantly between treatment groups (-1.8, 95% CL: -6.2, 2.6; P = 0.41). However, the proportion with a ≥30% reduction in FPI was significantly greater for propranolol (69.0%) than placebo (52.6%), and the associated number-needed-to-treat was 6.1 (P = 0.03). Propranolol was likewise efficacious for a ≥50% reduction in FPI (number-needed-to-treat = 6.1, P = 0.03). Adverse event rates were similar between treatment groups, except for more frequent fatigue, dizziness, and sleep disorder in the propranolol group. Propranolol was not different from placebo in reducing mean FPI but was efficacious in achieving ≥30% and ≥50% FPI reductions after 9 weeks of treatment among temporomandibular disorder participants.
Collapse
|
14
|
Wu M, Cai J, Yu Y, Hu S, Wang Y, Wu M. Therapeutic Agents for the Treatment of Temporomandibular Joint Disorders: Progress and Perspective. Front Pharmacol 2021; 11:596099. [PMID: 33584275 PMCID: PMC7878564 DOI: 10.3389/fphar.2020.596099] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/19/2020] [Indexed: 02/05/2023] Open
Abstract
Temporomandibular joint disorders (TMD) are a common health condition caused by the structural or functional disorders of masticatory muscles and the temporomandibular joint (TMJ). Abnormal mandibular movement in TMD patients may cause pain, chronic inflammation, and other discomfort, which could be relieved by a variety of drugs through various delivery systems. In this study, we summarized commonly used therapeutic agents in the management of TMD as well as novel bioactive molecules in preclinical stage and clinical trials. The emerging therapy strategies such as novel intra-TMJ delivery systems and implants based on tissue engineering are also discussed. This comprehensive review will strengthen our understanding of pharmacological approaches for TMD therapy.
Collapse
Affiliation(s)
- Mengjie Wu
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
| | - Jingyi Cai
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomato-logy, Sichuan University, Chengdu, China
| | - Yeke Yu
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sihui Hu
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
| | - Yingnan Wang
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
| | - Mengrui Wu
- College of Life Sciences, Zhejiang University, Zhejiang, China
| |
Collapse
|
15
|
Chaurand J, Godínez-Victoria M, Tellez-Girón A, Facio-Umaña JA, Jimenez-Ponce F. Incobotulinum toxin type A for treatment of chronic myofascial pain. J Oral Sci 2020; 63:37-40. [PMID: 33298638 DOI: 10.2334/josnusd.20-0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE This study assessed the effectiveness of incobotulinum toxin type A (IBTx) for chronic myofascial pain affecting the masseter and temporal muscles. METHODS Twenty two patients who received a diagnosis of chronic masseter and temporalis myofascial pain were evaluated by using a visual analog pain scale (VAS), digital pressure algometry, and the SF-36 Health Survey at baseline (T0), before IBTx injection. Patients were again evaluated at 2 months (T1) and 7 months (T2) after IBTx injection. RESULTS VAS scores for pain significantly differed (P = 0.029, Friedman test). Post-hoc tests showed a significant reduction in pain at 2 months (T0-T1) and 7 months (T0-T2) (P = 0.011 and P = 0.028, respectively; Wilcoxon test) but not between 2 and 7 months (P = 0.676; Wilcoxon test). There was no significant difference in pressure algometry values (P = 0.385, Friedman test). Quality of life (QOL) assessment showed a significant difference (P = 0.002, Friedman test). Post-hoc tests showed a significant improvement in QOLat 2 months, but no significant difference at 7 months (P = 0.004 and P = 0.260, Wilcoxon test). CONCLUSION IBTx injection resulted in safe, effective short-term pain relief for patients with chronic facial pain affecting the masseter and temporalis muscles.
Collapse
Affiliation(s)
- Jorge Chaurand
- Maxillofacial Surgery Department, National Medical Center "20 de Noviembre" Institute for Social Security and Services for State Workers
| | | | - Aldo Tellez-Girón
- Maxillofacial Surgery Department, National Medical Center "20 de Noviembre" Institute for Social Security and Services for State Workers
| | | | - Fiacro Jimenez-Ponce
- Regulatory and Attention to Hospitals Department, Institute for Social Security and Services for State Workers
| |
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW Myofascial pain syndrome (MPS) is a musculoskeletal pain condition that stems from localized, taut regions of skeletal muscle and fascia, termed trigger points. The purpose of this comprehensive review is to provide updated information on prevalence, pathophysiology, and treatment modalities with a focus on interventional modalities in managing MPS. RECENT FINDINGS Though MPS can present acutely, it frequently presents as a chronic condition, affecting up to 85% of adults during their lifetime. MPS is an often-overlooked component of pain with overarching effects on society, including patient quality of life, physical and social functioning, emotional well-being, energy, and costs on health care. The prevalence of MPS is generally increased among patients with other chronic pain disorders and has been associated with various other conditions such as bladder pain syndrome, endometriosis, and anxiety. MPS is poorly understood and remains a challenging condition to treat. Non-pharmacologic treatment modalities such as acupuncture, massage, transcutaneous electrical stimulation, and interferential current therapy may offer relief to some patients with MPS. Additional studies are warranted to get a better understanding of managing myofascial pain.
Collapse
|
17
|
Shimada A, Ishigaki S, Matsuka Y, Komiyama O, Torisu T, Oono Y, Sato H, Naganawa T, Mine A, Yamazaki Y, Okura K, Sakuma Y, Sasaki K. Effects of exercise therapy on painful temporomandibular disorders. J Oral Rehabil 2019; 46:475-481. [DOI: 10.1111/joor.12770] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 12/30/2018] [Accepted: 01/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Akiko Shimada
- Department of Oral Rehabilitation Osaka Dental University Hospital Osaka Japan
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Faculty of Health Aarhus University Aarhus Denmark
- Scandinavian Center for Orofacial Neurosciences Aarhus Denmark
| | - Shoichi Ishigaki
- Department of Fixed Prosthodontics Osaka University Graduate School of Dentistry Suita Japan
| | - Yoshizo Matsuka
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences Tokushima University Tokushima Japan
| | - Osamu Komiyama
- Department of Oral Function and Rehabilitation Nihon University School of Dentistry at Matsudo Chiba Japan
| | - Tetsurou Torisu
- Department of Prosthetic Dentistry, Graduate School of Biomedical Sciences Nagasaki University Nagasaki Japan
| | - Yuka Oono
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences Meikai University School of Dentistry Saitama Japan
| | - Hitoshi Sato
- Department of Oral and Maxillofacial Surgery, School of Dentistry Showa University Tokyo Japan
| | - Takuya Naganawa
- Department of Oral and Maxillofacial Surgery, School of Medicine Tokyo Women's Medical University Tokyo Japan
| | - Atsushi Mine
- Department of Fixed Prosthodontics Osaka University Graduate School of Dentistry Suita Japan
| | - Yoko Yamazaki
- Orofacial Pain Clinic, Tokyo Medical and Dental University Hospital of Dentistry Tokyo Japan
| | - Kazuo Okura
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences Tokushima University Tokushima Japan
| | - Yasushi Sakuma
- Department of Anesthesiology Osaka Dental University Graduate School Osaka Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry Tohoku University Graduate School of Dentistry Sendai Japan
| |
Collapse
|
18
|
Kütük SG, Özkan Y, Kütük M, Özdaş T. Comparison of the Efficacies of Dry Needling and Botox Methods in the Treatment of Myofascial Pain Syndrome Affecting the Temporomandibular Joint. J Craniofac Surg 2019; 30:1556-1559. [DOI: 10.1097/scs.0000000000005473] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|