Effects of Warm Needle Acupuncture on Temporomandibular Joint Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Temporomandibular Disorders Management-What's New? A Scoping Review

Temporomandibular disorders include various conditions that impact the masticatory system, affecting its structure, function, or physiology. Clinicians face a complex array of therapeutic options when treating this group of diseases, emphasizing the importance of evaluating the current evidence to guide decisions in patient care. The main objective of this article is to conduct a scoping review on the available treatment approaches to manage temporomandibular disorders (TMDs). An extensive search of the literature was performed on Scopus, Pubmed, Embase, and Web of Science. Systematic reviews published in the last 5 years were considered. Out of the 2183 publications identified, 109 studies were included in this review. Among them, 39 articles focused on the non-invasive approach, while 120 delved into the minimally invasive approach, and 15 explored the surgical approach. Non-invasive or conservative approaches like cognitive-behavioral therapy, physical therapy, and acupuncture offer effective pain management and functional improvements in TMDs. Emerging treatments offer promising alternatives for treating these disorders. Surgery should be reserved for severe cases, with conservative therapies used in conjunction with invasive procedures for optimal patient outcomes.

Use of Surface Electromyography to Evaluate Effects of Therapeutic Methods on Masticatory Muscle Activity in Patients with Temporomandibular Disorders: A Narrative Review

The presented narrative review aims to present the impact of therapeutic methods on the masticatory muscle activity measured using surface electromyography (sEMG) in patients with temporomandibular disorders (TMDs). Original interventional studies with baseline data for diagnosed TMD groups with full-text articles in English published in scientific journals in the last ten years were included in the evaluation process. The following narrative review considered only clinical, controlled, and randomized studies. Articles that included the following parameters were qualified for this review: adult participants, diagnosis of temporomandibular disorder, the presence of a musculoskeletal dysfunction, no other severe comorbidities, use of therapeutic interventions, and sEMG measurement before and after the intervention. Ten papers were accepted and analyzed for the final evaluation in the presented review. Several studies using surface electromyographic examination prove the effectiveness of various therapies to normalize the bioelectrical activity of the masticatory muscles, either reduction during rest or increase during a functional task in patients diagnosed with temporomandibular disorders. This narrative review shows the influence of manual and physical treatments on electromyographic masticatory muscle activity, including soft tissue mobilization, transcutaneous electrical nerve stimulation, low-level laser therapy, and moist heat therapy. Changes in masticatory muscle activity coincided with changes in TMD-associated pain and range of mandibular mobility.

Development, validation and psychometric evaluation of the Chinese version of the biopsychosocial impact scale in orofacial pain patients

Background

The objective of this study was to develop the Chinese version of the biopsychosocial impact scale (BPIm-S) to assess functional limitation and psychosocial distress in orofacial pain (OFP) patients in mainland China, and investigate the factor structure, reliability and validity, measurement invariance, as well as scores differences across genders, age and educational status among OFP patients.

Methods

The BPIm-S was developed and evaluated in four stages: (1) concept selection and item generation; (2) a pilot study assessing face and content validity; (3) the factors structure, reliability, convergent validity, and measurement invariance; and (4) concurrent validity and clinical responsiveness. Exploratory (EFA) and confirmatory factor analyses (CFA) were performed on data gathered from 406 OFP patients to assess construct validity. Composite Reliability (CR) and the Average Variance Extracted (AVE) were used to assess internal convergent validity. CR, internal consistency, and split-half reliability were also performed to determine the reliability. Multigroup CFA (MGCFA) was used to assess measurement invariance across genders, age and educational status. Mann-Whitney test compared scores across different genders, age and educational status. Participants completed the BPIm-S, visual analog scale (VAS), brief pain inventory facial (BPI-F), General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), and spearman's correlation coefficient was used to evaluate the concurrent validity and item-total correlations. A total of 12 patients with OFP completed the BPIm-S twice to test clinical responsiveness. To conduct the CFA and measurement invariance analysis, Mplus 8.4 was used. IBM SPSS Statistics 21 software and SPSSAU, a web-based data science algorithm platform tool, were used for all additional studies.

Results

For the preliminary version, 17 items were chosen. A total of four items were removed following the pilot research. The remaining 13 items of the BPIm-S comprised an overall summary scale. Excellent reliability (Item-to-total correlations ranged from 0.763 to 0.912) and strong internal consistency (Cronbach's α = 0.970, functional limitation, 0.962, and psychosocial distress, 0.977) were discovered. CFA also validated the structural validity of the 13-item scale. EFA was performed and a two-factor structure was investigated. In addition, MGCFA corroborated the measurement invariance of the BPIm-S across gender, age, and educational status. Patients over the age of 30, those with a medium level of education, and those with a low level of education showed substantially greater levels of functional limitation and psychological distress (Wilcoxon test, p < 0.001). Both concurrent validity and clinical responsiveness were assessed to be of good quality.

Conclusion

The BPIm-S demonstrated good psychometric qualities and is a reliable tool that can now be used by clinicians to evaluate functional limitation and psychosocial distress among OFP patient.

Oral Health-Related Quality of Life among Chinese Chronic Orofacial Pain Patients with Psychological Health Problems: A Moderated Mediation Model

Psychological therapies are important for comprehensive chronic orofacial pain (COFP) treatment. This study is to validate the effects of psychological factors on oral health-related quality of life (OHRQoL) among COFP patients in China. Pain catastrophizing, which is a subjective cognitive emotion used to manage the psychological aspects of pain among COFP patients, was examined in relation to COFP severity and OHRQoL. All 479 participants were recruited in Changsha, Hunan Province, China. Cronbach's alpha coefficients (0.868-0.960), composite reliability scores (0.924-0.969), and average variance extracted from each construct (0.555-0.753) all indicated a good model fit. Pearson's correlation analysis showed that age and education status have a positive correlation with COFP severity, pain catastrophizing, and anxiety. COFP severity was related to anxiety, depression, and COFP-OHRQoL. Pain catastrophizing was related to employment status. Anxiety and depression symptoms indirectly mediated the correlation between COFP severity and COFP-OHRQoL. As a second-stage moderator, pain catastrophizing moderated the mediating effects of anxiety symptoms and depression symptoms. Our findings suggest that anxiety, depression, and pain catastrophizing should be evaluated jointly to improve COFP-OHRQoL among COFP patients. This evidence will help therapists to comprehensively treat patients for the best treatment effect.

Efficacy and safety of warm acupuncture combined with Western medicine for sciatica: A protocol for systematic review and meta-analysis

BACKGROUND

There are more and more clinical studies on the efficacy of warm acupuncture in treating sciatica, but the systematic review of the efficacy of warm acupuncture is still lacking. The objective of this study was to evaluate the efficacy and safety of warm acupuncture combined with conventional Western medicine in the treatment of sciatica.

METHODS

The review was registered in the PROSPERO database (CRD42022379486) and was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The following databases will be used to search the existing literature (from inception to January 2023): Web of Science, Embase, Cochrane Library, PubMed, Cumulative Index to Nursing and Allied Health Literature, Wanfang, Allied and Complementary Medicine Database, China Knowledge Network, and SPORT-Discus. Included studies are considered eligible if they met the population, intervention, comparator, outcomes, and study design criteria as follows: Population: patients with newly diagnosed sciatica; Intervention: warm acupuncture combined with conventional Western medicine; Comparator: Western medicine alone; Outcomes: total response rate, pain score and pain threshold, adverse events and recurrence rate. Study design: randomized controlled trials or non-randomized cohort studies. Review Manager (RevMan) V.5.3 will be used to perform statistical analyses and to generate forest plots.

RESULTS

The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.

Changes in Maximum Mandibular Mobility Due to Splint Therapy in Patients with Temporomandibular Disorders

Splint therapy is widely used in the treatment of myofascial pain, but valid studies on the efficacy of this therapy are rare. The purpose of the present study was to investigate which qualifiable and quantifiable effects of splint therapy are detectable. For this purpose, 29 patients (21 women, mean age 44.6 ± 16 years) diagnosed with myofascial pain (RDC/TMD) were investigated in this prospective clinical trial (10/6/14An). Patients were treated with Michigan splints applied overnight for three months. Before (T1) and after three months of treatment (T2), patients were registered with an electronic ultrasound device with qualitative and quantitative evaluation of the registrations and a qualitative assessment of pain symptoms using a verbal analog scale. Significant differences were found between maximum mouth opening (MMP) (p < 0.001) and right condylar movement (CM) at MMP (p = 0.045). Qualitative assessment revealed that 24 of 29 patients experienced an improvement in pain symptoms, 17 of whom experienced complete remission. The results of the qualitative and quantitative analysis provide indications of the effectiveness of the splint therapy. In addition to quantitative measurements, the ultrasound facebow technique was also able to provide qualitative information.

Effectiveness and safety of warm needling therapy combined with electroacupuncture for patients with plantar heel pain syndrome: A protocol for systematic review and meta-analysis

BACKGROUND

Several studies have reported positive therapeutic effects of electroacupuncture, warm needling, or a combination of the 2 for heel pain; however, the quality of the evidence is limited by methodological limitations. Given that there are no high-quality meta-analyses or reviews incorporating the available evidence, the aim of this study was to systematically review the level I evidence in the literature to determine whether a combination of electroacupuncture and warm needling therapy is more beneficial than acupuncture alone in patients with plantar heel pain syndrome.

METHODS

From the inception to May 2022, the Wanfang, CNKI, EMBASE, PubMed, Web of Science, and Cochrane Library electronic databases will be searched using the key phrases "acupuncture", "warm needling", "electroacupuncture", "heel pain", "plantar pain", and "prospective" for all relevant studies. The outcomes include pain, physical disability, plantar fascia thickness, and foot functional status. Quality assessment of all studies included in this review will be independently assessed by 2 reviewers using the Cochrane Collaborations tool. We consider significant heterogeneity between trials if I2 > 50%, and severe heterogeneity if I2 > 75%. When significant heterogeneity is indicated, we will find the source of heterogeneity by subgroup or sensitivity analysis.

RESULTS

The results of our review will be reported strictly following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and the recommendations of the Cochrane Collaboration.

CONCLUSIONS

We initially hypothesized that combination therapy would lead to better treatment outcomes.Registration number: 10.17605/OSF.IO/VWBYJ.