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Mansourian A, Pourshahidi S, Sadrzadeh-Afshar MS, Ebrahimi H. A Comparative Study of Low-Level Laser Therapy and Transcutaneous Electrical Nerve Stimulation as an Adjunct to Pharmaceutical Therapy for Myofascial Pain Dysfunction Syndrome: A Randomized Clinical Trial. Front Dent 2020; 16:256-264. [PMID: 32342054 PMCID: PMC7181349 DOI: 10.18502/fid.v16i4.2084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/29/2018] [Indexed: 11/24/2022] Open
Abstract
Objectives: Myofascial pain dysfunction syndrome (MPDS) is the most common form of temporomandibular disorders. Because of the multifactorial nature of the problem, its management usually involves several treatment modalities to maximize their synergistic effects. This randomized clinical trial aimed to assess the efficacy of low-level laser therapy (LLLT) and transcutaneous electrical nerve stimulation (TENS) as an adjunct to pharmaceutical therapy for treatment of MPDS. Materials and Methods: This clinical trial evaluated 108 MPDS patients. First, the initial pain intensity of patients was determined using a visual analogue scale (VAS). The first phase of the study included education, awareness, self-care, behavior and relaxation therapy. After 1 month, the pain score was measured again using VAS. Patients who acquired a pain score >1 were divided into three groups of LLLT with diode (GAAlAr) laser with 0.2 W power, TENS, and control, using block randomization. All groups received 10 mg fluoxetine once daily, 0.25 mg clonazepam once daily and 10 mg baclofen three times a day. ANOVA was used to compare the recovery rate of the three groups. Results: Pain in the trapezius muscle and pain on mouth opening resolved faster in the laser + medication group. The recovery rate was faster in the mean muscle pain, general pain reported by patients, pain in the masseter and pterygoid muscles and pain and limitation in lateral movements in both laser + medication and TENS groups. Conclusion: Combination of LLLT and TENS with medication accelerated pain relief and resolved movement restrictions in MPDS patients. (IRCT registration number: IRCT201411113144N4)
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Affiliation(s)
- Arash Mansourian
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.,Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Pourshahidi
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hooman Ebrahimi
- Oral and Maxillofacial Medicine Department, Faculty of Dentistry, Islamic Azad University of Medical Sciences, Tehran, Iran
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Ghodrati M, Mosallanezhad Z, Shati M, Noroozi M, Moghadam AN, Rostami M, Nourbakhsh MR. Adding Temporomandibular joint treatments to routine physiotherapy for patients with non-specific chronic neck pain: A randomized clinical study. J Bodyw Mov Ther 2019; 24:202-212. [PMID: 32507146 DOI: 10.1016/j.jbmt.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 11/12/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Neck Pain can be related to the disorders of other adjacent areas such as the Temporomandibular Joint (TMJ). This study aimed to investigate whether there is value in adding TMJ treatments to routine physiotherapy in patients with non-specific chronic neck pain compared with a control group. METHODS A randomized, single-blind, clinical study desined including two groups of patients. Group A (20 people) received routine physiotherapy for neck pain and group B (20 people) received TMJ manual therapy plus exercise therapy in addition to routine physiotherapy for neck pain. The Treatment program included six sessions for two days a week over a period of 21 days. Assessments were performed during the first session, in the last session and one month after treatment as a follow-up. Outcome measures included neck range of motion (ROM), neck disability index (NDI) and visual analogue scale (VAS). Before starting the study, the reliability of methods for measuring neck ROM was evaluated. RESULTS Participants were 21 women and 19 men. Initially, a pilot study was carried out on the 40 volunteers to assess the reliability of the measurement methods, and the results were acceptable. With both the control group and the intervention group, the indexes showed significant improvement (p < 0.001), although the intervention group showed more improvement (p < 0.001). CONCLUSION This result means adding treatments of TMJ to routine neck physiotherapy can magnify the effect of the intervention, a significant change still in evidence at follow up. Moreover, given the clinically important differences, our results for VAS and NDI were acceptable.
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Affiliation(s)
- Maryam Ghodrati
- Health and Rehabilitation Sciences Program, University of Western Ontario, London, Canada
| | - Zahra Mosallanezhad
- Department of Physical Therapy and Research Center of Aging, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran.
| | - Mohsen Shati
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mehdi Noroozi
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Afsun Nodehi Moghadam
- Department of Physical Therapy and Research Center of Aging, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Mohamad Rostami
- Department of Physical Therapy and Research Center of Aging, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
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Marklund S, Mienna CS, Wahlström J, Englund E, Wiesinger B. Work ability and productivity among dentists: associations with musculoskeletal pain, stress, and sleep. Int Arch Occup Environ Health 2019; 93:271-278. [PMID: 31654126 PMCID: PMC7007882 DOI: 10.1007/s00420-019-01478-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/02/2019] [Indexed: 12/02/2022]
Abstract
Purpose Work ability can be measured by the work ability index (WAI), and work-related questions measuring productivity loss in terms of quality and quantity of work. Dentists have high occupational risk of musculoskeletal pain and the exposure of ergonomic strain is already high during dental education. The aim was to evaluate work ability and productivity among dentists, and to identify gender differences and associations with sleep, stress, and reported frequent pain. Methods The study population comprised 187 dentists (123 women and 64 men) who had been working as dentists between 5 and 12 years. Participants completed a questionnaire regarding sleep, stress, presence of pain at different sites, work ability assessed by WAI, and productivity in terms of quality and quantity of work. Results Poor sleep quality and high level of stress were reported by 31% and 48.1% of participants, respectively, with no gender differences and no association with age. The prevalence of frequent pain ranged 6.4–46.5% with shoulders being the most prevalent site. Thirty-three percent reported reduced work ability. Poor sleep, high amount of stress, and multi-site pain were associated with decreased work ability. Conclusions A high prevalence of pain was shown among dentists. Decreased work ability in terms of productivity loss was associated with poor sleep quality, high amount of stress, and multi-site pain. Preventive actions at the workplace should promote good musculoskeletal health, and measures taken, both individual and organizational, to minimize the risk of high, persistent stress and work-related pain.
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Affiliation(s)
- Susanna Marklund
- Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden.
| | - Christina S Mienna
- Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden
| | - Jens Wahlström
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Erling Englund
- Department of Research and Development, Umeå University, Sundsvall, Sweden
| | - Birgitta Wiesinger
- Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden
- Department of Research and Development, Umeå University, Sundsvall, Sweden
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La Touche R, Paris-Alemany A, Gil-Martínez A, Pardo-Montero J, Angulo-Díaz-Parreño S, Fernández-Carnero J. Masticatory sensory-motor changes after an experimental chewing test influenced by pain catastrophizing and neck-pain-related disability in patients with headache attributed to temporomandibular disorders. J Headache Pain 2015; 16:20. [PMID: 25902781 PMCID: PMC4385233 DOI: 10.1186/s10194-015-0500-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/04/2015] [Indexed: 01/03/2023] Open
Abstract
Background Recent research has shown a relationship of craniomandibular disability with neck-pain-related disability has been shown. However, there is still insufficient information demonstrating the influence of neck pain and disability in the sensory-motor activity in patients with headache attributed to temporomandibular disorders (TMD). The purpose of this study was to investigate the influence of neck-pain-related disability on masticatory sensory-motor variables. Methods An experimental case–control study investigated 83 patients with headache attributed to TMD and 39 healthy controls. Patients were grouped according to their scores on the neck disability index (NDI) (mild and moderate neck disability). Initial assessment included the pain catastrophizing scale and the Headache Impact Test-6. The protocol consisted of baseline measurements of pressure pain thresholds (PPT) and pain-free maximum mouth opening (MMO). Individuals were asked to perform the provocation chewing test, and measurements were taken immediately after and 24 hours later. During the test, patients were assessed for subjective feelings of fatigue (VAFS) and pain intensity. Results VAFS was higher at 6 minutes (mean 51.7; 95% CI: 50.15-53.26) and 24 hours after (21.08; 95% CI: 18.6-23.5) for the group showing moderate neck disability compared with the mild neck disability group (6 minutes, 44.16; 95% CI 42.65-45.67/ 24 hours after, 14.3; 95% CI: 11.9-16.7) and the control group. The analysis shows a decrease in the pain-free MMO only in the group of moderate disability 24 hours after the test. PPTs of the trigeminal region decreased immediately in all groups, whereas at 24 hours, a decrease was observed in only the groups of patients. PPTs of the cervical region decreased in only the group with moderate neck disability 24 hours after the test. The strongest negative correlation was found between pain-free MMO immediately after the test and NDI in both the mild (r = −0.49) and moderate (r = −0.54) neck disability groups. VAFS was predicted by catastrophizing, explaining 17% of the variance in the moderate neck disability group and 12% in the mild neck disability group. Conclusion Neck-pain-related disability and pain catastrophizing have an influence on the sensory-motor variables evaluated in patients with headache attributed to TMD.
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Affiliation(s)
- Roy La Touche
- Department of Physiotherapy, Faculty of Health Science, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain. .,Motion in Brains Research Group, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madird, Aravaca, Madrid, Spain. .,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain. .,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.
| | - Alba Paris-Alemany
- Department of Physiotherapy, Faculty of Health Science, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain. .,Motion in Brains Research Group, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madird, Aravaca, Madrid, Spain. .,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain. .,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.
| | - Alfonso Gil-Martínez
- Department of Physiotherapy, Faculty of Health Science, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain. .,Motion in Brains Research Group, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madird, Aravaca, Madrid, Spain. .,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain. .,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.
| | - Joaquín Pardo-Montero
- Department of Physiotherapy, Faculty of Health Science, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain. .,Motion in Brains Research Group, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madird, Aravaca, Madrid, Spain. .,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain. .,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.
| | - Santiago Angulo-Díaz-Parreño
- Motion in Brains Research Group, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madird, Aravaca, Madrid, Spain. .,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain. .,Faculty of Medicine, Universidad San Pablo CEU, Madrid, Spain.
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madird, Aravaca, Madrid, Spain. .,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain. .,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
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Correlation between TMD and cervical spine pain and mobility: is the whole body balance TMJ related? BIOMED RESEARCH INTERNATIONAL 2014; 2014:582414. [PMID: 25050363 PMCID: PMC4090505 DOI: 10.1155/2014/582414] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 05/23/2014] [Indexed: 12/26/2022]
Abstract
Temporomandibular dysfunction (TMD) is considered to be associated with imbalance of the whole body. This study aimed to evaluate the influence of TMD therapy on cervical spine range of movement (ROM) and reduction of spinal pain. The study group consisted of 60 patients with TMD, cervical spine pain, and limited cervical spine range of movements. Subjects were interviewed by a questionnaire about symptoms of TMD and neck pain and had also masticatory motor system physically examined (according to RDC-TMD) and analysed by JMA ultrasound device. The cervical spine motion was analysed using an MCS device. Subjects were randomly admitted to two groups, treated and control. Patients from the treated group were treated with an occlusal splint. Patients from control group were ordered to self-control parafunctional habits. Subsequent examinations were planned in both groups 3 weeks and 3 months after treatment was introduced. The results of tests performed 3 months after the beginning of occlusal splint therapy showed a significant improvement in TMJ function (P > 0.05), cervical spine ROM, and a reduction of spinal pain. The conclusion is that there is a significant association between TMD treatment and reduction of cervical spine pain, as far as improvement of cervical spine mobility.
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