Trigger point injection therapy in the management of myofascial temporomandibular pain

Amaç: Miyofasyal ağrılar en sık görülen temporomandibular bozukluklardır. Bu çalışmada, miyofasyal temporomandibular ağrının tedavisinde kombine tedavi yöntemlerinin etkinliği karşılaştırıldı. Gereç ve Yöntem: Klinik ve radyolojik olarak miyofasyal temporomandibular bozukluk tanısı almış 50 hasta (44 kadın, 6 erkek) çalışmaya alındı ve randomize olarak her grupta 25 hasta olacak şekilde iki gruba ayrıldı. Grup 1 stabilizasyon splinti (SS) ile Grup 2 ise SS tedavisi ile kombine olarak tetik nokta enjeksiyonlarıyla tedavi edildi. Bulgular: Genel bulgu ve belirtilerin düzelmesinde her iki grup arasında istatistik olarak önemli farklar bulundu. VAS skorlarında Grup 2’de önemli azalma görüldü ve istatistitiksel analiz sonucu tedavinin 4. ve 12. haftasında yapılan değerlendirmelerde Grup 1 ve Grup 2 arasında VAS skorları açısında önemli farklar bulundu (p

Temporomandibular miyofasyal ağrılarda tetik nokta enjeksiyonu tedavisi

Objectives: Myofascial pain is the most common temporomandibular disorder. The objective of this study was to compare the effectiveness of combined treatment modalities in the management of myofascial temporomandibular pain. Methods: Fifty patients (44 female, 6 male) clinically and radiologically diagnosed with myofascial temporomandibular disorder (TMD) were selected for the study and randomly assigned to two groups of 25 patients. Group 1 patients were treated with stabilization splint (SS) and Group 2 patients were treated with trigger point injection combined with SS therapy. Results: Positive improvement in overall signs and symptoms with statistically significant differences was observed in both groups. Group 2 showed significant reduction in visual analogue scale (VAS) scores, and statistical analysis revealed a significant difference between the VAS scores of Group 1 and Group 2 at the 4th and 12th weeks of treatment follow-up (p<0.001). Conclusion: Our results indicate that trigger point injection therapy combined with splint therapy is effective in the management of myofascial TMD pain. Further research, especially randomized controlled trials, should be carried out to ascertain its effectiveness over other treatment modalities.

___

  • 1. Laskin DM. Diagnosis and etiology myofascial pain and dysfunction. Oral Maxillofac Surg Clin North Am 1995;7:73-8.
  • 2. Gray RJM, Davies SJ, Quayle AA. A clinical guide to temporomandibular disorders. London: BDJ Books; 1997. p. 1-43.
  • 3. Gül K, Onal SA. Comparison of non-invasive and invasive techniques in the treatment of patients with myofascial pain syndrome. Agri 2009;21(3):104-12.
  • 4. Al-Ani Z, Gray RJ, Davies SJ, Sloan P, Glenny AM. Stabilization splint therapy for the treatment of temporomandibular myofascial pain: a systematic review. J Dent Educ 2005;69(11):1242-50.
  • 5. Davies SJ, Gray RJ. The pattern of splint usage in the management of two common temporomandibular disorders. Part III: Long-term follow-up in an assessment of splint therapy in the management of disc displacement with reduction and pain dysfunction syndrome. Br Dent J 1997;183(8):279-83.
  • 6. Murphy GJ. Physical medicine modalities and trigger point injections in the management of temporomandibular disorders and assessing treatment outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83(1):118-22.
  • 7. Gray RJ, Davies SJ. Occlusal splints and temporomandibular disorders: why, when, how? Dent Update 2001;28(4):194-9.
  • 8. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6(4):301-55.
  • 9. Okeson JP. Management of temporomandibular disorders and occlusion. St. Louis: Mosby- Year Book; 1993. p. 345-78.
  • 10. Travell JG, Simons DG. Myofascial pain and dysfunction. The trigger point manual. Baltimore: Williams & Wilkins; 1983.
  • 11. Friedman MH, Weisberg J. Temporomandibular joint disorders: diagnosis and treatment. Chicago: Quintessence Publishing Company; 1985. p. 119-40.
  • 12. Dao TT, Lavigne GJ. Oral splints: the crutches for temporomandibular disorders and bruxism? Crit Rev Oral Biol Med 1998;9(3):345-61.
  • 13. Turk DC, Zaki HS, Rudy TE. Effects of intraoral appliance and biofeedback/stress management alone and in combination in treating pain and depression in patients with temporomandibular disorders. J Prosthet Dent 1993;70(2):158-64.
  • 14. Ekberg E, Vallon D, Nilner M. The efficacy of appliance therapy in patients with temporomandibular disorders of mainly myogenous origin. A randomized, controlled, short-term trial. J Orofac Pain 2003;17(2):133-9.
  • 15. Raphael KG, Marbach JJ, Klausner JJ, Teaford MF, Fischoff DK. Is bruxism severity a predictor of oral splint efficacy in patients with myofascial face pain? J Oral Rehabil 2003;30(1):17- 29.
  • 16. Dimitroulis G, Gremillion HA, Dolwick MF, Walter JH. Temporomandibular disorders. 2. Non-surgical treatment. Aust Dent J 1995;40(6):372-6.
  • 17. Kuttila M, Le Bell Y, Savolainen-Niemi E, Kuttila S, Alanen P. Efficiency of occlusal appliance therapy in secondary otalgia and temporomandibular disorders. Acta Odontol Scand 2002;60(4):248-54.
  • 18. Minakuchi H, Kuboki T, Matsuka Y, Maekawa K, Yatani H, Yamashita A. Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disk displacement without reduction. J Dent Res 2001;80(3):924-8.
  • 19. Naikmasur V, Bhargava P, Guttal K, Burde K. Soft occlusal splint therapy in the management of myofascial pain dysfunction syndrome: a follow-up study. Indian J Dent Res 2008;19(3):196-203.
  • 20. Suvinen T, Reade P. Prognostic features of value in the management of temporomandibular joint pain-dysfunction syndrome by occlusal splint therapy. J Prosthet Dent 1989;61(3):355-61.
  • 21. Wong YK, Cheng J. A case series of temporomandibular disorders treated with acupuncture, occlusal splint and point injection therapy. Acupunct Med 2003;21(4):138-49.
  • 22. Baldry P. Management of myofascial trigger point pain. Acupunct Med 2002;20(1):2-10.
  • 23. Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician 2002;65(4):653-60.
  • 24. Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil 2001;82(7):986-92.
  • 25. Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep 2001;5(5):412-20.
  • 26. Madland G, Newton-John T, Feinmann C. Chronic idiopathic orofacial pain: I: What is the evidence base? Br Dent J 2001;191(1):22-4.