The aim of this study was to compare the effectiveness of different occlusal splints associated with counselling and self-care in the management of signs and symptoms of myofascial pain. In a double-blind controlled clinical trial, 42 myofascial pain patients with chief complaint of pain in the masseter muscle area were randomly assigned to 1 of the 3 experimental groups: hard (HS), soft (SS) or non-occluding (NS) occlusal splints. The Modified Symptom Severity Index (Mod-SSI) and tenderness to palpation were used as outcome measures during a 90-day follow-up. All patients improved over time and all splints offered the benefit. The results showed that all the three different appliances (HS, SS, and NS) associated with counselling were able to equally reduce the Mod-SSI (symptoms-Tukey test) and digital palpation (signed Kruskal-Wallis) test between baseline and 90 days.

Trigger point injections with different solutions have been studied mainly with regard to the management of myofascial pain (MFP) patient management. However, few studies have analyzed their effect in a chronic headache population with associated MFP. The purpose of this study was to assess if trigger point injections using botulinum toxin, lidocaine, and dry-needling injections for the management of local pain and associated headache management. Forty-five (45) myofascial pain patients with headaches that could be reproduced by activating at least one trigger point, were randomly assigned into one of the three groups: G1, dry-needling, G2, 0.25% lidocaine, at 0.25% and G3 botulinum toxin and were assessed during a 12 week period. Levels of pain intensity, frequency and duration, local postinjection sensitivity, obtainment time and duration of relief, and the use of rescue medication were evaluated. Statistically, all the groups showed favorable results for the evaluated requisites (p < or = 0.05), except for the use of rescue medication and local post injection sensitivity (G3 showed better results). Considering its reduced cost, lidocaine could be adopted as a substance of choice, and botulinum toxin should be reserved for refractory cases, in which the expected effects could not be achieved, and the use of a more expensive therapy would be mandatory.

Trigger point injections with different solutions have been studied mainly with regard to the management of myofascial pain (MFP) patient management. However, few studies have analyzed their effect in a chronic headache population with associated MFP. The purpose of this study was to assess if trigger point injections using lidocaine associated with corticoid would be better than lidocaine alone, as in comparison with dry-needling in for the management of local pain and associated headache management. Forty-five (45) myofascial pain patients with headaches that could be reproduced by activating at least one trigger point, were randomly assigned into one of the three groups: G1, dry-needling, G2, 0.25% lidocaine, at 0.25% and G3, 0.25% lidocaine at 0.25% associated with corticoid, and were assessed during a 12 week period. Levels of pain intensity, frequency and duration, local post-injection sensitivity, obtainment time and duration of relief, and the use of rescue medication were evaluated. Statistically, all three groups showed favorable results for the evaluated requisites (p < or = 0.05), but only for post-injection sensitivity did the association of lidocaine with corticoid present the best results and ingestion of rescue medication.

The use of tizanidine or cyclobenzaprine in addition to self-care management and patient education was not more effective than placebo for the management of patients with myofascial jaw pain upon awakening.