Effects of exercise training and photobiomodulation therapy (EXTRAPHOTO) on pain in women with fibromyalgia and temporomandibular disorder: study protocol for a randomized controlled trial

Abstract

BackgroundFibromyalgia (FM) is a syndrome most prevalent in women, in whom it is characterized mainly by chronic pain. An important issue is that many patients with FM are reported to have temporomandibular dysfunction (TMD), and the coexistence of these pathologies generates a clinical outcome of high complexity. The literature is unclear regarding an effective therapy for reducing pain in patients with both comorbidities. Exercise training and phototherapy (low-level laser therapy with light-emitting diode) are two of the approaches used to treat pain. Thus, the aim of this study is to assess the potential role of exercise training plus phototherapy in reducing chronic pain in women with FM and TMD. A further aim is to determine whether the interventions can improve quality of life and modulate endogenous serotonin.Methods/DesignA randomized controlled clinical trial will be conducted. It will involve 60 women ≥ 35 years of age with a diagnosis of FM and TMD. After recruitment, patients will be randomly allocated to one of four groups: a control group (no intervention), a group that will receive a phototherapy intervention (PHO), a group that will be prescribed muscle-stretching, aerobic, and facial exercises (EXT), or a group that will receive phototherapy plus exercise interventions (PHO + EXT). The trial will last 10 weeks, and the following outcomes will be evaluated on two separate occasions (baseline and within 24 h after the last day of the protocol). Pain intensity will be analyzed using a visual analogue scale and the McGill Pain Questionnaire, and pain thresholds will be punctuated using a digital algometer. FM symptoms will be assessed using the Fibromyalgia Impact Questionnaire, and quality of life will be determined with the 36-item Short Form Health Survey. Serotonin levels will be evaluated in salivary samples using a competitive enzyme-linked immunosorbent assay.DiscussionThis is the first randomized controlled trial in which the role of phototherapy, exercise training, and a combination of these interventions will be evaluated for chronic pain in patients with FM and TMD. The results will offer valuable clinical evidence for objective assessment of the potential benefits and risks of procedures.Trial registrationClinicalTrials.gov Identifier: NCT02279225. Registered 27 October 2014.

Effects of 8 weeks of masticatory muscles focused endurance exercises on women with oro‐facial pain and temporomandibular disorders: A placebo randomised controlled trial

“…Additionally, TMD symptoms tend to be underdiagnosed due to similar complaints of other disorders, such as headaches, fibromyalgia, and painful cervical and shoulder . The present study also had 26% dropout rate, while another randomised controlled study with combined therapy (laser + exercises) had 20% . A study with the same design using stabilisation splints in TMD subjects had 33% dropout rate .…”

“…26,27 The present study also had 26% dropout rate, while another randomised controlled study with combined therapy (laser + exercises) had 20%. 28 A study with the same design using stabilisation splints in TMD subjects had 33% dropout rate. 29 TMD subjects are used to receive a multimodal conservative approach.…”

Evaluation of the effectiveness of infrared light-emitting diode photobiomodulation in children with sleep bruxism

“…There are some studies related to photobiomodulation in bruxism patients in the literature, [13] but there are none with the use of the infrared LED as the light source, especially in bruxism. [14] Clinically, the relevance of the study is given by the fact that LED therapy is much cheaper than laser, providing greater accessibility to the population.…”

“…Photobiomodulation therapy with a light-emitting diode (LED) has also been used for the treatment of muscle disorders. Silva et al (2015) [14] established a treatment protocol for fibromyalgia including the use of LED. Besides the physiological gains that occur with LLLT, the authors consider LED treatment accessible because of its low cost and more durable equipment, making this a viable treatment option.…”

TMJ Dysfunction and Systemic Correlation

“…This short therapy with the bite leads to the resolution of contracture and painful problems in the neck and back, with consequent wellbeing and regained energy. Once the wellbeing is confirmed, a re-evaluation is carried out to define a definitive dental therapy, replacing the bite, which leads to the maintenance of the new wellbeing acquired [12][13][14][15][16][17][18][19][20][21]. There is an important correlation between sports activity and occlusal activity, as during periods of intense activity or particular concentration it is possible that occlusal parafunctions occur.…”