Multimodal physiotherapy treatment based on a biobehavioral approach for patients with chronic cervico-craniofacial pain: a prospective case series

Marcos-Martín, Fernando; González-Ferrero, Luis; Martín-Alcocer, Noelia; Paris‐Alemany, Alba

doi:10.1080/09593985.2017.1423522

Cited by 13 publications

(17 citation statements)

References 43 publications

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“…The other aim of the PTE is teaching active coping strategies and other strategies to help manage fear-avoidance beliefs and modulate pain [189]. These other strategies are distraction strategies, changing behaviors and misconceptions about pain and body perception, teaching on the benefits of therapeutic exercise and general physical activity, relaxation techniques and correction of inappropriate behaviors, such as parafunctions of the TMJ.…”

Section: Therapeutic Patient Educationmentioning

confidence: 99%

“…These other strategies are distraction strategies, changing behaviors and misconceptions about pain and body perception, teaching on the benefits of therapeutic exercise and general physical activity, relaxation techniques and correction of inappropriate behaviors, such as parafunctions of the TMJ. The biobehavioral intervention has shown positive effects for reducing chronic pain [189][190][191].…”

Section: Therapeutic Patient Educationmentioning

confidence: 99%

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Assessment and Brain Training of Patients Experiencing Head and Facial Pain with a Distortion of Orofacial Somatorepresentation: A Narrative Review

Piekartz¹,

Paris‐Alemany

2021

Applied Sciences

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The management of patients experiencing chronic orofacial pain is a great challenge, due to the complexity of chronic pain itself, combined with an increased peripheral sensitization in the craniofacial itself. Therefore, patients with orofacial pain may present a clear distortion of the somatorepresentation after some time. In this review, the authors develop a neurophysiological explanation of orofacial distortion, as well as propose assessment and treatment options, based on scarcely available scientific evidence and their own clinical experience. The assessments of facial somatosensory, cognitive-affective and motor dysfunctions are crucial to establish the most accurate treatment; the assessment tools are described in the article. Two-point discrimination, laterality recognition and emotion recognition are altered in patients with orofacial pain. Other sensorimotor assessment tools, such as motor acuity and auditory acuity, are also explained. Finally, the authors review their treatment proposals, based on the integration of brain training techniques and biobehavioral interventions. Somatosensory reintegration (tactile acuity training), facial emotion recognition, movement representation techniques, orofacial motor training and therapeutic patient education are explained in detail, and this may challenge new directions in rehabilitation and research.

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Section: Therapeutic Patient Educationmentioning

confidence: 99%

Section: Therapeutic Patient Educationmentioning

confidence: 99%

Assessment and Brain Training of Patients Experiencing Head and Facial Pain with a Distortion of Orofacial Somatorepresentation: A Narrative Review

Piekartz¹,

Paris‐Alemany

2021

Applied Sciences

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“…It is important to consider that patients with TMD need multimodal approaches and not isolated strategies. There is preliminary evidence supporting the combination of manual therapy, education, and exercises for patients with myofascial TMD [ 71 , 72 ], arthrogenic TMD [ 73 ], anterior disc displacement without reduction [ 74 ], or cervico-craniofacial pain [ 75 ].…”

Section: Scientific Evidence Of Bottom-up Interventionsmentioning

confidence: 99%

Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD): A Narrative Literature Review

Fernández‐de‐las‐Peñas

Piekartz²

2020

JCM

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The current narrative literature review aims to discuss clinical reasoning based on nociceptive pain mechanisms for determining the most appropriate assessment and therapeutic strategy and to identify/map the most updated scientific evidence in relation to physical therapy interventions for patients with temporomandibular disorders (TMDs). We will also propose an algorithm for clinical examination and treatment decisions and a pain model integrating current knowledge of pain neuroscience. The clinical examination of patients with TMDs should be based on nociceptive mechanisms and include the potential identification of the dominant, central, or peripheral sensitization driver. Additionally, the musculoskeletal drivers of these sensitization processes should be assessed with the aim of reproducing symptoms. Therapeutic strategies applied for managing TMDs can be grouped into tissue-based impairment treatments (bottom-up interventions) and strategies targeting the central nervous system (top-down interventions). Bottom-up strategies include joint-, soft tissue-, and nerve-targeting interventions, as well as needling therapies, whereas top-down strategies include exercises, grade motor imagery, and also pain neuroscience education. Evidence shows that the effectiveness of these interventions depends on the clinical reasoning applied, since not all strategies are equally effective for the different TMD subgroups. In fact, the presence or absence of a central sensitization driver could lead to different treatment outcomes. It seems that multimodal approaches are more effective and should be applied in patients with TMDs. The current paper also proposes a clinical decision algorithm integrating clinical diagnosis with nociceptive mechanisms for the application of the most appropriate treatment approach.

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“…In clinical practice, it is frequent to use a combination of several manual techniques, and the inclusion of the NM to other OMPT or SST techniques has also been studied among the craniofacial region [ 65 ]. It has been shown that the addition of NM to the OMT techniques may obtain greater therapeutic effects of pain reduction among cervical radiculopathy patients [ 27 , 66 , 67 ].…”

Section: Discussionmentioning

confidence: 99%

Hypoalgesic and Motor Effects of Neural Mobilisation versus Soft-Tissue Interventions in Experimental Craniofacial Hyperalgesia: A Single-Blinded Randomised Controlled Trial

Diaz-Saez

Sáenz-Jiménez

Villafañe

et al. 2021

JCM

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Objective: The present trial aimed to compare the effects of the mobilisation of the nervous system (NS) to those of a soft-tissue intervention in subjects exposed to an experimentally induced hyperalgesia of the masticatory muscles. Methods: The study was a single-blinded randomised controlled trial. A total of 49 participants (mean ± SD age: 41 ± 11 years; 61% female) with latent myofascial trigger points (LMTrPs) in the craniofacial region were randomly assigned to one of three groups: neural mobilisation (NM), soft-tissues techniques and stretching (STT-S), and control group (CG). An initial assessment (baseline) was performed before the provocation chewing masticatory test. The pre-treatment measurements were registered 24 hours later. Next, the randomised intervention was applied, and afterwards, post-treatment data were obtained. Outcome measures included pain-free maximum mouth opening (MMO), pressure pain thresholds (PPTs) in the trigeminal and cervical region, and trigeminal and cervical two-point discrimination (TPD). Results: ANOVA revealed significant differences for the time × group interaction for pain-free MMO and PPTs. The results showed an improvement in the MMO and the PPTs for NM and STT-S groups but not for the CG. There were no differences between the NM and STT-S groups. However, the effect sizes were large for the NM and medium for the STT-S. No differences were found for TDP between groups nor over time. Conclusion: The results show that with NM and STT-S techniques, we could influence motor and sensory variables in asymptomatic subjects with LMTrPs after a masticatory provocation test. Both techniques increased MMO and PPTs in the short term. These beneficial effects lead us to consider the importance of including these methods in clinical practice.

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Multimodal physiotherapy treatment based on a biobehavioral approach for patients with chronic cervico-craniofacial pain: a prospective case series

Cited by 13 publications

References 43 publications

Assessment and Brain Training of Patients Experiencing Head and Facial Pain with a Distortion of Orofacial Somatorepresentation: A Narrative Review

Assessment and Brain Training of Patients Experiencing Head and Facial Pain with a Distortion of Orofacial Somatorepresentation: A Narrative Review

Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD): A Narrative Literature Review

Hypoalgesic and Motor Effects of Neural Mobilisation versus Soft-Tissue Interventions in Experimental Craniofacial Hyperalgesia: A Single-Blinded Randomised Controlled Trial

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