Pressure Release Technique Versus Placebo Applied to Cervical and Masticatory Muscles in Patients With Chronic Painful Myofascial Temporomandibular Disorder. A Randomized Clinical Trial

Abstract

Background. This study investigated whether a Pressure Release Technique (PRT) is effective for reducing pain in people with chronic myofascial Temporomandibular Disorders (TMD). Methods. A single-blinded randomized parallel-group trial, with 3 months follow-up was conducted. A total of seventy-two patients were randomly allocated to receive PRT or sham PRT. The primary outcome was pain assessed with a Visual Analogue Scale (VAS). Secondary outcomes included Pressure Pain Thresholds (PPTs), Range of Opening of the Mouth (ROM), Neck Disability Index (NDI), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK-11), State-Trait Anxiety Index (STAI) and State-Trait Depression Index (ST-DEP). All parameters were assessed at baseline, at the end of the treatment and at 3 months follow-up. Statistical analysis was performed by ANOVA. Results. here were significant main effects of time, group and interaction between time and group (F ≥ 21.92; P < .001) on VAS pain. Post-hoc tests showed a significant reduction in VAS pain scores in the PRT group (≥ 31.9%; P < .001). Effect sizes were moderate in the PRT group at all follow-up periods (≥ 1.25 Cohen´s d). Also, there were significant effects of time in secondary outcomes (F ≥ 9.65; P < .001), and there were also interactions between time and group (F ≥ 3.82; P < .002) with better effects in the PRT group. Conclusions. The inclusion of PRT to conventional management with occlusal splints and self-care management appears to be effective to improve self-reported levels of pain in patients with chronic myofascial TMD pain. Retrospectively registered (ClinicalTrials.gov: NCT03619889).

The Efficacy of Manual Therapy Approaches on Pain, Maximum Mouth Opening and Disability in Temporomandibular Disorders: A Systematic Review of Randomised Controlled Trials

“…A total of 9639 records were retrieved from our searches, 6009 duplicates were removed, and the remaining 3630 titles and abstracts were screened. Then, 63 potential full texts were assessed for eligibility and 20 trials were included [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. The study selection flow diagram is available in Figure 1 .…”

“…Four trials [ 39 , 42 , 44 , 45 ] investigated the effects of manual therapy when compared with control (sham or waiting list) and twelve trials investigated the additional effects of manual therapy when combined with other active intervention on pain intensity [ 35 , 36 , 38 , 41 , 43 , 46 , 47 , 49 , 50 , 51 , 52 , 53 ]. Seven trials used the 0–10 NRS [ 39 , 42 , 46 , 47 , 49 , 50 , 52 ], five trials used the 0–10 VAS [ 36 , 38 , 41 , 43 , 51 ] and four trials used the 0–100 VAS [ 35 , 44 , 45 , 53 ]. For pooling, outcome data were converted to a common 0–10 points scale.…”

“…Three trials [ 42 , 45 , 48 ] investigated the effects of manual therapy when compared with the control (sham or waiting list) and 13 trials investigated its additional effects on MMO [ 35 , 36 , 37 , 41 , 43 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 ]. MMO was assessed with Caliper in six trials [ 36 , 37 , 45 , 47 , 48 , 50 ], with Ruler in three trials [ 51 , 52 , 53 ], with other measurement tools in two trials [ 42 , 49 ] and four trials did not report the instrument used [ 35 , 41 , 46 , 54 ].…”

“… Forest plot of the additional effects of manual therapy on maximum mouth opening at immediate-, short- and long-term. Studies included were: Alajbeg et al, 2015 [ 35 ]; Antunez et al, 2015 [ 36 ]; Blanco et al, 2015 [ 37 ]; Brochado et al, 2017 [ 38 ]; Hernanz et al, 2018 [ 41 ]; Kanhachon et al, 2021 [ 43 ]; Nagata et al, 2019 [ 47 ]; Reynolds et al, 2020 [ 49 ]; Rezaie et al, 2022 [ 50 ]; Sahin et al, 2020 [ 51 ]; Serna et al, 2019 [ 52 ]; Tuncer et al, 2012 [ 53 ]. …”