Short term efficacy of appliance and physical therapy for the treatment of bilateral masseter myalgia: A double blinded randomized clinical trial
Sharma, Abhimanyu R.
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Introduction: Temporomandibular disorders (TMD) refer to a group of musculoskeletal and neuromuscular conditions affecting the temporomandibular joint (TMJ) and/or the muscles of mastication and associated structures leading to symptoms of pain and decreased functional capacity. It has been suggested that the use of conservative therapies may result in better pain control and increased function, but clinical trials are limited comparing conservative therapies. Aims: The purpose of this study is to evaluate the short term effectiveness of physical therapy (Vapocoolant spray and stretch), inter-occlusal appliances and the combination of both for the management of bilateral masseter myalgia. Methods: A double blind randomized clinical trial was utilized in order to evaluate the efficacy of the different treatment modalities in reducing pain intensity and increasing range of mandibular motion. Subjects were randomly assigned to one of three treatment groups and did receive one intervention per week for five consecutive weeks. The treatment groups were (A): appliance, (B): physical therapy and (C): the combination group comprising both. All measurements were taken by a trained clinician at baseline and at the end of the trial (follow up visit). A second blinded trained clinician treated all of the subjects. The following outcomes were measured at baseline and at the follow up visit: Self-reported pain scales, utilizing the Characteristic Pain Intensity (CPI) scores and range of motion utilizing the pain free opening (PFO), maximum unassisted opening (MUO) and maximum assisted opening (MAO). One-way ANOVA was used to compare the outcome changes. Results: A total of 19 subjects were enrolled at baseline with 90% of the subjects adhering to the study protocol. The mean age of the subjects was 38 (± 11.7 SD) years and 89.5% of the subjects were females. Mean CPI scores showed no significant difference between the three groups (all p> .05). Mean scores of PFO, MUO or MAO also showed no significant differences among the three interventional groups. Improvement was noticed with regard to lower pain intensity and increasing range of motion in all the groups from baseline, no significant differences among groups was evident (all p>.05). Conclusion: There is no significant difference in the short term effectiveness of the three interventional groups in lowering pain intensity or increasing range of motion in a population of individuals suffering from bilateral masseter myalgia. These therapies are equally effective and may be used as non-invasive, conservative first line treatment in this population.