Self-medication Among Myofascial Pain Patients: A Preliminary Study

A systematic review of temporomandibular disorder diagnostic methods

Objective: To compile the screening tools used to study temporomandibular disorders (TMD), classify and analyze their potential application in the field of physiotherapy.Methods: All gathered data included randomized clinical trials on humans over 18 years of age pulled from three databases up to November 2019.Results: Nineteen articles were retained, in which the subjects included 1095 women and 385 men. The 32 valuation systems reported were classified as follows: direct, requiring observation and/or palpation in situ by a clinician, which can be subdivided into protocols and instrumental systems; and indirect, requiring neither observation nor palpation by a clinician, which can be subdivided into questionnaires and scales.Conclusion: In order to evaluate TMD, the best choice is to combine direct and indirect assessment methodologies. The valuation of pressure pain threshold with an algometer and Fonseca's Anamnestic Index in combination with Anamnestic Questionnaire CMD, respectively, seems to provide the best results.

Efficacy of rehabilitation on reducing pain in muscle-related temporomandibular disorders: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Patients with temporomandibular disorders (TMD) mostly suffer from muscle-related pain. Several conservative interventions have been suggested as treatments for TMD in the last years.

OBJECTIVE

The aim of this systematic review with meta-analysis was to assess the efficacy of rehabilitative approaches in reducing pain in patients with muscle-related TMD.

METHODS

PubMed, Scopus, and Web of Science were systematically searched from inception until April 28th, 2021 to identify randomized controlled trials (RCTs) presenting: patients with painful muscle-related TMD; rehabilitative approaches as interventions; placebo or sham treatment as comparisons; pain intensity, using visual analogue scale as outcome. A meta-analysis was performed to evaluate the overall effect on painful muscle-related TMD patients. PROSPERO registration number of this systematic review is CRD42021251904.

RESULTS

Out of 1997 papers suitable for title/abstract screening, 189 articles were assessed for eligibility. Sixteen RCTs were included and most of them (n= 6, 37.5%) investigated the effects of the laser therapy. The meta-analysis revealed that rehabilitative interventions had a significant overall effect size (ES) of 1.44 (p< 0.0001) in decreasing pain in patients with muscle-related disorders.

CONCLUSION

Findings of this systematic review with meta-analysis suggested that rehabilitative approaches might be effective in reducing pain in muscle-related TMD patients. However, the low number of RCTs evaluating conservative approaches might impair the synthesis of evidence regarding the different techniques, calling for caution in the interpretation of these results.

Changes in Maximum Mandibular Mobility Due to Splint Therapy in Patients with Temporomandibular Disorders

Splint therapy is widely used in the treatment of myofascial pain, but valid studies on the efficacy of this therapy are rare. The purpose of the present study was to investigate which qualifiable and quantifiable effects of splint therapy are detectable. For this purpose, 29 patients (21 women, mean age 44.6 ± 16 years) diagnosed with myofascial pain (RDC/TMD) were investigated in this prospective clinical trial (10/6/14An). Patients were treated with Michigan splints applied overnight for three months. Before (T1) and after three months of treatment (T2), patients were registered with an electronic ultrasound device with qualitative and quantitative evaluation of the registrations and a qualitative assessment of pain symptoms using a verbal analog scale. Significant differences were found between maximum mouth opening (MMP) (p < 0.001) and right condylar movement (CM) at MMP (p = 0.045). Qualitative assessment revealed that 24 of 29 patients experienced an improvement in pain symptoms, 17 of whom experienced complete remission. The results of the qualitative and quantitative analysis provide indications of the effectiveness of the splint therapy. In addition to quantitative measurements, the ultrasound facebow technique was also able to provide qualitative information.

Self-Medication Profile of Adult Patients with Temporomandibular Disorders in Southeast Brazil

BACKGROUND

Patients with temporomandibular disorder (TMD) often have orofacial pain and may use medication without professional prescription. Self-medication and inappropriate drug intake may cause serious health problems. This cross-sectional study evaluated the self-medication profile of TMD patients, the most used medications and their effect, and the relation between self-medication and socioeconomic factors.

METHODS

A non-representative sample (n=358) consisted of consecutive adult patients seeking TMD treatment in specialized referral centers for orofacial pain of two universities in São Paulo city, Brazil. A standardized questionnaire was used to collect the study variables before the TMD treatment: self-medication history, TMD pain intensity, sex, age, ethnicity, marital status, schooling and socioeconomic levels. Data were analyzed by descriptive statistics, chi-square test, and logistic regression models at the 0.05 significance level.

RESULTS

Almost 60% of 358 TMD patients reported self-medication. Patients with severe TMD were 4.7 times more likely to self-medicate when compared to patients with low TMD intensity (O=5.7; 95% CI=2.4; 13.3; P=0.043), as well as female patients were 30% more likely to self-medicate compared to male patients (OR=2.3; 95% CI=1.1; 5.1; P<0.001). The other independent variables were not associated with self-medication. The frequencies of moderate and severe TMD in women were larger than in those in men (P<0.001). Analgesics and anti-inflammatory drugs were the most used medications. Regarding medication efficacy, 82% of patients reported some improvement after use, but 9% reported side-effect sickness.

CONCLUSION

Self-medication is common among TMD patients attending specialized clinics, and this inappropriate practice is more likely to occur in women and in patients with severe signs and symptoms of TMD.

[At the forefront of the temporomandibular dysfunction: a study of experiences]

How does one address an ailment related to such unique experiences without dissociating it from relationships, living conditions and society? Temporomandibular Disorder (TMD) is one of a group of chronic disorders that are difficult to diagnose and provide treatment. As in other similar ailments, such difficulties may accentuate a negative impact on health. The study seeks to identify experiences of health service users with TMD, aiming to contribute to reflection and management practices for the issue. A qualitative otobiographical study was developed, using interviews with people undergoing TMD treatment. Based on the Nietzschean premise that the process of subjectivation is fed by experiences, the method seeks to identify traces of these experiences through the texts resulting from the interviews. Patients' experiences were grouped into five categories: recognition; frustrations; concealment; sadness, fear and death; and destinies. A variety of negative effects have been described in the first three stages, whereas the last one, namely destinies, elicits feelings of well-being. The value of the interactive (professional-user) space, which expresses itself as the power to create innovative and sensitive ways of dealing with health-disease processes, needs to be highlighted.

Effects of dipyrone and acetylsalicylic acid on contractions of distal cauda epididymis duct, serum testosterone and sperm count in rats

The effects of dipyrone and acetylsalicylic acid (ASA) on male fertility are still not fully understood, mainly considering the epididymis as a putative target for their anti-fertility effects. Therefore, this study aimed to investigate the effects of dipyrone and ASA on the contractions of distal cauda epididymis duct, serum testosterone levels and sperm parameters in rats. Firstly, we checked the in vitro effects of dipyrone and ASA (10-1000 μM) on the contractions of distal cauda epididymis duct by pharmacological experiments. We also evaluated the effects of in vivo treatment with dipyrone and ASA 100 mg/kg (p.o.) for 15 days on epididymal duct contractions, serum testosterone levels and sperm parameters. In vitro dipyrone or ASA decreased the epididymal duct contractions induced by phenylephrine or carbachol. We observed that in vivo treatment with both drugs decreased the daily sperm production, serum testosterone levels and sperm count through epididymis without altering the epididymal duct contractions and sperm transit time through epididymis. In conclusion, in vitro dipyrone and ASA were able to diminish the contractions of epididymal duct, whilst in vivo administration decreased the sperm count throughout epididymis as a consequence of a low sperm production caused by reduced testosterone levels.

Diagnostic accuracy of the short-form Fonseca Anamnestic Index in relation to the Diagnostic Criteria for Temporomandibular Disorders

STATEMENT OF PROBLEM

Screening for temporomandibular disorders (TMDs) is important in research and clinical practice. The short-form Fonseca Anamnestic Index (SFAI) was recently introduced but had only been validated for muscle disorders.

PURPOSE

The purpose of this clinical study was to determine the diagnostic accuracy of the SFAI and its discrete and pooled items in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) benchmark.

MATERIAL AND METHODS

A total of 866 consecutive participants with TMDs and 57 TMD-free controls (aged ≥18 years) were recruited. The participants (n=923; mean age 32.8 ±13.3 years; women 79.2%) answered the FAI, and TMD diagnoses were derived based on the DC/TMD protocol and algorithms. The 5-item SFAI, which comprised 2 pain-related and 3 function-related TMD questions, was subsequently acquired and assessed with reference to the DC/TMD diagnoses. The receiver operating characteristics (ROC) was used to verify accuracy (area under the curve [AUC]) and the best cutoff points. Sensitivity, specificity, predictive values, and likelihood ratios were also examined.

RESULTS

Pain-related (PT) and intra-articular (IT) TMDs were present in 48.3% (446/923) and 82.7% (763/923) of the participants, respectively. The SFAI demonstrated high accuracy for identifying all TMDs, PT, and IT (AUC of 0.97, 0.99, and 0.97, respectively). The best cutoff points were 12.5 for all TMDs/IT and 17.5 for PT. Sensitivity of the SFAI ranged from 90.7% to 97.5% while specificity varied from 93.0% to 96.5%, with the highest values for PT. As positive predictive values (99.4% to 99.5%) were greater than negative ones (41.7% to 83.3%), the SFAI was better at detecting the presence than the absence of TMDs. With reference to PT, the sensitivity, and specificity of the 2 discrete and pooled pain-related questions (questions 3 and 4), extended from 82.3% to 99.3% and 77.2% to 96.5% respectively. With regard to IT diagnoses, sensitivity and specificity ranged from 56.0% to 98.3% and 86.0% to 98.3% for the 3 discrete and pooled function-related items (questions 1, 2, and 5).

CONCLUSIONS

The SFAI presented high degrees of diagnostic accuracy in relation to the DC/TMD and can be used for screening TMDs. SFAI scores between 15 and 50 points should be used to identify the presence of TMDs, with scores ≥20 points specifying possible pain-related TMDs.

Are occlusal splints effective in reducing myofascial pain in patients with muscle-related temporomandibular disorders? A randomized-controlled trial

Objectives

This study aims to evaluate the effectiveness of upper Michigan occlusal splint (OS) compared to mandibular OS in terms of pain, range of motion (ROM), and muscle activity as assessed by surface electromyography (sEMG) in patients affected by muscle-related temporomandibular disorders (TMD).

Patients and methods

In this randomized-controlled trial, a total of 40 adult patients (13 males, 27 females; mean age: 47.2±12.8 years; range, 22 to 56 years) with a diagnosis of myofascial pain, lasting from at least three months on at least one masseter muscle. The patients were randomly allocated into two groups: Group 1 (n=20) using upper Michigan OS and Group 2 (n=20) using mandibular OS. At baseline (T0), at one (T1), three (T2), and six months (T3), the following outcomes were assessed: myofascial pain by Visual Analog Scale (VAS) and ROM of mandible movements, activity of the main masticatory muscles through sEMG.

Results

There were no significant intra-group differences in the outcome measures assessed in both groups. However, Group 2 had a significantly higher right lateral mandibular ROM at T2 (7.1±3.1 vs. 9.8±2.3, respectively; p<0.05) and a significantly higher left lateral mandibular ROM at T3 (7.6±3.5 vs. 10.5±2.1, respectively; p<0.05). We found no significant difference in none of the sEMG parameters.

Conclusion

Our study results suggest that OS, independently from being built on the upper or lower arch, seems to not have significant effects in reducing pain over a six-month period in TMD patients.

Self-medication for oral health problems among adults attending the University Dental Hospital, Sharjah

Objective

The aim of this study was to investigate the self-medication practices for oral health problems among adults attending the University Dental Hospital Sharjah (UDHS). The reasons for visits and types, durations, and sources of self-medication were recorded.

Methods

This cross-sectional study was conducted among adult patients attending UDHS. A total of 566 participants were recruited using pre-determined inclusion and exclusion criteria. Data collection was performed using a self-administered closed-ended questionnaire, and information was analysed using SPSS software version 22.

Results

Four hundred of 566 (70.7%) respondents indicated that they practice self-medication. Among those who practiced self-medication for oral health problems, the mean age was 26 ± 9.4 years (52% men and 48% women), and the majority (46%) had obtained higher education, although their profession was not related to the medical field (69.97%). The most common factor that triggered self-medication practices was toothache (56.5%), while the main reasons for self-medication were both lack of time to visit a dental clinic (37.6%) and the perception that dental ailments were not serious health issues (36.8%). Analgesics were the main medicines used for self-medication.

Conclusion

Self-medication for oral health problems is a common practice in UAE. Lack of time to visit dental clinics and the perceived low importance of oral health problems were the main reasons for self-medication. Analgesics for toothache were the most frequent medications purchased from the local pharmacy.