| Alencar et al.2626 Alencar F, Viana P, Zamperini C, Becker A. Patient education and self-care for the management of jaw pain upon awakening: a randomized controlled clinical trial comparing the effectiveness of adding pharmacologic treatment with cyclobenzaprine or tizanidine. J Oral Facial Pain Headache. 2014;28(2):119-27.
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Compare the effectiveness of adding CYC, TZA or placebo to patient education and a self-care management program for patients with myofascial pain and who specifically present jaw pain on awakening. |
45 patients in this 3-week study, diagnosed with myofascial pain, were randomly assigned to one of three groups: placebo group, TZA 4 mg group, or CYC 10 mg group. The patients were evaluated for changes in pain intensity, frequency, and duration. |
All three groups had reduced pain symptoms and improved sleep quality based on comparison of pre-treatment and treatment scores. However, no significant differences were observed between the groups at post-treatment assessment. |
Mujakperuo et al.11 Mujakperuo HR, Watson M, Morrison R, Macfarlane TV. Pharmacological interventions for pain in patients with temporomandibular disorders. Cochrane Oral Health Group, organizador. Cochrane Database Systematic Rev. 6 de outubro de 2010 [citado 20 de outubro de 2022]; Disponível em: https://doi.wiley.com/10.1002/14651858.CD004715.pub2.
https://doi.wiley.com/10.1002/14651858.C...
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To evaluate the effectiveness of pharmacological interventions alone and in combination with non-pharmacological therapy on pain relief in patients with chronic TMD. |
Randomized controlled trials in which a pharmacological agent was compared with placebo for pain control in TMD patients. |
There is insufficient evidence to support or disprove the effectiveness of the reported drugs for the treatment of pain due to TMD. There is a need for more well-conducted randomized controlled studies in the management of TMD. |
| Häggman-Henrikson et al.2727 Häggman-Henrikson B, Alstergren P, Davidson T, Högestätt ED, Östlund P, Tra-naeus S. Pharmacological treatment of oro-facial pain - health technology assessment including a systematic review with network meta-analysis. J Oral Rehabil. 2017;44(10):800-26.
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Conduct a health technology assessment (HTA) including a review with meta-analysis of randomized clinical trials to evaluate the treatment effectiveness, health economics, and ethical aspects of pharmacological treatments in patients with chronic orofacial pain. |
Randomized controlled trials were included for treatment in patients ≥18 years old with chronic orofacial pain. The patients were divided into subgroups: muscular TMD and joint TMD. |
The study summarizes the current evidence, although limited by the small number of studies that can be included, which reduces the generalizability of the results. Even with these limitations, the meta-analysis allowed to observe that the muscle relaxant cyclobenzaprine showed a positive effect in the treatment of TMD muscle pain. |
| Calderon et al.3030 Calderon P dos S, Tabaquim M de LM, Oliveira LC de, Camargo APA, Ramos Netto T de C, Conti PCR. Effectiveness of cognitive-behavioral therapy and amitriptyline in patients with chronic temporomandibular disorders: a pilot study. Braz Dent J. 2011;22(5):415-21.
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To evaluate the effectiveness of cognitive-behavioral therapy (CBT) and the use of amitriptyline in patients with chronic temporomandibular disorders. |
47 women (mean age = 35.4 years) with chronic TMD were included in the study and divided into 4 groups: amitriptyline; amitriptyline and CBT; placebo and CBT, and placebo alone (control). Patients were treated for 7 consecutive weeks. Follow-up assessments were done at 1st, 7th and 11th week of treatment. The presence and severity of pain, depression levels, quality of life and sleep were measured. |
All three groups showed improvement, although there were no statistically significant differences. At the end of the control, the positive results remained for the CBT + Amitriptyline group in TMD. They also showed that this association is effective in reducing depression levels and improving quality of life. |
| List and Axelsson2929 List T, Axelsson S. Management of TMD: evidence from systematic reviews and meta-analyses: management of TMD. J Oral Rehabil. 2010;37(6):430-51.
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Assess the methodological quality of published SRs on TMD management. |
The systematic reviews were searched in the Pubmed, Cochrane, and Bandolier databases between 1987 and September 2009. |
There is evidence that amitriptyline is effective in relieving TMD pain. |
| Gauer and Semidey99 Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician. 2015;91(6):378-86.
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To review the literature on the therapeutic management of TMD patients. |
The literature review used the key terms: temporomandibular joint disorders, temporomandibular disorders, headache, diagnosis, acupuncture, treatment, occlusal plates, occlusal adjustment, pharmacotherapy, randomized controlled trials, meta-analysis, botulinum toxin, differential diagnosis, biofeedback, cognitive behavior therapy, physical therapy, and classification. Searches on the Cochrane Library, UpToDate, Essential Evidence databases were also included. |
Muscle relaxants may prove beneficial if a muscle component is involved. Antidepressants are considered to be first-line therapy in chronic pain associated with TMD. Gabapentin is considered to be very effective for chronic pain. |
| Sugimine et al.3232 Sugimine S, Saito S, Araki T, Yamamoto K, Obata H. Endogenous analgesic effect of pregabalin: a double-blind and randomized controlled trial. Eur J Pain. 2017;21(6):997-1006.
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To verify the efficacy of pregabalin for endogenous analgesia, especially in patients with pain (low endogenous analgesia). |
59 healthy subjects were randomly assigned to a pregabalin group or a placebo group and 50 of them completed the study. The correlation of initial CPM with the change in CPM was compared between the pregabalin and placebo groups. |
CPM significantly affected the pregabalin group, but not the placebo group (pregabalin group p < 0.001; placebo group: p = 0.56) which indicate that pregabalin has a greater endogenous analgesic effect in individuals with lower original endogenous analgesia. |
| Pramod et al.22 Pramod G V, Shashikanth MC, Shambulingappa P, Lele S. Analgesic efficacy of dia-zepam and placebo in patients with temporomandibular disorders: a double blind randomized clinical trial. Indian J Dent Res. 2011;22(3):404-9.
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To evaluate and compare the analgesic efficacy of placebo and diazepam in patients with temporomandibular disorder. |
35 patients with a diagnosis of temporomandibular dysfunction were recruited. The patients were randomly placed in one of two groups, placebo or diazepam. Mean pain intensity was recorded with the visual analog scale (VAS) at pre-treatment, at the weekly interval until completion of a three--week trial, and at the post-treatment visit at week eight of baseline. |
A statistically significant (P <0.01) decrease in temporomandibular dysfunction pain in the placebo group (65%) and a statistically significant (P <0.001) decrease in the diazepam group (72%) were observed on the VAS after three weeks of treatment. Inter-group comparison showed no statistically significant difference between the groups. |
| Nitecka-Buchta et al.3636 Nitecka-Buchta A, Nowak-Wachol A, Wachol K, Walczyńska-Dragon K, Olczyk P, Batoryna O. Myorelaxant effect of transdermal cannabidiol application in patients with tmd: a randomized, double-blind trial. J Clin Med. 2019;8(11):1886.
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To evaluate the efficiency of the myorelaxation effect of cannabidiol after transdermal application in patients with myofascial pain. |
60 TMD patients were randomly divided into 2 groups. Group 1 received transdermal cannabidiol and group 2 received topical placebo. Masseter muscle activity and pain intensity were measured by surface electromyography and VAS, respectively, for 14 days with topical applications twice daily. |
In group 1, masseter activity decreased significantly, being 11% in the right and 12.6% in the left masseter muscles. In group 2, masseter activity was recorded as 0.23% in the right masseter muscle and 3.3% in the left. Pain intensity on the VAS was significantly decreased in group 1: 70.2%, compared to group 2: 9.81%. |
