A Comparative Analysis Between Soft Tissue Manipulation and Pharmacotherapy in TMJ Myofascial Dysfunction Management: A Randomized Controlled Trial.

BACKGROUND Myofascial pain dysfunction syndrome (MPDS) is a common musculoskeletal non-inflammatory disorder affecting the temporomandibular joint (TMJ) characterized by localized pain and restricted mouth opening. Patients with MPDS typically consult a dentist and are prescribed pharmacotherapy, which has associated side effects. Soft tissue manipulation is a safer and effective alternative to pharmacotherapy for MPDS. However, comparative studies are lacking between pharmacotherapy and manual therapy approaches.

PURPOSE To determine and compare the effectiveness of soft tissue manipulation versus pharmacotherapy in the management of MPDS affecting TMJ.

SETTING Dental and physiotherapy outpatient department settings of a tertiary care hospital.

PARTICIPANTS Individuals between 18 and 55 years of age presenting with pain on palpation of TMJ, restricted mouth opening, and intermittent clicking of joints.

RESEARCH DESIGN Single blinded randomized controlled trial.

INTERVENTION Thirty-four individuals were included and randomized into two groups. Seventeen individuals in the experimental group received soft tissue manipulation techniques such as massage and myofascial release (MFR) for facial muscles. The intervention was given by a qualified and trained physiotherapist who executed five hands-on sessions every other day over 10 days. Seventeen individuals in the control group were prescribed muscle relaxants with analgesics. The referring/consulting dentist prescribed medication for 7 days.

MAIN OUTCOME MEASURES In both groups, the patients were analyzed pre-and post-intervention using the following outcome measures: Numeric Pain Rating Scale (NPRS), Chronic Graded Pain Version (CGPV) 2.0, maximum mouth opening (MMO), and TMJ Disability Index (TMI).

RESULTS A statistically significant difference was observed in both groups for pain, CGPV2.0, MMO, and TMI with p = 0.001. An intergroup comparison showed no significant difference between the two groups in terms of pain (p = 0.066); however, a significant difference was noted in CGPV2.0, MMO, and TMI with p = 0.001, with the soft tissue manipulation group being superior to the pharmacotherapy group.

CONCLUSIONS Soft tissue manipulation was more effective in alleviating pain, improving mouth opening, and reducing disability in patients with MPDS of TMJ. Further, pharmacotherapy only showed an effect on pain reduction with no increase in mouth opening.