|Year : 2021 | Volume
| Issue : 3 | Page : 124-127
Comparing the Effects of Low-Level Laser Therapy with Ibuprofen in Improving Myofascial Pain Dysfunction Syndrome
Farid Abbasi1, Ali Moaddabi2, Ghazal Beithardan3, Mohammad Asnaashari4, Seyede Fateme Rezaei5, Amirhossein Moaddabi6
1 Department of Oral and Maxillofacial Medicine, School of Dentistry, Shahed University, Tehran, Iran
2 Oral and Maxillofacial Medicine Specialist, Sari, Iran
3 Dentist, Sari, Iran
4 Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
6 Department of Oral and Maxillofacial Surgery, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran
|Date of Submission||19-Aug-2021|
|Date of Decision||24-Aug-2021|
|Date of Acceptance||03-Sep-2021|
|Date of Web Publication||2-Nov-2021|
School of Dentistry, Khazar Blvd, Sari, Postal Code: 4816895475
Source of Support: None, Conflict of Interest: None
Introduction Myofascial pain dysfunction syndrome (MPDS) can be a consequence of conditions such as temporomandibular disorders. The aim of this study was to compare the effect of diode laser and ibuprofen to reduce pain and inflammation in patients with MPDS. Methods and materials: In this study, 40 patients with MPDS were randomly divided into two groups. One group received ibuprofen 500 mg two times a day for 3 weeks and had placebo laser sessions. The other group received active laser (diode 810 nm CW) as treatment factor and placebo drug. Pain intensity was measured by visual analog scale and maximum painless mouth opening was also measured as a functional index every session and in a 2-month follow-up. Data were collected and analyzed using independent t test and analysis of variance (α = 0.05). Results Low-level laser group showed a significant reduction in pain and a significant increase in mouth opening. In ibuprofen group, neither pain intensity nor maximum mouth opening had significant improvement. Conclusion Treatment with low-level laser improved mouth opening and pain intensity significantly in patients with MPDS. Therefore, low-level laser can be a good treatment modality for these patients.
Keywords: Low-level laser therapy, myofascial pain, temporomandibular disorders
|How to cite this article:|
Abbasi F, Moaddabi A, Beithardan G, Asnaashari M, Rezaei SF, Moaddabi A. Comparing the Effects of Low-Level Laser Therapy with Ibuprofen in Improving Myofascial Pain Dysfunction Syndrome. Dent Hypotheses 2021;12:124-7
|How to cite this URL:|
Abbasi F, Moaddabi A, Beithardan G, Asnaashari M, Rezaei SF, Moaddabi A. Comparing the Effects of Low-Level Laser Therapy with Ibuprofen in Improving Myofascial Pain Dysfunction Syndrome. Dent Hypotheses [serial online] 2021 [cited 2022 Jan 27];12:124-7. Available from: http://www.dentalhypotheses.com/text.asp?2021/12/3/124/329755
| Introduction|| |
Temporomandibular disorders (TMDs) are heterogeneous disorders that involve temporomandibular joint, masseter muscles, or both, and are accompanied with muscle or joint pain, joint crackle, mouth-opening restriction and deviation. The etiology of TMD includes a wide range of biological, behavioral, environmental, emotional, cognitive, and genetic factors. One of the most common TMD is myofascial pain dysfunction syndrome (MPDS)., In the majority of cases, MPDS is due to involvement of masseter muscle.,
Among treatment modalities, drug therapy is the most common used option in patients. Nonsteroidal anti-inflammatory drugs (NSAIDs) are particularly used for alleviation of TMD symptoms., Ibuprofen, one of the most prevalent used NSAIDs for TMDs, inhibits prostaglandin production by reversible and nonselective inhibition of COX-1 and COX-2. The aim of treatment with ibuprofen is reducing pain and improving the function of masticatory system using its anti-inflammatory effects.
In the recent years, low potent lasers have been used to alleviate pain, inflammation, and muscular disorders., It has been shown that low-level lasers may be effective to reduce TMD pain, but there is no study comparing the effects of NSAIDs and low-level laser therapy on MPDS. Considering adverse drug effects in case of long-term use as needed for TMD, it is of great importance to find new ways to control pain and inflammation. Therefore, the aim of this study was to compare the effect of diode laser (810 nm) and ibuprofen to reduce pain and inflammation in patients with masticatory muscle pain.
| Methods and Materials|| |
This was a double-blind randomized clinical trial codenamed NCT01659372 at clinicaltrials.gov. Data gathering tool was interview and physical examination.
Patients with pain in masticatory muscles admitted to Dentistry Clinic of Shahid Beheshti University from September 2011 to February 2013 entered the study. Considering a power of 90% and confidence level of 95%, 17 patients were considered for each group. Inclusion criteria were patients with pain in masticatory muscles for at least 3 months and patient consent to participate. Exclusion criteria were patient disagreement, gastrointestinal and renal diseases, asthma, pregnancy, epidermal cancer and proliferative disorders, infectious and febrile diseases, epilepsy, diabetes, and thyroids diseases. Informed consent was obtained from all patients according to the principles mentioned in the Helsinki Declaration. Bioethics Committee of Shahid Beheshti Medical University approved this study (no. 69).
Forty-six patients with MPDS were enrolled in this study. Physical examination was performed for all patients by a resident of oral medicine under supervision of a professor of oral medicine. The examiners were blinded to patients’ allocation to the two groups. Pain in masticatory muscles was assessed by provocation test. Pain severity was assessed by visual analog scale (VAS) from 0 indicating no pain to 10 indicating the worst imaginable pain. Limitation in mouth opening was assessed by Helkimo index.,, Maximum mouth opening (MMO) was also examined. Patients were assigned into two groups using a matched-pair randomization design for age, sex, and pain intensity.
The laser group received laser therapy every day in the first week, every other day in the second week, and two visits a week in third and fourth weeks. Diode laser (continuous wave; Doctor Smile, Brendola, Italy, [email protected]; GA-Al-As 810 nm) was used. Patients’ follow-up was performed 2 months after the treatment course. In the ibuprofen group, patients received ibuprofen 400 mg each 12 hours for 3 weeks., Patients in laser group received a placebo drug physically similar to the ibuprofen tablets and those in ibuprofen group received placebo laser with the device in off mode.
Improvement in pain was measured using the Turk index characterized by 50% decrease in VAS. VAS and MMO changes were compared between the two groups.
Data analysis was performed using SPSS software (version 16.0; SPSS Inc., Chicago, Illinois, USA) by descriptive and analytic tests. Frequency, mean, standard deviation (SD), and median were calculated for descriptive analyses. Kolmogorov‒Smirnov test was used to assess data normal distribution. Independent T test and analysis of variance were used for comparison between the two groups (α = 0.05).
| Results|| |
In total, 46 patients were included in the study; six patients withdrew and the analysis was performed on 40 patients. Thirty patients (75%) were female. Regarding age, 10% were below 20 years, 50% between 20 and 40 years and 40% between 40 and 60 years. Twelve patients indicated that pain intensity was increased in anger. All patients indicated increased pain when chewing. Yawning and opening mouth increased pain intensity in 30 patients. Two patients mentioned increased pain when speaking. Three patients indicated increased pain intensity in cold climate. All patients had pain in masticatory muscles, 15 (37.5%) otalgia, 32 (80%) stiffness of masticatory muscles at morning, 8 patients (20%) headache, and 11 (27.5%) neck pain. Masseter muscle pain was observed in 85% of patients, medial pterygoid in 62%, lateral pterygoid in 55% and temporalis in 22%. Mean MMO was 32.27 mm. Based on the Helkimo index, 25 patients (62.5%) had mild limitation and 11 (27.5%) severe limitation. Four patients did not have any limitation in mouth opening. Eighteen patients (45%) had click while opening mouth, 16 patients (40%) deflection, and 5 (5.12%) deviation.
Changes in pain intensity were as follows: mean of pain intensity in laser group was 7.25 ± 1.51 and 6.6 ± 1.50 at the first session of treatment. After initiation of treatment, VAS decreased in the both groups, but the decrease was only significant in the laser group. Decrease in pain between the two groups reached a significant difference after the third session (P < 0.05) [Table 1].
|Table 1 Mean ± standard deviation values of pain intensity in patients during the treatment course|
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Mean of MMO in laser group was 31.63 ± 7.35 mm (mean ± SD) and 33.95 ± 3.85 mm (mean ± SD) in ibuprofen group. There was a significant difference regarding MMO after the seventh session of treatment (P < 0.05) [Table 2].
|Table 2 Mean ± standard deviation values of maximum mouth opening in patients during the treatment course|
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In laser group after the end of treatment, pain resolved in 15 patients (75%), 4 patients had (20%) VAS of 1, and 1 patient VAS of 2. Therefore, all patients resolved based on the Turk score (50% decrease in VAS). In ibuprofen group, pain alleviation and improvement in painless mouth opening did not reach a meaningful difference (P > 0.05).
| Discussion|| |
Based on this study, low-level laser group showed a significant reduction in pain and a significant increase in mouth opening. In the ibuprofen group, neither pain intensity nor MMO had significant improvement.
Associated symptoms of MPDS in our patients include otalgia, morning stiffness of masticatory muscles, headache, neck pain, long-term contraction of masticatory muscles during the night and following decrease in blood flow, and accumulation of nociceptive mediators. These associated symptoms were in accordance with the study by Mortazavi et al. In addition, headache was the most common associated symptom in a previous investigation. Prevalence of deflection and deviation in our study were in accordance with the study by Mortazavi et al. Based on our findings, masseter muscle was the most common masticatory muscle involved in MDPS, whereas in the investigation by Mortazavi et al., the most common site of pain was in the medial pterygoid muscle. In another study by Darbandi and Jajouei, the most involved muscle was lateral pterygoid muscle. These differences could be due to different demographic factors and habits of patients and different techniques of physical examination.
Ibuprofen is a NSAID with a peak effect of 1 to 4 hours and half-life of 24 hours. Therefore, using the medication two times a day provides its effective dosage in the blood. Ibuprofen has the least cardiovascular adverse effects among NSAIDs and its adverse effects include gastrointestinal and hematologic effects.
Several studies have been performed on the efficacy of low-level laser therapy on MPDS. For instance, in a study using GA-AL-AS laser therapy, Salmos-Brito et al. revealed that this low-level laser treatment improves mouth opening and pain severity in patients with chronic and acute myogenic TMD. Additionally, Wang et al. reported that low-level laser therapy significantly resolves pain and increases excursive mandibular movements in patients with TMDs. Similar findings indicative of effectiveness of low-level laser therapy have been reported in several other studies., However, some other researchers showed no meaningful difference between laser and placebo for the treatment of MPDS,, which could be due to inappropriate selection of laser device, nonselective excitatory power of the device, or inadequate treatment sessions.
Limitations of the present study were low cooperation of patients because of repeated visits and relatively high costs of laser therapy. Nevertheless, the efficacy of different laser modalities and wavelengths has to be explored in resolving TMD symptoms.
| Conclusion|| |
Low-level laser (810 nm) caused significant improvement in pain and mouth opening in patients with MPDS. Similar improvement was not observed in ibuprofen group. Therefore, low-level laser can be a good treatment modality for these patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F. Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:453-62.
Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. New Engl J Med. 2008;359:2693-705.
Cardelli P, Lattari M, Massaro P, Pollicita M, Barlattani A. Pharmacologic treatment of the dysfunctional patient. Minerva Stomatol 2005;54:265-79.
Bolouri A, Delavarian Z, Mortazavi H, Asl H, Falaki A, Falaki F. The effect of combination therapy with fluoxetine and clonazepam in my facial pain dysfunction syndrome. Aust J Basic Appl Sci 2011;5:520-5.
Martins RL, Palma A, Marquardt E, Gordin T. Temporomandibular disorders: a report of 124 patients. J Contemp Dent Pract 2010;11:071-8.
Fleckenstein J, Zaps D, Rüger LJ et al.
Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord 2010;11:1-9.
Cairns B. Pathophysiology of TMD pain-basic mechanisms and their implications for pharmacotherapy. J Oral Rehabil 2010;37:391-410.
Argoff CE. Pharmacologic management of chronic pain. J Am Osteopath Assoc 2002;10:21-7.
Tunç SK, Değirmenci BÜ, Yaylı NA, Aslan Ş, Akdeniz MŞ. Evaluation the effects of low-level laser therapy on disc displacement with reduction. Turk J Phys Med Rehabil 2020;66:24.
Del Vecchio A, Floravanti M, Boccassini A et al.
Evaluation of the efficacy of a new low-level laser therapy home protocol in the treatment of temporomandibular joint disorder-related pain: a randomized, double-blind, placebo-controlled clinical trial. Cranio 2021;39:141-50.
Ahmad SA, Hasan S, Saeed S, Khan A, Khan M. Low-level laser therapy in temporomandibular joint disorders: a systematic review. J Med Life 2021;14:148.
Okeson JP. Management of Temporomandibular Disorders and Occlusion-E-book. Elsevier Health Sciences; 2019 Feb 1.
Tuner J, Hode L. The Laser Therapy Handbook. Tallinn: Prima Books AB; 2004.
Seres JL. The fallacy of using 50% pain relief as the standard for satisfactory pain treatment outcome. In Pain Forum. Churchill Livingstone; 1999. Vol. 8, No. 4, pp. 183-8.
Mortazavi H, Javadzadeh A, Delavarian Z, Zare Mahmoodabadi R. Myofascial pain dysfunction syndrome (MPDS). Iran J Otorhinolaryngol. 2010;22:131-6.
Woo SB, Greenberg M. Ulcerative, vesicular and bullous lesions. Burket Oral Med. 2008;10:41-76.
Ta LE, Dionne RA. Treatment of painful temporomandibular joints with a cyclooxygenase-2 inhibitor: a randomized placebo-controlled comparison of celecoxib to naproxen. Pain 2004;111:13-21.
Darbandi A, Jajouei A. Etiology of TMJ Disorders in Patients Referred to Shahed Dental School Tehran-2000.
Salmos-Brito JAL, de Menezes RF, Teixeira CEC et al.
Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders. Lasers Med Sci 2013;28:57-64.
Wang X, Yang Z, Zhang W, Yi X, Liang C, Li X. Efficacy evaluation of low-level laser therapy on temporomandibular disorder. West China J Stomatol 2011;29:393-399.
Madani A, Ahrari F, Fallahrastegar A, Daghestani N. A randomized clinical trial comparing the efficacy of low-level laser therapy (LLLT) and laser acupuncture therapy (LAT) in patients with temporomandibular disorders. Lasers Med Sci 2020;35:181-92.
Ren H, Liu J, Liu Y, Yu C, Bao G, Kang H. Comparative effectiveness of low-level laser therapy with different wavelengths and transcutaneous electric nerve stimulation in the treatment of pain caused by temporomandibular disorders: a systematic review and network meta-analysis. J Oral Rehabil. 2021 Jul 21.
Carrasco TG, Guerisoli LDC, Guerisoli DMZ, Mazzetto MO. Evaluation of low intensity laser therapy in myofascial pain syndrome. Cranio 2009;27:243-7.
Emshoff R, Bösch R, Pümpel E, Schöning H, Strobl H. Low-level laser therapy for treatment of temporomandibular joint pain: a double-blind and placebo-controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:452-6.
[Table 1], [Table 2]