ABSTRACT
AIMS: To compare the effectiveness of adding cyclobenzaprine, tizanidine, or placebo to patient education and a self-care management program for patients with myofascial pain and specifically presenting with jaw pain upon awakening. METHODS: Forty-five patients with a diagnosis of myofascial pain based on the guidelines of the American Academy of Orofacial Pain participated in this 3-week study. The subjects were randomly assigned into one of three groups: placebo group, TZA group (tizanidine 4 mg), or CYC group (cyclobenzaprine 10 mg). Patients were evaluated for changes in pain intensity, frequency, and duration by using the modified Severity Symptoms Index and changes in sleep quality with the use of the Pittsburgh Sleep Quality Index. Data were analyzed by ANOVA and post-hoc or nonparametric statistical tests as appropriate. RESULTS: All three groups had a reduction in pain symptoms and improvement of sleep quality based on a comparison of pretreatment and treatment scores. However, no significant differences among the groups were observed at the posttreatment evaluation. CONCLUSION: The use of tizanidine or cyclobenzaprine in addition to self-care management and patient education was not more effective than placebo for the management of patients with myofascial jaw pain upon awakening.
Subject(s)
Amitriptyline/analogs & derivatives , Clonidine/analogs & derivatives , Muscle Relaxants, Central/therapeutic use , Patient Education as Topic , Self Care , Temporomandibular Joint Dysfunction Syndrome/therapy , Adolescent , Adult , Aged , Amitriptyline/therapeutic use , Analgesics, Non-Narcotic/therapeutic use , Clonidine/therapeutic use , Double-Blind Method , Facial Pain/drug therapy , Facial Pain/therapy , Female , Humans , Ibuprofen/therapeutic use , Male , Middle Aged , Pain Measurement , Placebos , Severity of Illness Index , Sleep/physiology , Temporomandibular Joint Dysfunction Syndrome/drug therapy , Treatment Outcome , Young AdultABSTRACT
Trigger point injections with different solutions have been studied mainly with regard to the management of myofascial pain (MFP) patient management. However, few studies have analyzed their effect in a chronic headache population with associated MFP. The purpose of this study was to assess if trigger point injections using botulinum toxin, lidocaine, and dry-needling injections for the management of local pain and associated headache management. Forty-five (45) myofascial pain patients with headaches that could be reproduced by activating at least one trigger point, were randomly assigned into one of the three groups: G1, dry-needling, G2, 0.25% lidocaine, at 0.25% and G3 botulinum toxin and were assessed during a 12 week period. Levels of pain intensity, frequency and duration, local postinjection sensitivity, obtainment time and duration of relief, and the use of rescue medication were evaluated. Statistically, all the groups showed favorable results for the evaluated requisites (p < or = 0.05), except for the use of rescue medication and local post injection sensitivity (G3 showed better results). Considering its reduced cost, lidocaine could be adopted as a substance of choice, and botulinum toxin should be reserved for refractory cases, in which the expected effects could not be achieved, and the use of a more expensive therapy would be mandatory.
Subject(s)
Anesthetics, Local/administration & dosage , Botulinum Toxins/administration & dosage , Headache/drug therapy , Lidocaine/administration & dosage , Myofascial Pain Syndromes/drug therapy , Neuromuscular Agents/administration & dosage , Headache/classification , Headache/etiology , Humans , Injections, Intramuscular , Myofascial Pain Syndromes/complications , Needles , Statistics, Nonparametric , Treatment OutcomeABSTRACT
Trigger point injections with different solutions have been studied mainly with regard to the management of myofascial pain (MFP) patient management. However, few studies have analyzed their effect in a chronic headache population with associated MFP. The purpose of this study was to assess if trigger point injections using lidocaine associated with corticoid would be better than lidocaine alone, as in comparison with dry-needling in for the management of local pain and associated headache management. Forty-five (45) myofascial pain patients with headaches that could be reproduced by activating at least one trigger point, were randomly assigned into one of the three groups: G1, dry-needling, G2, 0.25% lidocaine, at 0.25% and G3, 0.25% lidocaine at 0.25% associated with corticoid, and were assessed during a 12 week period. Levels of pain intensity, frequency and duration, local post-injection sensitivity, obtainment time and duration of relief, and the use of rescue medication were evaluated. Statistically, all three groups showed favorable results for the evaluated requisites (p < or = 0.05), but only for post-injection sensitivity did the association of lidocaine with corticoid present the best results and ingestion of rescue medication.
