ABSTRACT
Temporomandibular joint (TMJ) arthrocentesis is one of the most commonly used non-invasive surgical interventions in the treatment of refractory pain and dysfunction associated with internal derangement. Several adjunctive therapies have been used in combination with arthrocentesis in an attempt to increase its efficacy and long-term maintenance. Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor which is used in different chronic pain conditions. This study aimed to assess the efficacy of duloxetine in combination with arthrocentesis compared with arthrocentesis alone. Twenty-eight patients with chronic TMJ pain were included and randomly allocated into 2 groups (control and study groups). The control group included patients who underwent TMJ arthrocentesis only, and the study group included patients who underwent arthrocentesis followed by giving duloxetine (30 mg) orally twice daily for 3 months. Pain, maximum mouth opening, and level of anxiety and depression were assessed preoperatively and followed at regular intervals of 1 week, 1 month, 3 months, and 6 months postoperatively. Pain was significantly reduced in both groups at all postoperative intervals and was significantly lower in the study group than the control group at 6 months. Maximum mouth opening increased significantly in both groups, but the difference between them was not significant. Level of anxiety and depression was significantly decreased in both groups, with no statistically significant difference between them. The results of this study indicate that duloxetine in combination with arthrocentesis may provide effective and long-term pain control; however, its use is associated with a higher risk of adverse events.
Subject(s)
Arthrocentesis , Duloxetine Hydrochloride , Pain Measurement , Temporomandibular Joint Disorders , Humans , Duloxetine Hydrochloride/therapeutic use , Female , Male , Adult , Temporomandibular Joint Disorders/drug therapy , Temporomandibular Joint Disorders/surgery , Arthrocentesis/methods , Treatment Outcome , Combined Modality Therapy , Middle Aged , Anxiety , Depression , Chronic Pain/drug therapy , Serotonin and Noradrenaline Reuptake Inhibitors/therapeutic use , Serotonin and Noradrenaline Reuptake Inhibitors/administration & dosageABSTRACT
Attempts of needle relocation and extension of the operation time are the most common cause of postoperative edema and swelling after temporomandibular joint arthrocentesis. To facilitate the placement of needles and decrease patient discomfort, a template-based technique that includes design of patient-specific guide was performed to direct access to the temporomandibular joint space for arthrocentesis.
