O uso do laser de baixa intensidade nas disfunções temporomandibulares: estudo clínico randomizado / The use of low intensity laser in temporomandibular dysfunctions: randomized clinical study

O desequilíbrio no Sistema Estomatognático pode levar a alterações em funções vitais, como a mastigação, deglutição e fonação. Essa ultrapassagem da tolerância fisiológica do indivíduo, pode desenvolver uma patologia conhecida como Disfunção Temporomandibular (DTM). O paciente pode apresentar dor nos músculos da mastigação e/ou nas articulações temporomandibulares (ATM) e pode estar associado a outras estruturas. A DTM é a principal causa de dor não dental na região orofacial, sendo esse sintoma a principal busca pelo tratamento, que abrange um grande número de recursos, incluindo fármacos, psicoterapia, eletroterapia, mobilização articular, entre outros. Mas uma técnica que tem ganhado destaque é o laser de baixa intensidade (LBI). Pois possuí efeitos antinflamatórios e antiálgicos. O objetivo deste estudo foi avaliar a eficácia do LBI em pacientes com DTM muscular. Para tal, uma amostra de 139 pacientes foi recrutada para a avaliação dos critérios de elegibilidade. A amostra final foi composta por 21 pacientes, os quais obedeceram aos critérios de inclusão e foram randomicamente alocados nos grupos de tratamento laser e placebo. Os pacientes foram tratados com o laser AsGaAl pontual de 808nm (100 mW/ 8 segundos ­ 30 J/cm²) com a aplicação sobre os pontos gatilhos dos músculos masseter e temporal anterior, em 8 sessões (2 vezes por semana). Os testes de Friedman, teste de Dunn e teste de Mann-Whitney com nível de significância de 5% (p<0.05) foram considerados. Os resultados obtidos mostraram que houve uma diferença estatisticamente significativa (p<0.05) ao avaliar a EVA (Escala Visual Analógica) pré e pós tratamento em ambos os grupos de tratamento, mas na comparação LBI com o placebo não houve diferença estatística significativa. Pode-se concluir que o tratamento a laser não é superior ao placebo(AU)

Imbalance in the Stomatognathic System can lead to changes in vital functions such as chewing, swallowing and phonation. This overcoming of the individual's physiological tolerance may develop a condition known as Temporomandibular Dysfunction (TMD). The patient may present pain in the chewing muscles and / or in the temporomandibular joints (TMJ) and may be associated with other structures. TMD is the main cause of non-dental pain in the orofacial region, and this symptom is the main search for treatment, which covers a large number of resources, including drugs, psychotherapy, electrotherapy, joint mobilization, among others. But one technique that has gained prominence is the low intensity laser (LBI). Because it has antiinflammatory and analgesic effects. The aim of this study was to evaluate the efficacy of LBI in patients with muscular TMD. To that end, a sample of 139 patients was recruited for the evaluation of the eligibility criteria. The final sample consisted of 21 patients, who met the inclusion criteria and were randomly assigned to the laser and placebo treatment groups. Patients were treated with the 808nm spot laser (100 mW / 8 seconds - 30J / cm²) with application on the trigger points of the masseter and anterior temporal muscles, in 8 sessions (2 times per week). Friedman's tests, Dunn's test and Mann-Whitney test with significance level of 5% (p <0.05) were considered. The results showed that there was a statistically significant difference (p <0.05) when evaluating VAS (Visual Analogue Scale) before and after treatment in both treatment groups, but in LBI comparison with placebo there was no significant statistical difference. It can be concluded that the laser treatment is not superior to placebo(AU)

[Definition, classification, clinical diagnosis and prognosis of fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles]. / Definition, Klassifikation, klinische Diagnose und Prognose des Fibromyalgiesyndroms : Aktualisierte Leitlinie 2017 und Übersicht von systematischen Übersichtsarbeiten.

BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A systematic search of the literature from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. RESULTS AND CONCLUSION: The clinical diagnosis of fibromyalgia syndrome can be established by the American College of Rheumatology (ACR) 1990 classification criteria (with examination of tender points) or without the examination of tender points by the modified preliminary diagnostic ACR 2010 or 2011 criteria.

The pelvic floor muscle hyperalgesia (PFMH) scoring system: a new classification tool to assess women with chronic pelvic pain: multicentre pilot study of validity and reliability.

OBJECTIVE: The contribution of pelvic floor muscle tenderness to chronic pelvic pain (CPP) is well established in the literature. However pelvic floor muscle hyperalgesia (PFMH) is often missed during vaginal examination of women with CPP. To our knowledge criteria for diagnosing PFMH has not been established or validated so far. The aim of this study is to assess the validity and reliability of the PFMH scoring system. STUDY DESIGN: Women with and without PFMH were recruited prospectively. Digital pelvic examination was performed to detect any pain. All women were asked to report of any discomfort or pain evoked by digital palpation of the PFMs and to rate the severity of pain/discomfort as none (grade 0), mild (grade I) moderate (grade II) or severe (grade III). All women were also asked to describe the severity of the pain/discomfort using a visual analogue scale (VAS). Following examination a PFMH score was given according to each patient's reactions. Intra-observer and inter-observer reliability was assessed. Construct and content validity was also determined. RESULTS: 111 (44 symptomatic and 67 controls) were recruited. Intraobserver reliability had ICCs between 0.426 and 0.804. Interobserver reliability had ICCs between 0.724 and 0.917. There was a good correlation between PFMH scores and VAS scores (rho 0.994, p<0.01). Total scores between symptomatic and controls were significantly different (p<0.01 Mann-Whitney U test). CONCLUSION: The PFMH scoring system is a simple, reliable, valid and easy screening tool for in the assessment of women with CPP.

Comparación de resultados obtenidos en el tratamiento del dolor miofascial de la cintura pélvica con toxina botulínica sola y asociada con lidocaína / Comparison of results obtained in the treatment of the myofascial pain of the pelvic girdle with botulinum toxin alone and associated with lidocaine

Objetivos: entre el 70 y el 85 % de la población adulta sufre de dolor de espalda alguna vez en su vida. El síndrome de dolor miofascial (SDM) ha sido descrito recientemente definiéndose como dolor musculoesquelético no inflamatorio, localizado, desarrollado sin causa aparente, refractario a tratamientos farmacológicos y físicos, y se acompaña de la presencia de puntos gatillos y de bandas tensas palpables en el músculo. Su prevalencia se estima que varía entre un 30 y un 85 %. Los músculos psoas, cuadrado lumbar y piramidal son los más frecuentemente implicados en el SDM de cintura pélvica. Una de las principales alternativas para tratar el SDM es la toxina botulínica tipo A (TB), que actúa en la membrana sináptica en la placa neuromuscular, inhibiendo la liberación de acetilcolina, produciendo relajación muscular y alivio del dolor, aunque, en muchas ocasiones, su efecto no se hace evidente hasta transcurridos varios días. La lidocaína es un anestésico local (AL) tipo amida con duración de acción intermedia que actúa impidiendo la propagación del impulso nervioso disminuyendo la permeabilidad de los canales de sodio. El objetivo de este estudio era comprobar si al añadir AL a ladosis de TB, conseguíamos un acortamiento en el tiempo dela reducción de la EVA y mejoría de la calidad de vida. Material y métodos: el diseño del estudio fue prospectivo, controlado, longitudinal y aleatorizado en el que se ha valorado la evolución de 20 pacientes divididos en dos grupos. Al primer grupo se les administró TB tipo A (grupo T). Al segundo grupo se les trató con TB tipo A y dosis adicional de lidocaína al 2% (grupo TL). Previamente, ambos grupos, habían respondido de forma positiva a un test con infiltración del músculo afecto con lidocaína al 2 %. El seguimiento de los pacientes se hizo secuencialmente a los 3, 7, 15 y 90 días de iniciado el tratamiento. Para el análisis estadístico se utilizó un análisis de la varianza, ANOVA, complementada por la prueba de Mauchly para comprobación de la esfericidad y la prueba de Greenhouse-Geisser, con un intervalo de confianza del 95 %, considerando una p<0,05 para establecer diferencias estadísticas. Resultados: hubo diferencia estadísticamente significativa entre la EVA del grupo TL Y TB en la valoración a los tres días, del mismo modo en la evaluación del índice de Lattinen. No hubo diferencias significativas en el resto de valoraciones. En ambos grupos hubo diferencia significativa en la reducción del EVA y mejoría del índice de Lattinen, al principio y final del estudio. Conclusiones: la TXB-A presenta una alternativa al tratamiento de este cuadro cuando la terapia conservadora ha fracasado. Los anestésicos locales producen una relajación previsible, breve y reversible de la musculatura provocada por el bloqueo de la conducción nerviosa en las terminaciones nerviosas, mientras que la TXB actúa en las terminaciones neuronales de la placa motora, impidiendo la liberación de la acetil colina. Su acción la ejercen en lugares distintos y con características diferentes. La acción de los anestésicos locales es casi instantánea y breve, la de la TXB es diferida y duradera en el tiempo, por lo que pueden ser complementarias y agonistas en su efecto final

Objectives: between 70 and 85 % of the adult population suffers from back pain sometime in their life. Myofascial pain syndrome (MPS) has been described recently and defined as a localized non-inflammatory musculoskeletal pain, developed without apparent cause, being refractory to pharmacological and physical treatments, and is accompanied by the presence of trigger points and palpable taut bands in the muscle. Its prevalence is estimated to vary between 30 and 85 %. The psoas, quadratus lumborum and pyramidal muscles are the most frequently involved in the pelvic girdle MPS. One of the main alternatives to treat MPS is botulinum toxin type A (BT), which acts in the synaptic membrane at the neuromuscular junction, inhibiting the release of acetylcholine, producing muscle relaxation and pain relief, although in many cases its effect is not evident until several days have passed. Lidocaine is an amide type local anesthetic with an intermediate duration of action, which act by preventing the propagation of nerve impulses by decreasing the permeability of sodium channels. The objective of this study was to test whether adding LA to the BT dose, we got a shortening in the time of the reduction of EVA and improvement in quality of life. Material and methods: the study design was prospective, controlled, longitudinal and randomized in which we have evaluated the evolution of 20 patients randomly divided into two groups. The first group were given BT A type (group T). The second group was treated with BT A type and an additional dose of 2 % lidocaine (group TL). Previously, both groups had responded positively to a test with lidocaine 2 % infiltration of the affected muscle. Monitoring patients was sequentially to 3, 7, 15 and 90 days of treatment performed. For statistical analysis we used an analysis of variance, ANOVA, complemented by Mauchly test for sphericity check and by Greenhouse-Geisser test, with a confidence interval of 95 %, considering p < 0.05 to establish statistical differences. Results: there was statistically significant difference between group EVA TL and TB in the assessment on the third day, just as in the evaluation of Lattinen Index. No significant differences in the other reviews. In both groups there was significant difference in EVA reduction and Lattinen Index improvement at the beginning and end of the study. Conclusions: BT-A presents an alternative to the management of this condition when conservative therapy has failed. Local anesthetics cause a predictable, short and reversible muscle relaxation caused by blocking nerve conduction in nerve endings, while BT acts on the neuronal endings of the motor plate, preventing the release of acetylcholine. Its action is exercised in different places and with different characteristics. The action of local anesthetics is almost instantaneous and short, the TXB action is delayed and long lasting, so both can be complementary and agonists in their final effect

A systematic comparison between subjects with no pain and pain associated with active myofascial trigger points.

OBJECTIVE: To determine whether standard evaluations of pain distinguish subjects with no pain from those with myofascial pain syndromes (MPS) and active myofascial trigger points (MTrPs) and to assess whether self-reports of mood, function, and health-related quality of life differ between these groups. DESIGN: A prospective, descriptive study. SETTING: University. PATIENTS: Adults with and without neck pain. METHODS: We evaluated adults with MPS and active (painful) MTrPs and those without pain. Subjects in the "active" (A) group had at least one active MTrP with spontaneous pain that was persistent, lasted longer than 3 months, and had characteristic pain on palpation. Subjects in the "no pain" (NP) group had no spontaneous pain. However, some of these subjects had discomfort upon MTrP palpation (latent MTrP), whereas others in the NP group had no discomfort upon palpation of nodules or had no nodules. OUTCOME MEASURES: Each participant underwent range of motion measurement, a 10-point manual muscle test, and manual and algometric palpation. The latter determined the pain/pressure threshold using an algometer of 4 predetermined anatomic sites along the upper trapezius. Participants rated pain using a verbal analog scale (0-10) and completed the Brief Pain Inventory and Oswestry Disability Scale (which included a sleep subscale), the Short -Form 36 Health Survey, and the Profile of Mood States. RESULTS: The A group included 24 subjects (mean age 36 years; 16 women), and the NP group included 26 subjects (mean age 26 years; 12 women). Group A subjects differed from NP subjects in the number of latent MTrPs (P = .0062), asymmetrical cervical range of motion (P = .01 for side bending and P = .002 for rotation), and in all pain reports (P < .0001), algometry (P < .03), Profile of Mood States (P < .038), Short Form 36 Health Survey (P < .01), and Oswestry Disability Scale (P < .0001). CONCLUSION: A systematic musculoskeletal evaluation of people with MPS reliably distinguishes them from subjects with no pain. The 2 groups are significantly different in their physical findings and self-reports of pain, sleep disturbance, disability, health status, and mood. These findings support the view that a "local" pain syndrome has significant associations with mood, health-related quality of life, and function.

[Tender points and trigger points--differences and similarities]. / Tender points i trigger points--róznice i podobienstwa.

Two main types of myalgia that are not inflammatory are fibromyalgia (FB) and myofasical pain (MFP). In both of them during diagnosing tender points (characteristic for fibromyalgia) and trigger points (MTrP--characteristic for myofasical pain) are of key importance. A great degree of similarity together with the inability to differentiate between those points result in wrong diagnosis and, as a consequence, failure of therapy. Additional difficulties are caused by the lack of unity in nomenclature, as in literature the term tender point and trigger point are used interchangeably. Moreover, some centres question the existence of fibromyalgia and myofascial pain as separate pain entities.

Chronic widespread musculoskeletal pain - a comparison of those who meet criteria for fibromyalgia and those who do not.

Fibromyalgia is currently classified as chronic widespread pain with widespread allodynia to pressure pain. There are few data describing pain characteristics, quality of life, consequences for daily living, and psychosocial status in patients who meet the classification criteria for fibromyalgia proposed by the American College of Rheumatology compared with patients with chronic widespread pain but not widespread allodynia. This study used a randomly selected sample from the general population. A postal questionnaire and a pain mannequin were sent to 9952 people. The response rate was 76.7%. The pain drawings showed that 345 people had widespread pain; that is, they noted pain in all four extremities and axially. Clinical examination, which included a manual tender point examination, was performed in 125 subjects. These people answered commonly used questionnaires on pain, quality of life, coping strategies, depression, and anxiety. Compared with chronic widespread pain without widespread allodynia, fibromyalgia was associated with more severe symptoms/consequences for daily life and higher pain severity. Similar coping strategies were found. Chronic widespread pain without widespread allodynia to pressure pain was found in 4.5% in the population and fibromyalgia in 2.5%.

Localización de puntos dolorosos miofasciales en cuello caracterización fisioterapeutica-kinesiologia / Location of painful points miofasciales in neck-physiotherapeutic characterization kinesiologica

Contenido: 7. Marco teórico, 8. EL dolor, 8. 1 Definición, 8. 2 Dolor agudo, 8. 3 Dolor crónico, 8. 4 Consideraciones del dolor, 8. 5 Fisiologia del dolor, 8. 6 Hiperalgesia, 8. 7 Conducción del impulso doloroso, 8. 8 Percepción del dolor en el cerebro, 8. 9 Otros aspectos de interes sobre el dolor, 9. Anatomia y fisiologia del cuello, 9. 1 Limites del cuello, 9. 2 Cotractura muscular, 9. 3 Tejido muscular Gereralidades, 10. El sindrome de Dolor Miofacial, 10. 1 La miofascia, 102, Puntos miofasciale, 103 Síntomas, 11. Causas, 12. Diagnostico, 12. 1 Diagnóstico diferencial, 13. Tratamiento, 13. 1 Tratamiento médico, 13. 2 Tratamiento fisioterapéutico y kinesiológico en el S. D. M. 14. Diseño metodologico, 14. 1 Tipo de estudio, 14. 2 Población, 14. 3 Metologia, 15. Material y metodo, 16. Limite temporo especial

Classification, epidemiology, and natural history of myofascial pain syndrome.

Myofascial pain syndrome is a disease of muscle that produces local and referred pain. It is characterized by a motor abnormality (a taut or hard band within the muscle) and by sensory abnormalities (tenderness and referred pain). It is classified as a musculoskeletal pain syndrome that can be acute or chronic, regional or generalized. It can be a primary disorder causing local or regional pain syndromes, or a secondary disorder that occurs as a consequence of some other condition. When it becomes chronic, it tends to generalize, but it does not change to fibromyalgia. It is a treatable condition that can respond well to manual and injection techniques, but requires attention to postural, ergonomic, and structural factors, and toxic or metabolic factors that impair muscle function.

Síndrome dolorosa miofascial disfuncional: revisão da literatura e relato de caso / Myofacial pain syndrome: literature review and report of a case

As disfunções têmporo-mandibulares, assim como as dores de origem muscular, são as causas mais freqüentes de desconforto nas regiões crânio-cérvico-maxilofaciais. Essas devem ser diferenciadas de outras algias faciais para que se possa chegar a um diagnóstico correto e consequentemente a um tratamento adequado. As dosres miofasciais são provenientes de estruturas musculares, tendinosas e de fáscias que sofrem estiramentos, esforços excessivos em contratura, isquemia e hiperemia, assim como nos processos traumáticos ou de natureza inflamatória. Esse trabalho objetiva apresentar uma forma de tratamento para um quadro específico dessa disfunção e ao mesmo tempo informar a respeito da gama de fatores envolvidos na Síndrome Dolorosa Miofascial Disfuncional

A narrative review on classification of pain conditions of the upper extremities.

Local and regional musculoskeletal discomfort and pain in the shoulder girdle or upper extremities are often reported, especially in the working population. In this review we describe the most important problems and factors when classifying musculotendinous pain in the upper extremities and shoulders. This includes an analysis of how four common diagnoses (wrist tenosynovitis, lateral epicondylitis, rotator-cuff tendinitis, myofascial pain syndrome) fulfil basic criteria of validity. It is evident that there are some serious problems regarding the validity of the current classification of the conditions. Clinical criteria are often poorly defined and the reliability insufficiently tested. The relationship to objective pathoanatomic or physiological findings seems inconsistent. Although magnetic resonance and ultrasonographic imaging are promising, they are still only preliminary methods for evaluation of tendon and connective tissue structures. The prognosis with and without treatment also seems heterogeneous and can vary between studies. A generally accepted terminology is lacking in the pathogenetically complex regional muscle pain conditions.

Painful rib syndrome. A variant of myofascial pain syndrome.

1. Painful rib syndrome has many similarities to a new classification of pain conditions called myofascial pain syndrome. Both conditions respond well to noninvasive, supportive nursing interventions. 2. Painful rib syndrome is characterized by pain in the upper abdomen or lower chest, a tender spot on the costal margin, and reproduction of pain when pressing on the tender spot or trigger point. 3. The most critical intervention is to explain the benign nature of the condition, and provide support that the pain is real and can be managed. Prognosis is not gender or age specific, but is related to treatment response. 4. Employees and their families living and working with pain syndromes need the nurses' ongoing support and advocacy. Pain syndromes are difficult to diagnose and treatment may not eliminate the pain.

Myofascial pain syndromes: where are we? Where are we going?

In recent years, research activity related to myofascial pain syndromes due to trigger points (TrPs) has blossomed. This paper introduces and relates the presentations made in a symposium entitled "Myofascial Pain Syndromes: Where are we? Where are we going?" at the 47th Annual Assembly of the American Academy of Physical Medicine and Rehabilitation in Kansas City October 2, 1985. It summarizes a number of recent research advances and key research issues related to myofascial pain syndromes: 1. Thermography appears valuable for imaging the reflex thermal tracks of previously identified TrPs. 2. Three new devices are reported to measure reliably the pressure threshold for pain of TrPs and tender points (TePs). 3. Fibrositis/fibromyalgia and myofascial pain syndromes may or may not be separate entities. The question needs to be resolved. 4. New evidence strongly supports previous indications that a TrP is a region of increased energy consumption with an inadequate oxygen supply. 5. A foundation has been established for investigating the sensitizing agent(s) responsible for the increased sensitivity of TrPs and muscular TePs. 6. At least four mechanisms can account for the pain referred by TrPs in muscles. The convergence-projection mechanism appears to be consistently present in visceral pain pathways and to be likely in mammalian muscle nociceptive pathways.