Temporomandibular disorders (TMD) encompass dysfunction and pain of the masticatory muscles and temporomandibular joint (TMJ). Pain in the TMJ, restricted jaw movement, and joint sounds are common conditions in this disorder. This can impact patients' ability to perform daily activities such as eating, speaking, laughing, or yawning, significantly affecting their quality of life.
The TMJ and masticatory muscles are innervated by the auriculotemporal branch and the mandibular nerve (V3), a branch of the trigeminal nerve. An estimated 60% to 70% of the population shows signs of TMD, of which up to 12% report intense symptoms requiring treatment.
Percutaneous electrical nerve stimulation (PENS) could be a clinically relevant therapy in TMD patients applied through minimally invasive physiotherapy. To our knowledge, there are no trials evaluating the non-surgical clinical efficacy of PENS on the mandibular nerve.
The project's objective is to assess the effectiveness of PENS on the mandibular nerve in this type of condition.
Patients with local myofascial pain and/or increased tension in the masticatory muscles.
Patients with myofascial pain from temporomandibular disorder (TMD) at the time, diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD).
Absence of temporomandibular disc displacement with or without reduction.
Pain in the masticatory muscles associated with limited mouth opening (<40mm).
Injury to the face or head during the research participation.
Undergone surgical procedures performed in the craniocervical region and degenerative neurological diseases.
Sudden illness of the patient that prevented participation in the study.
Will to end participation in the study.
Parallel
Percutaneous nerve stimulation
Procedure/SurgeryPercutaneous nerve stimulation (PENS) involves inserting a dry needling needle through muscle tissue until it reaches a nerve branch. At this point, a bipolar TENS current with different parameters is applied to the needle with the goal of improving the patient's pain perception.
Manual therapy
Other interventionDigital pressure techniques in muscle areas with the aim of reducing the perception of stiffness and pain
exercise
Other interventionExercises for improving mandibular mobility, occlusion coordination and regulation of temporomandibular muscle tone
pain intensity
Numerical Pain Rating Scale (NPRS) (Appendix 2). Pain at rest and with chewing on a visual analogue scale. The minimum value is 0, and the maximum is 10. Higher values indicate more pain.
Pressure pain thresholds (PPT)
A pressure algometer (kg/cm2) will be used. The measurement will be taken with which the minimum amount of pressure applied to the masseter muscle produces pain.
Pain-free mandibular opening range of motion
herabite® System ruler (Appendix 3). 6 mm has been determined as the minimum detectable change in maximum mouth opening \[56\]. Mandibular range of motion (maximum mouth opening) will be measured with a device that allows the evaluation of mouth movements in millimeters.
Self-reported quality of life (SF-12)
The SF-12 Life Satisfaction Scale measures health-related quality of life. While not directly scoring life satisfaction, it assesses physical and mental health perceptions. Scores for each dimension provide insights into overall life satisfaction. The SF-12 comprises 12 questions across 8 dimensions, such as physical limitations, social roles, pain, and mental health. These yield two summary components: Physical Component Summary (PCS) and Mental Component Summary (MCS). Scores, standardized with a mean of 50 and a standard deviation of 10 in the general population, indicate better health-related quality of life with higher scores.
Electromyographic activation rate of the masseter muscle.
The surface EMG recording will be obtained using an 11 mDurance® four-channel surface electromyograph. The unit of measurement will be in picovolts. Higher picovolt detection indicates greater muscle excitability. Visual graphs will be used to represent the amount of activation of the masseter muscle. The EMG signal was captured in two tasks: during resting mandibular position (MR) and during a 5-second sustained maximum occlusion contraction (MVC).
Click on the lead sponsor to view all of their trials.
OrigenKinesis fisioterapia
Lead sponsor
Universidad Rey Juan Carlos
Collaborator
