UTCAT611, Found CAT view, CRITICALLY APPRAISED TOPICs

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Title

Biofeedback, Acupuncture And Possibly Massage Are Beneficial For TMD

Clinical Question

Are Biofeedback, Massage and Acupuncture Beneficial for TMD?

Clinical Bottom Line

Meta analysis supports the use of Biofeedback. Clinical trials support the use of acupuncture, self exercise, and massage. There is an absence of primary research articles on acupressure on PUBMED. A narrative review article argues in favor of muscle stretching, self massage, trigger point massage, biofeedback, and relaxation techniques. (See Comments on the CAT below)

Best Evidence

(you may view more info by clicking on the PubMed ID link)

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
#1) 7629347	Wright/1995		Review Article
Key results	Muscle stretching, self massage, trigger point massage, biofeedback, and relaxation techniques are effective and useful for patients. Injection of trigger points with local anesthetic seems to be useful. Acupuncture is as helpful as splint therapy, but only provides temporary benefit.
#2) 10425966	Crider/1999		Meta Analysis
Key results	Biofeedback treatment for TMD is superior to placebo. 69% of patients become symptom free or experience significant improvement.
#3) 18082232	Katsoulis/2008	27 patients with TMD	Clinical Trial
Key results	TMD patients received 6 sessions of physical therapy consisting of oral and facial massage and education about self exercise of the TM joint. This was a single group trial with no control or comparison group. 93% of patients had a significant reduction of pain, p< .05.
#4) 7629347	Shen/2009	28 adults diagnosed with chronic myofacial pain	Randomized controlled trial
Key results	Acupuncture recipients had decreased jaw pain, decreased jaw tightness, decreased neck pain, (p = .04) and increased pain tolerance in the masseter muscle (p = .001), when compared with recipients of sham acupuncture.

Evidence Search

"Temporomandibular Joint Dysfunction Syndrome"[Mesh] and "complementary therapies" [Mesh] limited to Review Articles. To find more specific articles searched under"Temporomandibular Joint Dysfunction Syndrome"[Mesh] and "Biofeedback, Psychology"[Mesh]"Massage"[Mesh] and "Temporomandibular Joint Dysfunction Syndrome"[Mesh] did not yield satisfactory results, meta analysis article found because it cited narrative review."Acupuncture Therapy"[Mesh] and “Temporomandibular Joint Dysfunction Syndrome"[Mesh]

Comments on
The Evidence

The topic of complementary and alternative therapy for TMD is broad. The 1995 article is included in the evidence because it is the only review article to deal with the large topic. Many articles are available providing solid clinical evidence on specific alternative therapies for TMD. The evidence supporting biofeedback, massage and acupuncture is strong.

Applicability

The alternative medicine therapies reviewed may be appropriate for TMD patients diagnosed with Myofacial Pain.

Specialty/Discipline

(General Dentistry) (Behavioral Science)

Keywords

Temporomandibular Joint Dysfunction Syndrome;Complementary therapies

ID#

611

Date of submission:

05/10/2010

E-mail

paynejr@uthscsa.edu

Author

James Payne

Co-author(s)

Co-author(s) e-mail

Faculty mentor/Co-author

Edward F. Wright, DDS, MS

Faculty mentor/Co-author e-mail

WrightE2@uthscsa.edu

Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)	post a rationale
None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

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