Comparative Efficacy of Low-Level Laser Acupuncture and Cupping for Treatment of Patients with Myofascial Pain Dysfunction Syndrome: A Double-blinded, Randomized Clinical Trial
Abstract
Background: Myofascial pain dysfunction syndrome (MPDS) is among the most common causes of facial pain. This study compared the efficacy of low-level laser (LLL) acupuncture and cupping for the treatment of MPDS. Materials and Methods: This double-blind, before-after, randomized clinical trial evaluated 60 MPDS patients that were divided into two groups for LLL acupuncture (808 nm, 0.5 W, 30 J, 4 J/cm2 energy density, 60 seconds; group 1), and cupping (group 2) of masticatory muscle trigger points. Both treatments were performed for maximally eight sessions once every other day. The level of pain at the trigger points was measured upon admission, before and 5 minutes after treatment in each session, at ten days, and two months after treatment completion by a visual analog scale (VAS). The painless maximum mouth opening (MMO) and patient satisfaction with treatment were also assessed at the time as mentioned earlier points. Results: Averagely, 4.5 treatment sessions were required to achieve a 50% reduction in VAS pain score, with no significant difference between the two groups (P=0.9). Both treatments significantly decreased the number of trigger points and pain score, but this reduction occurred significantly sooner in the cupping group (P<0.01). MMO significantly improved in both groups after treatment with no significant difference between them (P=0.2). Patients were significantly more satisfied with LLL acupuncture (P<0.05). Conclusion: Both cupping and LLL acupuncture are equally effective for MPDS; thus, the patient can choose the type of treatment after receiving sufficient information regarding the two modalities. [GMJ.2022;11:e2305]References
Carrara SV, Conti PC, Barbosa JS. Termo do 1º consenso em disfunção temporomandibular e dor orofacial. Dental Press Journal of Orthodontics. 2010;15:114-20.
https://doi.org/10.1590/S2176-94512010000300014
Greene CS. The etiology of temporomandibular disorders: implications for treatment. J Orofac Pain. 2001;15(2):93-105.
Glaros AG. Temporomandibular disorders and facial pain: a psychophysiological perspective. Appl Psychophysiol Biofeedback. 2008 ;33(3):161-71.
https://doi.org/10.1007/s10484-008-9059-9
PMid:18726689
Al-Jundi MA, John MT, Setz JM, Szentpétery A, Kuss O. Meta-analysis of treatment need for temporomandibular disorders in adult nonpatients. J Orofac Pain. 2008;22(2):97-107.
Thilander B, Bjerklin K. Posterior crossbite and temporomandibular disorders (TMDs): need for orthodontic treatment?. Eur J Orthod. 2012;34(6):667-73.
https://doi.org/10.1093/ejo/cjr095
PMid:21896884
Manfredini D, Winocur E, Ahlberg J, Guarda-Nardini L, Lobbezoo F. Psychosocial impairment in temporomandibular disorders patients. RDC/TMD axis II findings from a multicentre study. J Dent. 2010;38(10):765-72.
https://doi.org/10.1016/j.jdent.2010.06.007
PMid:20600559
de Oliveira SB, de Siqueira SR, Sanvovski AR, do Amaral LM, de Siqueira JT. Temporomandibular Disorder in Brazilian patients: a preliminary study. J Clin Psychol Med Settings. 2008;15(4):338-43.
https://doi.org/10.1007/s10880-008-9135-6
PMid:19104992
Ohrbach R, Turner JA, Sherman JJ, Mancl LA, Truelove EL, Schiffman EL, Dworkin SF. The Research Diagnostic Criteria for Temporomandibular Disorders. IV: evaluation of psychometric properties of the Axis II measures. J Orofac Pain. 2010;24(1):48-62.
Dworkin SF, Sherman J, Mancl L, Ohrbach R, LeResche L, Truelove E. Reliability, validity, and clinical utility of the research diagnostic criteria for Temporomandibular Disorders Axis II Scales: depression, non-specific physical symptoms, and graded chronic pain. J Orofac Pain. 2002;16(3):207-20.
John MT, Dworkin SF, Mancl LA. Reliability of clinical temporomandibular disorder diagnoses. Pain. 2005;118(1-2):61-9.
https://doi.org/10.1016/j.pain.2005.07.018
PMid:16154702
Bolouri AJ, Delavarian Z, Mortazavi H, ASl HR, Falaki A, Falaki F. The effect of combination therapy with Fluoxetine and Clonazepam in My facial Pain Dysfunction Syndrome. Aust. J. Basic & Appl. Sci. 2011;5(12):520-5.
Barbosa TS, Leme MS, Castelo PM, Gavião MB. Evaluating oral health-related quality of life measure for children and preadolescents with temporomandibular disorder. Health Qual Life Outcomes. 2011;9(1):1-12.
https://doi.org/10.1186/1477-7525-9-32
PMid:21569403 PMCid:PMC3115836
Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008;359(25):2693-705.
https://doi.org/10.1056/NEJMra0802472
PMid:19092154
Sipilä K, Zitting P, Siira P, Laukkanen P, Järvelin M-R, Oikarinen KS, et al. Temporomandibular disorders, occlusion, and neck pain in subjects with facial pain: a case-control study. Cranio. 2002;20(3):158-64.
https://doi.org/10.1080/08869634.2002.11746206
PMid:12150261
Alencar Jr F, Becker A. Evaluation of different occlusal splints and counselling in the management of myofascial pain dysfunction.J Oral Rehabil. 2009;36(2):79-85.
https://doi.org/10.1111/j.1365-2842.2008.01913.x
PMid:18976268
Fleckenstein J, Zaps D, Rüger LJ, Lehmeyer L, Freiberg F, Lang PM, Irnich D. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord. 2010;11(1):1-9.
https://doi.org/10.1186/1471-2474-11-32
PMid:20149248 PMCid:PMC2836281
Cairns BE. Pathophysiology of TMD pain-basic mechanisms and their implications for pharmacotherapy. J Oral Rehabil. 2010;37(6):391-410.
https://doi.org/10.1111/j.1365-2842.2010.02074.x
PMid:20337865
Argoff CE, Kopecky EA. Patients with chronic pain and dysphagia (CPD): unmet medical needs and pharmacologic treatment options. Curr Med Res Opin. 2014;30(12):2543-59.
https://doi.org/10.1185/03007995.2014.967388
PMid:25244248
Rosted P, Bundgaard M, Pedersen AM. The use of acupuncture in the treatment of temporomandibular dysfunction-an audit. Acupunct Med. 2006;24(1):16-22.
https://doi.org/10.1136/aim.24.1.16
PMid:16618045
La Touche R, Angulo-Díaz-Parreño S, de-la-Hoz JL, Fernández-Carnero J, Ge HY, Linares MT, Mesa J, Sánchez-Gutiérrez J. Effectiveness of acupuncture in the treatment of temporomandibular disorders of muscular origin: a systematic review of the last decade. J Altern Complement Med. 2010;16(1):107-12.
https://doi.org/10.1089/acm.2008.0484
PMid:20038262
Cidral-Filho FJ, Da Silva MD, Moré AO, Córdova MM, Werner MF, Santos AR. Manual acupuncture inhibits mechanical hypersensitivity induced by spinal nerve ligation in rats. Neuroscience. 2011;193:370-6.
https://doi.org/10.1016/j.neuroscience.2011.07.076
PMid:21835228
Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008;85(4):355-75.
https://doi.org/10.1016/j.pneurobio.2008.05.004
PMid:18582529
Ebneshahidi NS, Heshmatipour M, Moghaddami A, Eghtesadi-Araghi P. The effects of laser acupuncture on chronic tension headache-a randomised controlled trial. Acupunct Med. 2005;23(1):13-8.
https://doi.org/10.1136/aim.23.1.13
PMid:15844435
Ferreira LA, de Oliveira RG, Guimarães JP, Carvalho AC, De Paula MV. Laser acupuncture in patients with temporomandibular dysfunction: a randomized controlled trial. Lasers Med Sci. 2013;28(6):1549-58.
https://doi.org/10.1007/s10103-013-1273-x
PMid:23380907
Litscher G. High-tech laser acupuncture is Chinese medicine. Medical Acupuncture. 2008;20(4):245-54.
https://doi.org/10.1089/acu.2008.0643
Schikora D. Laserneedle acupuncture: a critical review and recent results. Medical Acupuncture. 2008;20(1):37-42.
https://doi.org/10.1089/acu.2007.0606
Litscher G, Wang L, Wiesner-Zechmeister M. Specific effects of laserpuncture on the cerebral circulation. Lasers Med Sci.science. 2000;15(1):57-62.
https://doi.org/10.1007/s101030050048
PMid:24590200
Chi LM, Lin LM, Chen CL, Wang SF, Lai HL, Peng TC. The Effectiveness of Cupping Therapy on Relieving Chronic Neck and Shoulder Pain: A Randomized Controlled Trial. Evid Based Complement Alternat Med. 2016;2016:7358918.
https://doi.org/10.1155/2016/7358918
PMid:27073404 PMCid:PMC4814666
Aboushanab TS, AlSanad S. Cupping therapy: an overview from a modern medicine perspective. J Acupunct Meridian Stud. 2018;11(3):83-7.
https://doi.org/10.1016/j.jams.2018.02.001
PMid:29436369
Al-Bedah AM, Elsubai IS, Qureshi NA, Aboushanab TS, Ali GI, El-Olemy AT, Khalil AA, Khalil MK, Alqaed MS. The medical perspective of cupping therapy: Effects and mechanisms of action. J Tradit Complement Med. 2019;9(2):90-7.
https://doi.org/10.1016/j.jtcme.2018.03.003
PMid:30963043 PMCid:PMC6435947
Salmos-Brito JA, de Menezes RF, Teixeira CE, Gonzaga RK, Rodrigues BH, Braz R, Bessa-Nogueira RV, de Martínez Gerbi ME. Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders. Lasers Med Sci. 2013;28(1):57-64.
https://doi.org/10.1007/s10103-012-1065-8
PMid:22367394
Ahrari F, Madani AS, Ghafouri ZS, Tunér J. The efficacy of low-level laser therapy for the treatment of myogenous temporomandibular joint disorder. Lasers Med Sci. 2014;29(2):551-7.
https://doi.org/10.1007/s10103-012-1253-6
PMid:23318917
Uemoto L, de Azevedo RN, Alfaya TA, Reis RN, de Gouvêa CV, Garcia MA. Myofascial trigger point therapy: laser therapy and dry needling. Curr Pain Headache Rep. 2013;17(9):357.
https://doi.org/10.1007/s11916-013-0357-4
PMid:23904202
Fernández-Carnero J, La Touche R, Ortega-Santiago R, Galan-del-Rio F, Pesquera J, Ge HY, Fernández-de-Las-Peñas C. Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders. J Orofac Pain. 2010;24(1):106-12.
Okeson JP. Management of Temporomandibular Disorders and Occlusion-E-Book. Elsevier Health Sciences. 2014:184-91.
Glick M. Burket's oral medicine. PMPH USA. 2015:281.
Carlsson GE, Magnussan T. Managment Of Temporomandibular Disorders In The General Dental Practice. Quintessence Publishing Company; 1999:183-8.
Mortazavi H, Javadzadeh A, Delavarian Z, Zare Mahmoodabadi R. Myofascial pain dysfunction syndrome (MPDS). Iranian Journal of Otorhinolaryngology. 2010;22(4):131-6.
Rajkannan P. Dry needling technique in myogenous temporomandibular disorders: A clinical commentary. Journal of Advanced Clinical and Research Insights. 2016;3(3):107-9.
https://doi.org/10.15713/ins.jcri.116
Tanganeli JP, de Souza Zaroni WC. Trigger Point Inactivation by Infrared Low Level Laser Therapy Compared With Dry Needling. Advances in Dentistry & Oral Health. 2017.
https://doi.org/10.19080/ADOH.2017.06.555688
Tham LM, Lee HP, Lu C. Cupping: from a biomechanical perspective. J Biomech . 2006;39(12):2183-93.
https://doi.org/10.1016/j.jbiomech.2005.06.027
PMid:16126216
Khalique SKA, Ukhalkar V. Cupping therapy in pain management-A review. National Journal of Research in Ayurved Science. 2019;7(3).
https://doi.org/10.52482/ayurlog.v7i03.367
Alkhutari AS, Alyahya A, PC RC, Christidis N, Al-Moraissi EA. Is the therapeutic effect of occlusal stabilization appliances more than just placebo effect in the management of painful temporomandibular disorders? A network meta-analysis of randomized clinical trials. J Prosthet Dent. 2021;126(1):24-32.
https://doi.org/10.1016/j.prosdent.2020.08.015
PMid:33070972
Costa SAP, Florezi GP, Artes GE, Costa JRD, Gallo RT, Freitas PM, et al. The analgesic effect of photobiomodulation therapy (830 nm) on the masticatory muscles: a randomized, double- blind study. Braz Oral Res. 2017;31:e107.
https://doi.org/10.1590/1807-3107bor-2017.vol31.0107
Madani AA, Mahdizadeh F. Prevalence of temporo mandibular joint disorders in patients referred to mashhad dental school. 2002;20(2):242-51.
Darbandi A, Jajouei A. Etiology of TMJ Disorders in Patients Referred to Shahed Dental School Tehran-2000. 2003;21(1):36-43.
Seifi M, Ebadifar A, Kabiri S, Badiee MR, Abdolazimi Z, Amdjadi P. Comparative Effectiveness of Low Level Laser Therapy and Transcutaneous Electric Nerve Stimulation on Temporomandibular Joint Disorders. J Lasers Med Sci. 2017;8(1):27-31.
https://doi.org/10.15171/jlms.2017.s6
PMid:29071032 PMCid:PMC5642175
Khalighi HR, Mortazavi H, Mojahedi SM, Marhabi SA, Abbasabadi FM. Low level laser therapy versus pharmacotherapy in improving myofascial pain disorder syndrome. J Lasers Med Sci. 2016;7(1):45-50.
https://doi.org/10.15171/jlms.2016.10
PMid:27330698 PMCid:PMC4908981
Azizi A, Sahebjamee M, Lawaf S, Jamalee F, Maroofi N. Effects of Low-level Laser in the Treatment of Myofascial Pain Dysfunction Syndrome. J Dent Res Dent Clin Dent Prospects. 2007;1(2):53-8.
Manfredini D, Favero L, Cocilovo F, Monici M, Guarda-Nardini L. A comparison trial between three treatment modalities for the management of myofascial pain of jaw muscles: A preliminary study. Cranio. 2018;36(5):327-31.
https://doi.org/10.1080/08869634.2017.1349571
PMid:28697676
Basili M, Barlattani Jr A, Venditti A, Bollero P. Low-level laser therapy in the treatment of muscle-skelet pain in patients affected by temporo-mandibular disorders. Oral Implantol (Rome). 2017;10(4):406-11.
https://doi.org/10.11138/orl/2017.10.4.406
PMid:29682258 PMCid:PMC5892668
Wang X, Yang Z, Zhang W, Yi X, Liang C, Li X. Efficacy Evaluation of Low-Level Laser Therapy on Temporomandibular Disorder. Hua Xi Kou Qiang Yi Xue Za Zhi. 2011;29(4):393-9.
Rohlig BG, Kipirdi S, Meric U, Capan N, Keskin H. Detailed Search Results Masticatory muscle pain and low-level laser therapy: a double-blind and placebo-controlled study. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi [Turkish Journal of Physical Medicine and Rehabilitation]. 2011;57(1):31-7
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