Magri Laís Valencise, Carvalho Vinícius Almeida, Rodrigues Flávia Cássia Cabral, Bataglion César, Leite-Panissi Christie Ramos Andrade
Psychobiology Graduate Program, School of Philosophy, Science and Literature of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14040-901, SP, Brazil.
Department of Restorative Dentistry of Dentistry School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14040-904, SP, Brazil.
Lasers Med Sci. 2017 Feb;32(2):419-428. doi: 10.1007/s10103-016-2138-x. Epub 2017 Jan 4.
Women with temporomandibular disorders (TMD) frequently report pain areas in body regions. This process is associated with central sensitization phenomena, present in chronic pain. The low-level laser therapy (LLLT) has been reported as a therapeutic option for the painful TMD treatment. The aim of this study was to analyze the effect of LLLT on pain intensity (visual analogue scale, VAS), pain sensitivity in orofacial and corporal points (pressure pain threshold, PPT), and on Short Form-McGill Pain Questionnaire (SF-MPQ) indexes of women with myofascial pain (subtype of muscle TMD). Ninety-one women (18-60 years) were included in the study, among which 61 were diagnosed with myofascial pain (Research Diagnostic Criteria for Temporomandibular Disorder-Ia and Ib) and were divided into laser (n = 31) and placebo group (n = 30), and 30 were controls. The LLLT was applied at pre-established points, twice a week, eight sessions (780 nm; masseter and anterior temporal = 5 J/cm, 20 mW, 10 s; TMJ area = 7.5 J/cm, 30 mW, 10 s). Pain intensity, pain sensitivity, and the SF-MPQ indexes were measured at the baseline, during laser sessions, and 30 days after treatment. For intra-group comparisons, the Friedman test was performed, and for inter-group, the Mann-Whitney test. Increased pain sensitivity was found in women with myofascial pain when compared to controls (p < 0.05). There was a reduction in pain intensity for both groups after LLLT. The LLLT did not change the PPT for any group (p > 0.05). Active laser and placebo reduced the indexes of sensory, total pain, and VAS, maintaining the results after 30 days; there was a reduction in the affective pain rating index for both groups, with no maintenance after 30 days for placebo, and the present pain intensity decreased in the laser group and did not change in the placebo after LLLT. In conclusion, the LLLT active or placebo are effective in reducing the overall subjective perception of myofascial pain (VAS and SF-MPQ indexes); however, they have no effectiveness in reducing the pain sensitivity in orofacial and corporal points (PPT increase).
患有颞下颌关节紊乱症（TMD）的女性经常报告身体其他部位有疼痛区域。这一过程与慢性疼痛中出现的中枢敏化现象有关。低强度激光疗法（LLLT）已被报道为治疗疼痛性TMD的一种治疗选择。本研究的目的是分析LLLT对肌筋膜疼痛（肌肉TMD的亚型）女性的疼痛强度（视觉模拟量表，VAS）、口面部和身体部位的疼痛敏感性（压痛阈，PPT）以及简短麦吉尔疼痛问卷（SF-MPQ）指标的影响。91名女性（18 - 60岁）被纳入研究，其中61名被诊断为肌筋膜疼痛（颞下颌关节紊乱症研究诊断标准 - Ia和Ib），并分为激光组（n = 31）和安慰剂组（n = 30），30名作为对照组。LLLT应用于预先确定的部位，每周两次，共八次（780nm；咬肌和颞前 = 5J/cm，20mW，10s；颞下颌关节区域 = 7.5J/cm，30mW，10s）。在基线、激光治疗期间和治疗后30天测量疼痛强度、疼痛敏感性和SF-MPQ指标。组内比较采用Friedman检验，组间比较采用Mann-Whitney检验。与对照组相比，肌筋膜疼痛女性的疼痛敏感性增加（p < 0.05）。LLLT后两组的疼痛强度均降低。LLLT对任何一组的PPT均无改变（p > 0.05）。活性激光组和安慰剂组均降低了感觉、总疼痛和VAS指标，30天后结果维持不变；两组的情感疼痛评分指数均降低，安慰剂组30天后未维持，激光组治疗后当前疼痛强度降低，安慰剂组无变化。总之，活性或安慰剂LLLT在降低肌筋膜疼痛的总体主观感受（VAS和SF-MPQ指标）方面有效；然而，它们在降低口面部和身体部位的疼痛敏感性（PPT增加）方面无效。
