Department of Oral Medicine, School of Dentistry, Kyung Hee University, Seoul, Korea.
Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea.
Oral Dis. 2018 Nov;24(8):1591-1598. doi: 10.1111/odi.12919. Epub 2018 Jul 6.
This placebo-controlled randomized double-blinded clinical study assessed the analgesic efficacy of intramuscular morphine in TMD patients with myofascial pain and sex-dependent responses of the morphine treatment.
Men and women with TMD were treated with morphine (1.5 or 5 mg), lidocaine, or saline in the masseter muscle. VAS of pain intensity, PPT, and PPtol were compared between treatment groups and gender. An additional group was treated with morphine in the trapezius muscle to evaluate the systemic effect of morphine that may reduce pain in the masseter muscle.
There was a significant difference in VAS scores between the morphine 5 mg group and the saline group favoring morphine, but not between the morphine 5 mg and lidocaine. Morphine 1.5 and 5 mg treatments led to consistently and significantly elevated PPT and PPtol measures in men, but not in women. Morphine administered in the trapezius muscle did not affect the outcome measures.
A single dose intramuscular morphine produced analgesic effects up to 48 hr in patients with myofascial pain. Intramuscular morphine elevated mechanical pain threshold and tolerance in the masseter only in male patients, suggesting sex differences in local morphine effects. No systemic effect of intramuscular morphine was detected.
本安慰剂对照随机双盲临床试验评估了肌肉内注射吗啡治疗颞下颌关节紊乱肌筋膜疼痛患者的镇痛效果及其对吗啡治疗的性别依赖性反应。
男性和女性 TMD 患者在咬肌中接受吗啡（1.5 或 5mg）、利多卡因或生理盐水治疗。比较治疗组和性别之间的 VAS 疼痛强度评分、PPT 和 PPtol。另外一组在斜方肌中接受吗啡治疗，以评估吗啡的全身作用，可能减轻咬肌疼痛。
吗啡 5mg 组与生理盐水组的 VAS 评分有显著差异，吗啡组更优，但吗啡 5mg 组与利多卡因组之间无差异。吗啡 1.5mg 和 5mg 治疗在男性中一致且显著提高了 PPT 和 PPtol 测量值，但在女性中则没有。斜方肌中注射吗啡对结局测量没有影响。
单次肌肉内注射吗啡可在肌筋膜疼痛患者中产生长达 48 小时的镇痛效果。肌肉内注射吗啡仅在男性患者中提高了咬肌的机械疼痛阈值和耐受力，表明局部吗啡作用存在性别差异。未检测到肌肉内注射吗啡的全身作用。
