Comparison of the Effect of Drug Therapy and Physical Therapy on Myofascial Pain and Dysfunction
-
Yasamin Mahjoobi
,
Sahereh Soltani
,
Atefeh Baghbani Torghabe
,
Bahareh Fattahi
,
Seyed Amirhossein Rahimizadeh Hosseini
Abstract
Introduction: Myofascial Pain Disorder (MPD), a prevalent subtype of Temporomandibular Disorders, presents with localized pain and functional limitations. While pharmacotherapy and transcutaneous electrical nerve stimulation (TENS) are common interventions, their comparative effectiveness remains underexplored, particularly in regional contexts like Bojnourd, Iran, during 2020–2021. Materials and Methods: In this randomized controlled trial, 30 patients with MPD were randomized into two groups (n = 15 each): Group 1 received active TENS (100 Hz, 25mA, 30 minutes weekly for 4 weeks) plus placebo capsules; Group 2 received active medication (Naproxen 500mg and Diazepam 2mg twice daily for 10 days) plus sham TENS. Pain intensity (Visual Analog Scale, 0–10) and maximum pain-free mouth opening (mm) were assessed at baseline, day 10, and 4 weeks. Data were analyzed using repeated-measures ANCOVA (α = 0.05).Results: TENS significantly outperformed pharmacotherapy in pain reduction (p < 0.001), with Group 1 achieving a 67.5% VAS reduction by day 10 versus 28.3% in Group 2. Both groups showed comparable improvements in mouth opening (p = 0.727). No adverse events were reported. Conclusion: High-frequency TENS provides faster and more substantial pain relief than pharmacotherapy in acute MPD, with equivalent functional outcomes. These findings support TENS as a first-line, non-invasive therapy for MPD, informing evidence-based practice in regional and global contexts. Keywords: Myofascial pain syndromes; Transcutaneous electric nerve stimulation; Temporomandibular joint disorders.
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21. Grossmann E, Barbosa TS, de Araujo MTS, Chaves TC, Grossmann LV, Castelo PM. Effectiveness of transcutaneous electrical nerve stimulation (TENS) and low-level laser therapy (LLLT) in the treatment of temporomandibular disorder: a randomized clinical trial. J Appl Oral Sci. 2012;20(3):295–302.
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24. Dalewski B, Chruściel-Nogalska M, Frączek W, Wieczorek A, Pawlak W. Evaluation of effectiveness of physiotherapy in temporomandibular disorders: a retrospective study. Pain Res Manag. 2019; 2019:6583724.
25. Kirupa KK, Ganapathy D, Kumar S, Rajesh S. Evaluation of pain and mouth opening after low-level laser therapy and conventional therapy in myofascial pain dysfunction syndrome patients. J Contemp Dent Pract. 2019;20(3):294–8.
26. Singh GP, Tyagi S, Godbole G, Anurag T. Efficacy of transcutaneous electrical nerve stimulation (TENS) in the management of temporomandibular joint disorders. Natl J Maxillofac Surg. 2014;5(2):161–5.
27. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804.
28. Cairns BE. Pathophysiology of TMD pain—basic mechanisms and their implications for pharmacotherapy. J Oral Rehabil. 2010;37(6):391–410.
29. Rodrigues D, Gamero GH, Sacco IC, Arnone AC, da Silva AP. Evaluation of the analgesic effect of TENS and low-level laser therapy on temporomandibular disorder. Pain Res Manag. 2004;9(3):145–9.
30. De Giorgi R, Castroflorio T, D'Amico D, Deregibus A. Efficacy of transcutaneous electrical nerve stimulation in reducing pain in patients with temporomandibular disorders: a systematic review. Cranio. 2017;35(3):189–97.
31. Kurita GP, Pimenta CA, Prado WA. Effects of nonsteroidal anti-inflammatory drugs on pain and disability in patients with myofascial pain: a systematic review. J Pain. 2015;16(1):3–10.
32. Melis M, Zawawi KH, Al-Badawi EA, Lobo SL, Mehta NR. The effect of TENS on occlusal bite force and EMG activity in subjects with or without TMD. Cranio. 2019;37(3):156–62.
33. Cooper BC. Parameters of an optimal temporomandibular joint orthotic. Cranio. 1995;13(4):203–17.
34. Bender T, Nagy G, Barna I, Tefner I, Kádas É, Géher P. The effect of physical therapy on temporomandibular joint dysfunction: a randomized controlled trial. J Oral Rehabil. 2014;41(3):179–84.
35. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9(2):105–21.
36. NIH Technology Assessment Conference Panel. Management of temporomandibular disorders. J Am Dent Assoc. 1996;127(11):1595–606.
2. De Leeuw R, Klasser GD. Orofacial pain: guidelines for assessment, diagnosis, and management. 6th ed. Chicago: Quintessence Publishing; 2018.3.
3. Ananthan S, Benoliel R. Chronic orofacial pain. J Neural Transm (Vienna). 2020;127(4):575–88.
4. Okeson JP. Management of temporomandibular disorders and occlusion. 7th ed. St. Louis: Mosby; 2014.
5. Svensson P, Cairns BE, Wang K, Hu JW, Graven-Nielsen T, Arendt-Nielsen L. Glutamate-evoked pain and mechanical sensitization of human masseter muscle. Pain. 2003;101(3):221–7.
6. Cummings TM, Baldry PE. Regional myofascial pain: diagnosis and management. Best Pract Res Clin Rheumatol. 2007;21(2):367–87.
7. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications. J Oral Facial Pain Headache. 2014;28(1):6–27.
8. Truelove EL, Sommers EE, LeResche L, Dworkin SF, Von Korff M. Clinical diagnostic criteria for TMD: new classification permits multiple diagnoses. J Am Dent Assoc. 2010;141(4):453–61.
9. Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F. Research Diagnostic Criteria for Temporomandibular Disorders: a systematic review of axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;112(4):453–62.
10. Suvinen TI, Reade PC, Kemppainen P, Könönen M, Dworkin SF. Review of aetiological concepts of temporomandibular pain disorders: towards a biopsychosocial model for integration of physical disorder factors with psychological and psychosocial illness impact factors. Eur J Pain. 2005;9(6):613–33.
11. Giamberardino MA, Affaitati G, Costantini R, Fabrizio A, Lapenna D, Tafuri E, et al. Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain. 2011;15(1):61–9.
12. Huang GJ, LeResche L, Critchlow CW, Martin MD, Drangsholt MT. Risk factors for diagnostic subgroups of painful temporomandibular disorders (TMD). J Dent Res. 2002;81(4):284–8.
13. Ta LE, Dionne RA. Treatment of myofascial pain syndrome with nonsteroidal anti-inflammatory drugs: a review of the literature. J Orofac Pain. 2004;18(4):337–49.
14. Dym H, Israel H, Tamborello J. Diagnosis and treatment of temporomandibular disorders. Dent Clin North Am. 2016;60(1):105–24.
15. Ouanounou A, Goldberg M, Haas DA. Pharmacotherapy in management of temporomandibular disorders: a review. J Can Dent Assoc. 2017;83:h7.
16. McNeely ML, Armijo-Olivo S, Magee DJ. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Phys Ther. 2006;86(5):710–25.
17. Wänman A, Marklund S. Treatment of myofascial temporomandibular disorder pain with occlusal appliance, acupuncture, or relaxation therapy: a randomized controlled trial. J Orofac Pain. 2019;33(2):129–36.
18. Al-Ani Z, Gray RJ, Davies SJ, Sloan P, Glenny AM. Stabilisation splint therapy for temporomandibular pain dysfunction syndrome. Cochrane Database Syst Rev. 2004;(1):CD002778.
19. Azangoo Khiavi F, Pouraliakbar H, Tabrizi R, Davoudi A. Comparison of the effects of low-level laser therapy and pharmacotherapy on temporomandibular disorders: a randomized controlled clinical trial. J Dent Res Dent Clin Dent Prospects. 2020;14(2):93–8.
20. Khalighi S, Emadian Razavi E, Dolati A. Comparison of low-level laser therapy and pharmacotherapy in treatment of myofascial pain dysfunction syndrome. J Lasers Med Sci. 2016;7(1):43–8.
21. Grossmann E, Barbosa TS, de Araujo MTS, Chaves TC, Grossmann LV, Castelo PM. Effectiveness of transcutaneous electrical nerve stimulation (TENS) and low-level laser therapy (LLLT) in the treatment of temporomandibular disorder: a randomized clinical trial. J Appl Oral Sci. 2012;20(3):295–302.
22. Ba AB, El Ouni S, Ajmi TN, Chebil M, Bouguezzi A, Triki M, et al. Efficacy of therapeutic ultrasound in the treatment of myofascial pain syndrome: a randomized controlled trial. J Back Musculoskelet Rehabil. 2021;34(1):111–7.
23. Mishra S, Tripathi T, Rai P, Dada R. Role of genetic polymorphisms in pain perception and response to analgesia in temporomandibular disorders: a review. J Oral Biol Craniofac Res. 2015;5(3):162–70.
24. Dalewski B, Chruściel-Nogalska M, Frączek W, Wieczorek A, Pawlak W. Evaluation of effectiveness of physiotherapy in temporomandibular disorders: a retrospective study. Pain Res Manag. 2019; 2019:6583724.
25. Kirupa KK, Ganapathy D, Kumar S, Rajesh S. Evaluation of pain and mouth opening after low-level laser therapy and conventional therapy in myofascial pain dysfunction syndrome patients. J Contemp Dent Pract. 2019;20(3):294–8.
26. Singh GP, Tyagi S, Godbole G, Anurag T. Efficacy of transcutaneous electrical nerve stimulation (TENS) in the management of temporomandibular joint disorders. Natl J Maxillofac Surg. 2014;5(2):161–5.
27. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804.
28. Cairns BE. Pathophysiology of TMD pain—basic mechanisms and their implications for pharmacotherapy. J Oral Rehabil. 2010;37(6):391–410.
29. Rodrigues D, Gamero GH, Sacco IC, Arnone AC, da Silva AP. Evaluation of the analgesic effect of TENS and low-level laser therapy on temporomandibular disorder. Pain Res Manag. 2004;9(3):145–9.
30. De Giorgi R, Castroflorio T, D'Amico D, Deregibus A. Efficacy of transcutaneous electrical nerve stimulation in reducing pain in patients with temporomandibular disorders: a systematic review. Cranio. 2017;35(3):189–97.
31. Kurita GP, Pimenta CA, Prado WA. Effects of nonsteroidal anti-inflammatory drugs on pain and disability in patients with myofascial pain: a systematic review. J Pain. 2015;16(1):3–10.
32. Melis M, Zawawi KH, Al-Badawi EA, Lobo SL, Mehta NR. The effect of TENS on occlusal bite force and EMG activity in subjects with or without TMD. Cranio. 2019;37(3):156–62.
33. Cooper BC. Parameters of an optimal temporomandibular joint orthotic. Cranio. 1995;13(4):203–17.
34. Bender T, Nagy G, Barna I, Tefner I, Kádas É, Géher P. The effect of physical therapy on temporomandibular joint dysfunction: a randomized controlled trial. J Oral Rehabil. 2014;41(3):179–84.
35. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9(2):105–21.
36. NIH Technology Assessment Conference Panel. Management of temporomandibular disorders. J Am Dent Assoc. 1996;127(11):1595–606.
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| Issue | Vol 13, No 1 (Winter 2026) | |
| Section | Original Article(s) | |
| Keywords | ||
| Myofascial pain syndromes; Transcutaneous electric nerve stimulation; Temporomandibular joint disorders. | ||
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How to Cite
1.
Mahjoobi Y, Soltani S, Baghbani Torghabe A, Fattahi B, Rahimizadeh Hosseini SA. Comparison of the Effect of Drug Therapy and Physical Therapy on Myofascial Pain and Dysfunction. J Craniomaxillofac Res. 2026;13(1):79-85.
