Myofascial Pain: Diagnosis and Behavior in Patients with Orofacial Pain and TMD
Abstract
Nivaldo Vanni Filho and Adriane R Gomes Vanni
The high prevalence, significant demand for treatment of patients with Chronic Pain, and the general difficulty of establishing an accurate diagnosis, together with psychosocial and behavioral conditions, lead many therapeutic approaches to failure or unexpected outcomes. The objective of the present report was to show the evolution of a clinical case of long-term and highintensity Myofascial Pain, in which the patient had been undergoing treatment with Tricyclic Antidepressants (Nortriptyline Hydrochloride) for two years, using minimally invasive conduct. In order to reach the Diagnostic Hypothesis of Myalgia, the DC/TMD (Diagnosis Criteria for Temporomandibular Disorders) protocol was employed, in which the subdivision of this form of TMD was attained. We found substantial myofascial impairment of chewing and cervical muscles, with referred pain and secondary cephalea. The temporomandibular joints (TMJ) did not exhibit any clinical changes in movement, noise or arthralgia. After locating the myofascial trigger points (TrPs), Dry Needling was incorporated, with manipulation of the oral and cervical musculature (with and without resistance), in addition to electrotherapy with TENS (Transcutaneous Electrical Nerve Stimulation) coupled with heat application. The patient was instructed to perform cervical and masseter stretching exercises twice daily and to carry out sleep and medication prophylaxis. The result was rewarding. After seven visits in six months, with an interval from the sixth to the seventh visit of sixty days (follow-up), the patient was discharged and scheduled to return after a six-month period. Pain episodes continue to occur occasionally, but with low intensity, score 3 on the visual analog scale (VAS), and short duration. The course of treatment was well administered by the patient, without the use of antidepressants and cephalea and myofascial pain, and without the use of interocclusal devices, as shown in this report.