A comparison of medical and physical therapies in the management of facial arthromyalgia (temporomandibular joint dysfunction).

This thesis reports on a randomised controlled trial of medical and physical therapy in the management of chronic temporomandibular joint pain and dysfunction. The literature review first explores the meaning and measurement of chronic pain. The anatomy and dynamic function of the temporomandibular joint and associated musculature is then introduced before describing the pain and dysfunction which affects this specific region. The development of terminology, classification and epidemiology is addressed to provide a basis for understanding the condition. A discussion of the presumed multifactorial aetiology and current management follows, with focus on the two areas of specific interest in this study the physical and medical therapies The study methods, results and discussion are presented in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. A referral cohort of 1,038 subjects were screened and assessed. 250 subjects met inclusion criteria and agreed to participate with informed consent. Subjects were randomised into four groups: medical therapy, placebo, occlusal bite guard, medical therapy and occlusal bite guard. A three month treatment phase and a six month follow-up phase were then conducted. The first section of the results examines the referral cohort. Demographic, clinical diagnostic, and psychosocial profile are reported with treatment uptake for the trial. The second section examines the three month trial phase, treatment efficacy and outcome. The analysis of subgroups is explored, including the characteristics of responders and non-responders to therapy in addition to outcome measures in subjects with initially high pain scores and high levels of depression. The final section analyses reasons for patient withdrawal and non compliance before examining the follow up phase post therapy for maintenance of improvement. Both primary and secondary outcome measures revealed significant improvement in pain amongst all four groups which was maintained during the follow-up phase