Diagnostic concordance between MRI and electrovibratography of the temporomandibular joint of subjects with disc displacement disorders

OBJECTIVES: The aim of this study is to evaluate the diagnostic concordance of MRI and electrovibratography (EVG) of the temporomandibular joint (TMJ) in the diagnosis of articular disc displacement with reduction (ADDwR) and articular disc displacement without reduction (ADDw/oR). METHODS: 50 patients (12 males, 38 females; mean age 37.46 ± 15.64 years) with a hypothesis of disc displacement were selected. For each patient an MRI of the TMJ was performed. MRIs were evaluated sorting the 100 TMJs by kind of pathology (no pathology, ADDwR, ADDw/oR, and joint hypermobility). Afterwards, the patients had an EVG exam. The EVG exams were performed with vibration transducers over each TMJ, enabling simultaneous, bilateral recording of vibrations emanating from joint sounds during the opening and closing movements. The presence of a sound peak was compared with the MRI diagnosis of ADDwR, while a multipeak aspect was compared with ADDw/oR diagnosis using Cohen's kappa test. RESULTS: The presence of a peak-shaped track has high specificity for ADDwR (90.27%). The Cohen's kappa calculated for the ADDwR was 0.5615 (good–moderate). The presence of a multipeak-shaped track has low specificity (65.22%) and sensitivity (70.42%). The Cohen's kappa calculated for the ADDw/oR was 0.2992 (poor). CONCLUSIONS: The present study recommends the use of EVG to support the clinical diagnosis of a disc displacement with reduction when MRI is not available or when subjects cannot be investigated by MRI

Auriculotherapy for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVES: Side-effects of standard pain medications can limit their use. Therefore, nonpharmacologic pain relief techniques such as auriculotherapy may play an important role in pain management. Our aim was to conduct a systematic review and meta-analysis of studies evaluating auriculotherapy for pain management. DESIGN: MEDLINE,(®) ISI Web of Science, CINAHL, AMED, and Cochrane Library were searched through December 2008. Randomized trials comparing auriculotherapy to sham, placebo, or standard-of-care control were included that measured outcomes of pain or medication use and were published in English. Two (2) reviewers independently assessed trial eligibility, quality, and abstracted data to a standardized form. Standardized mean differences (SMD) were calculated for studies using a pain score or analgesic requirement as a primary outcome. RESULTS: Seventeen (17) studies met inclusion criteria (8 perioperative, 4 acute, and 5 chronic pain). Auriculotherapy was superior to controls for studies evaluating pain intensity (SMD, 1.56 [95% confidence interval (CI): 0.85, 2.26]; 8 studies). For perioperative pain, auriculotherapy reduced analgesic use (SMD, 0.54 [95% CI: 0.30, 0.77]; 5 studies). For acute pain and chronic pain, auriculotherapy reduced pain intensity (SMD for acute pain, 1.35 [95% CI: 0.08, 2.64], 2 studies; SMD for chronic pain, 1.84 [95% CI: 0.60, 3.07], 5 studies). Removal of poor quality studies did not alter the conclusions. Significant heterogeneity existed among studies of acute and chronic pain, but not perioperative pain. CONCLUSIONS: Auriculotherapy may be effective for the treatment of a variety of types of pain, especially postoperative pain. However, a more accurate estimate of the effect will require further large, well-designed trials