Effect of photobiomodulation therapy on painful temporomandibular disorders

Abstract

To evaluate the effect of photobiomodulation therapy (PBMT) on painful temporomandibular disorders (TMD) patients in a randomized, double-blinded, placebo-controlled manner. Participants were divided into a masseter myalgia group (n = 88) and a temporomandibular joint (TMJ) arthralgia group (n = 87) according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Both groups randomly received PBMT or placebo treatment once a day for 7 consecutive days, one session. The PBMT was applied with a gallium-aluminum-arsenide (GaAlAs) laser (wavelength = 810 nm) at pre-determined points in the masseter muscle (6 J/cm², 3 regions, 60 s) or TMJ region (6 J/cm², 5 points, 30 s) according to their most painful site. Pain intensity was rated on a 0-10 numerical rating scale (NRS) and pressure pain thresholds (PPT) and mechanical sensitivity mapping were recorded before and after the treatment on day 1 and day 7. Jaw function was assessed by pain free jaw opening, maximum unassisted jaw opening, maximum assisted jaw opening, maximum protrusion and right and left excursion. Data were analyzed with a mixed model analysis of variance (ANOVA). Pain intensity in arthralgia patients decreased over time (P < 0.001) for both types of interventions, however, PBMT caused greater reduction in pain scores than placebo (P = 0.014). For myalgia patients, pain intensity decreased over time (P < 0.001) but without difference between interventions (P = 0.074). PPTs increased in both myalgia (P < 0.001) and TMJ arthralgia patients over time (P < 0.001) but without difference between interventions (P ≥ 0.614). Overall, PBMT was associated with marginally better improvements in range of motion compared to placebo in both myalgia and arthralgia patients. Pain intensity, sensory function and jaw movements improve after both PBMT and placebo treatments in myalgia and arthralgia patients indicating a substantial non-specific effect of PBMT.

Figure 1

Flow chart of study. Personal reasons: include lack of time, work problem or reluctance to continue the experiment.

Figure 2

(a) The relative change of pressure pain thresholds (PPT) and NRS pain scores (mean and standard error) in masseter myalgia patients during the experiment (n = 50). Photobiomodulation (PBM) group (n = 25); Placebo group (n = 25). “*” indicates significant difference between D1-pre and other time points (P < 0.05). (b) The relative change of pressure pain thresholds (PPT) and NRS pain scores (mean and standard error) in TMJ arthralgia patients during the experiment (n = 50). Photobiomodulation (PBM) group (n = 25); Placebo group (n = 25). “*” indicates significant difference between D1-pre and other time points (P  < 0.05); “#” indicates significant difference between PBM and placebo (P < 0.05).

Figure 3

The mechanical sensitivity mapping of masseter myalgia patients before and after the treatment with photobiomodulation (PBM) (n = 25) and placebo (n = 25). NRS: numerical rating scale from 0–50–100 with 50 = moderate painful. Measurements were taken before and after treatment at Day 1 and Day 7 (D1 pre/D1 post; D7 pre/D7 post).

Figure 4

The mechanical sensitivity mapping of TMJ arthralgia patients before and after the treatment with photobiomodulation (PBM) (n = 25) and placebo (n = 25). NRS: numerical rating scale from 0–50–100 with 50 = moderate painful. Measurements were taken before and after treatment at Day 1 and Day 7 (D1 pre / D1 post; D7 pre/D7 post).

Figure 5

A quantitative mechanical palpometer with 1.0-kg pressure force was applied to 15 grids of masseter muscle (a) and a palpometer with 0.5-kg pressure force was applied to 9 grids of TMJ region (b). Point A = intersection point between the superior margin and posterior margin of the superficial masseter muscle. In the TMJ region the hinge axis point was on average 13 mm in front of the middle of the tragus.