EvaluaciĆ³n de CPM en mujeres con dolor miofascial, bajo tratamiento de ejercicios mandibulares
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Fecha
2015
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Profesor/a GuĆa
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Idioma
es
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Universidad AndrƩs Bello
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Licencia CC
Licencia CC
Resumen
Objective: To evaluate the performance of conditioned pain modulation (CPM) in women consuming oral contraceptives, with myofascial pain therapy treatment under jaw exercises. Method: Randomized trial blind. 25 patients with myofascial pain as RDC / TMD without articular pathology. They were given treatment at random: isometrics, isotonic or control group. 25 patients were women who took oral contraceptives (OC). Were examined four times: on days 1, 7, 14 and 21 of treatment, measuring pain threshold (PPT) and pain tolerance (PPT) in masseter, temporal and arm by algometry more pain perception through a visual analog scale (VAS), then were measured under the same points conditioning (cold immersion bath) for data CPM stimulus. After the study was reevaluated its CPI and a diagnostic output RDC / TMD was performed. Variations between each week were analyzed with paired t-test with Bonferroni correction. Results: PPT values and PPTol in the isometric exercise increase their thresholds in the 3 muscle groups for 21 days, but their values are not significant (p> 0.05) PPT values in the isotĆ³nics excercise of muscles masseter and temporal tend to increase but not significant (p> 0.05) in exchange for arm muscle tends to decrease, being significant between day 1 and 7 (p =0.04), while for PPTol maintains their doorsteps in time for masseter and temporal no significant (p> 0.05), while for arm decreases their values significantly (p =0.00) between days 1 and 7. In the control group exists a varied behavior in the 3 muscle groups for its two variables. For VAS there is a decrease in pain perception in the control group and isometric exercises for 21 days, with significant values (p =0.00; p=0.04) .For CPM the is an increased modulatory response to isometric exercise for the 21 day with significant values (p =0.00). Conclusions: Isometric exercises tend to increase the thresholds for the 3 muscle groups and decrease pain perception to the day 21.Isotonic exercises tend to increase the thresholds in the facial muscle groups, while the arm tends to dicrease. For the control group there is a trend of increasing the thresholds for the facial muscles, but for arm muscle tends to decrease, while their subjective values of pain, decrease. In terms of CPM many changes are observed through the day in the different treatment groups and muscle. With these data we can not correlate CPM and results of ejercicios.Estos data do not provide evidence to support exercises for management of orofacial pain although some improve pain patients. Modulating pain patients after 21 days of monitoring improvement. These results are not sufficient to understand whether physical improvement is due to the modulation of central pain in these patients or peripheral muscular role attained by the exercises.
Objetivo: Evaluar el comportamiento de la modulaciĆ³n condicionada del dolor (CPM) en mujeres que consuman Anticonceptivos orales, con dolor
miofascial, bajo tratamiento de terapia de ejercicios mandibulares. MĆ©todo: Estudio clĆnico aleatorizado ciego. N=25, con dolor miofascial segĆŗn CDI/TTM y sin patologĆa articular. Se les dividiĆ³ en 3 grupos de manera aleatoria: ejercicios isomĆ©tricos, isotĆ³nicos o grupo control. Se realizaron mediciones de umbral de dolor (PPT) y tolerancia al dolor (PPTol) en maseteros, temporales y brazo, mediante algometrĆa, mĆ”s la percepciĆ³n de dolor a travĆ©s de una escala visual anĆ”loga (VAS) , luego fueron medidos los mismos puntos bajo estĆmulo condicionante frĆo (baƱo de inmersiĆ³n) para los datos de CPM Fueron examinadas cuatro veces: los dĆas 1, 7, 14 y 21 de tratamiento.. Finalizado el estudio fue evaluada nuevamente su CPI y se realizĆ³ un diagnĆ³stico de salida CDI/TTM. Las variaciones entre cada semana fueron analizadas con prueba t pareada con correcciĆ³n de Bonferroni. Resultados: Para el ejercicio isomĆ©trico los valores de PPT y PPTol aumentan sus umbrales en los 3 grupos musculares durante los 21 dĆas, pero sus valores no son significativos (p>0,05), Para el ejercicio isotĆ³nico los valores de PPT de los mĆŗsculos masetero y temporal tienden al aumento pero no son significativos (p>0,05) en cambio para el mĆŗsculo del brazo tiende a la disminuciĆ³n siendo significativos entre el dĆa 1 y 7 (p=0,04), en tanto para PPTol, mantiene sus umbrales en el tiempo para masetero y temporal sin valores significativos (p>0,05), mientras que para brazo disminuye sus valores de manera significativa (p=0,00) entre los dĆas 1 y 7.En el grupo control se presenta un comportamiento variado en los 3 grupos musculares para sus dos variables. Para VAS hay una disminuciĆ³n de la percepciĆ³n dolorosa en el grupo control y para los ejercicios isomĆ©tricos durante los 21 dĆas con valores significativos (p=0,00; p=0,04)).Para CPM se registra un aumento de la respuesta modulatoria para los ejercicios isomĆ©tricos para el dĆa 21 con valores significativos (p=0,00). Conclusiones: Los ejercicios isomĆ©tricos tienen tendencia al aumento de los umbrales para los 3 grupos musculares y disminuyen la percepciĆ³n dolorosa al dĆa 21. Los ejercicios isotĆ³nicos tienden al aumento de los umbrales en los grupos musculares faciales, en tanto al brazo tiende a disminuirlos. Para el grupo control existe una tendencia al aumento de los umbrales para los mĆŗsculos faciales, pero para el musculo del brazo tiende a la disminuciĆ³n, en tanto sus valores subjetivos del dolor, disminuyen. A nivel de CPM se observan cambios variados a travĆ©s de los dĆas en los distintos grupos de tratamiento y musculares. Con estos datos no se puede correlacionar CPM y los resultados de los ejercicios.Estos datos no entregan evidencia para utilizar los ejercicios para el manejo del dolor orofacial aunque algunos mejoran el dolor de las pacientes. La modulaciĆ³n de pacientes con dolor luego de 21 dĆas de seguimiento mejora. Estos resultados no son suficientes para entender si la mejora fĆsica es debido a la modulaciĆ³n del dolor central de esos pacientes o al rol muscular perifĆ©rico logrado por los ejercicios .
Palabras Claves: Manejo de dolor, Tratamiento Muscular, ejercicios mandibulares, CDI/TTM, CPM.
Objective: To evaluate the performance of CPM in women consuming oral contraceptives, with myofascial pain therapy treatment under jaw exercises. Method: Randomized trial blind. 25 patients with myofascial pain as CDI / TTM without articular pathology. They were given treatment at random: isometrics, isotonic or control group. 25 patients were women who took oral contraceptives (OC). Were examined four times: on days 1, 7, 14 and 21 of treatment, measuring pain threshold (PPT) and pain tolerance (PPT) in masseter, temporal and arm by algometry more pain perception through a visual analog scale (VAS), then were measured under the same points conditioning (cold immersion bath) for data CPM stimulus. After the study was reevaluated its CPI and a diagnostic output CDI / TTM was performed. Variations between each week were analyzed with paired t-test with Bonferroni correction. Results: For the isometric exercise PPT values and PPTol increase their thresholds in the 3 muscle groups for 21 days, but their values are not significant (p> 0.05) For the isotonic exercise PPT values of muscles masseter and temporal tend to increase but not significant (p> 0.05) in exchange for arm muscle tends to decrease, being significant between day 1 and 7 (p <0.05), while for PPTol maintains their doorsteps in time for masseter and temporal no significant (p> 0.05), while for arm decreases their values significantly (p <0.05) between days 1 and 7. In the control group exists a varied behavior in the 3 muscle groups for its two variables. For VAS there is a decrease in pain perception in the control group and isometric exercises for 21 days, with significant values (p <0.05) .For CPM the is an increased modulatory response to isometric exercise for the 21 day with significant values (p <0.05). Conclusions: Isometric exercises tend to increase the thresholds for the 3 muscle groups and decrease pain perception to the day 21.Isotonic exercises tend to increase the thresholds in the facial muscle groups, while the arm tends to dicrease. For the control group there is a trend of increasing the thresholds for the facial muscles, but for arm muscle tends to decrease, while their subjective values of pain, decrease. In terms of CPM many changes are observed through the day in the different treatment groups and muscle.
Objective: To evaluate the performance of CPM in women consuming oral contraceptives, with myofascial pain therapy treatment under jaw exercises. Method: Randomized trial blind. 25 patients with myofascial pain as CDI / TTM without articular pathology. They were given treatment at random: isometrics, isotonic or control group. 25 patients were women who took oral contraceptives (OC). Were examined four times: on days 1, 7, 14 and 21 of treatment, measuring pain threshold (PPT) and pain tolerance (PPT) in masseter, temporal and arm by algometry more pain perception through a visual analog scale (VAS), then were measured under the same points conditioning (cold immersion bath) for data CPM stimulus. After the study was reevaluated its CPI and a diagnostic output CDI / TTM was performed. Variations between each week were analyzed with paired t-test with Bonferroni correction. Results: For the isometric exercise PPT values and PPTol increase their thresholds in the 3 muscle groups for 21 days, but their values are not significant (p> 0.05) For the isotonic exercise PPT values of muscles masseter and temporal tend to increase but not significant (p> 0.05) in exchange for arm muscle tends to decrease, being significant between day 1 and 7 (p <0.05), while for PPTol maintains their doorsteps in time for masseter and temporal no significant (p> 0.05), while for arm decreases their values significantly (p <0.05) between days 1 and 7. In the control group exists a varied behavior in the 3 muscle groups for its two variables. For VAS there is a decrease in pain perception in the control group and isometric exercises for 21 days, with significant values (p <0.05) .For CPM the is an increased modulatory response to isometric exercise for the 21 day with significant values (p <0.05). Conclusions: Isometric exercises tend to increase the thresholds for the 3 muscle groups and decrease pain perception to the day 21.Isotonic exercises tend to increase the thresholds in the facial muscle groups, while the arm tends to dicrease. For the control group there is a trend of increasing the thresholds for the facial muscles, but for arm muscle tends to decrease, while their subjective values of pain, decrease. In terms of CPM many changes are observed through the day in the different treatment groups and muscle.
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Tesis (OdontologĆa)
Palabras clave
Manejo de dolor, Tratamiento Muscular, Ejercicios mandibulares, Dolor Miofacial, Terapias