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that elicits LTRs improves treatment outcomes. It has been • Pain associated with two or more movements
suggested that A-delta nerve fibers are activated, as the (severe disorder)
needle pierces the skin, resulting in inhibition of muscular • Sensitivity to posterior pressure (severe disorder).
C-nerve fibers that transmit pain from the TrPs. [32]
Methods
Injection of a local anesthetic is one of the most effective
treatment options available and is cited repeatedly as The patients were divided randomly into four groups with
each comprising 18 patients.
a way of achieving optimal results. The use of a local
anesthetic is more comfortable for many patients and Treatments
results in a longer lasting reduction in MTrP pain. [10] Group I (low‑level laser)
Pulsed electromagnetic field (PEMF) stimulation is a form After locating of MTrP LLLT (wavelength 980 nm, power 0.2
of alternative therapy that claims to treat disease by W, total energy 12 J) was applied using a fiber probe over
applying electromagnetic energy to the body. Among the TrPs in a circular movement for 50 s. In this group,
[33]
the reported therapeutic methods, the use of biophysical each patient received LLLT 3 times per week for 4 weeks.
interventions, such as PEMF therapy, has attracted the Group II (dry needling)
attention of clinicians in recent years, because of their Each TrPs was marked clearly and the skin prepared and
noninvasive characteristics. [34,35] It was observed that cleansed. The overlying skin was held between the thumb
PEMF may affect tissue healing through a primary effect and index finger. It was then punctured with a dry needle.
on vascular growth therefore has a role in stimulation of In this group, each patient received three sessions per
the healing process. [36-38] week for 4 weeks, each session lasting 50 s.
Although MTrPs are a widely recognized phenomenon Group III (anesthesia)
in clinical practice, much remains to be elucidated with Each TrPs was injected with 0.5 ml mepivacaine 3% local
regarding their pathophysiology, mechanisms of pain anesthetic solution. In this group, the injections were
referral, and treatment of choice. Hence, this study aimed given 3 times per week for 4 weeks, using a standard
to examine the effect of the four most common treatment dental syringe and 27-gauge needle.
modalities used to treat pain associated with MPDS
through their direct effect on MTrPs. Group IV: (pulsed electromagnetic field)
Each TrPs was exposed to (PEMF) stimulation. In this
PATIENTS AND METHODS group, each patient received three sessions per week for
4 weeks, each session lasting 50 min.
Patients Clinical examination
We enrolled 72 patients, from the outpatient clinic of The masseter muscle was located by a flat palpation
the Oral and Maxillofacial Surgery Department, Faculty of technique, using one index finger. The masseter muscle
Oral and Dental Medicine, Cairo University, Egypt. They was examined by means of palpation to determine:
were 57 females and 15 males aged 18–42 years (average • A palpable taut band
30 years), all with active MTrPs of the masseter muscle. The • A hypersensitive area within the taut band
review board of Cario University approved this study. • Pain felt by the patient when pressure was applied to the
General inclusion criteria were: sensitive area (identifying an active TrPs)
• Diagnosis of temporomandibular disorder • Repetition of a referred pain sensation upon stimulation
• Aged >18 years of the area
• Musculoskeletal dysfunction • The occurrence of a LTR upon sharp palpation of the taut
• Pain impairment band.
• The presence of a TrPs characterized by spontaneous pain
of the right or left masseter muscle Each patient pointed to the exact location of the pain and
• Restricted range of mouth opening rated the pain (on a visual analog scale [VAS]) from 0 to
• No previous surgery in the temporomandibular region 10 with 0 corresponding to no pain and 10 correspond
• No other morbid conditions in the temporomandibular to the worst pain. This information was recorded on the
region as rheumatic diseases, or neurological diseases. patient’s chart. The pain was evaluated preoperatively and
after 1 month, 2 months, and 3 months respectively from
In addition, each patient had to fulfill the following
criteria (according to the Helkimo index) [39] the start of treatment.
• Slightly impairment of movement (index DiI) Assessment of painless maximum mouth opening (MMO)
• Moderate dysfunction = DiII was performed by measuring the distance (in mm)
• Muscle pain sensitivity to pressure in four places (severe between the edges of the upper and lower central incisors
disorder) using a Vernier graduated caliper.

Plast Aesthet Res || Vol 1 || Issue 1 || Jun 2014 23