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Table 3: The mean percentage, SD values and results of Kruskal–Wallis test for comparison between percentage
decrease in pain scores (at rest) in the four groups
Time period Group I Group II Group III Group IV P value
Mean SD Mean SD Mean SD Mean SD
Preoperative to 2 weeks −8.2 b 13.5 −7.3 b 5.9 −56.6 a 38.8 −62.2 a 37.8 0.001*
Preoperative to 3 months −4.9 b 19.7 −5.8 b 13.4 −69.3 a 35.5 −72.8 a 40.2 0.004*
*Significant at P≤0.05, different letters are statistically significantly different according to Mann–Whitney U‑test. SD: Standard deviation

Table 4: The mean, SD values and results of Kruskal– The percentage change was calculated before.
Wallis test for comparison between pain scores (PPT) For all time periods: there was no statistically significant
in the four groups
difference between the four groups [Table 9].
Time Group I Group II Group III Group IV P value
period
Mean SD Mean SD Mean SD Mean SD DISCUSSION
Preoperative 9.1 a 0.9 8.9 a 1.3 7.8 b 1.2 7.9 b 1.2 0.008*
2 weeks 7.4 a 2.4 8.1 a 2 3.4 b 2.9 3.2 b 2.3 <0.001* Temporomandibular pain of myofascial origin is a
3 months 8 a 2.3 6.4 a 2.8 2.1 b 2.4 1.2 b 1.9 <0.001* condition that is often referred to outpatient clinics of
Oral and Maxillofacial Surgery Department. In this study,
*Significant at P≤0.05, different letters are statistically significantly
different according to Mann–Whitney U‑test. SD: Standard deviation, the highest proportion of patients with TMJD is among
PPT: Pain‑pressure threshold women aged 21–30 years. One explanation for higher
prevalence is that women have lower levels of muscle
strength under stress than men.
Table 5: The mean differences, SD values and results
of Wilcoxon signed-rank test for the changes by time The use of noninvasive and costless methods of treatment
in mean pain scores (PPT) of each group with reduced morbidity is our aim. The standard way
Group Time period Mean difference SD P value of treating temporomandibular myofascial pain in our
I Preoperative to 2 weeks −1.6 2.6 0.055 hospital is to use a combination of pharmacologic
Preoperative to 3 months −1.1 2.2 0.095 and splint therapy, which produces temporary relief.
II Preoperative to 2 weeks −0.7 1.8 0.131 However, pharmacologic treatments quickly reach the
Preoperative to 3 months −2.4 2.5 0.008* limit of therapeutic efficacy and they are also associated
III Preoperative to 2 weeks −4.3 2.6 0.002* with side effects (e.g., gastrointestinal disorders,
Preoperative to 3 months −5.7 2.3 0.002* drug interactions, and adverse reactions), so research
IV Preoperative to 2 weeks −4.7 2.6 <0.001* is currently focused on the search for alternative
Preoperative to 3 months −6.7 2.4 <0.001* treatments.
*Significant at P≤0.05. SD: Standard deviation, PPT: Pain‑pressure threshold
Active exercise, manual therapy, postural training, and
relaxation techniques, may decrease pain and increase
pain scores of Groups III and IV; both showed a statistically overall vertical mouth opening. The characteristics of
significantly highest mean percentage reduction in pain TMJD, however, remain highly debated as its hallmark
scores. There was no statistically significant difference findings of taut bands (localized areas of increased
between percentage reduction in pain scores of Groups I muscle tone and tenderness) and TrPs (smaller areas of
and II; both showed a statistically significant mean increased tenderness within the bands that produce
percentage reduction in pain scores [Table 6]. referred pain on pressure) depend on the clinician’s skills
Maximum mouth opening at identification.
Preoperatively and after 2 weeks: there was no statistically The identification of taut bands and TrPs is important
significant difference in MMO between the four groups. not only for diagnosis, but also for potential treatment.
We believe that pain from TMJD is better expressed by
After 3 months: Group IV showed a statistically significant the participant themself, so patients are required to
highest mean MMO. There was no statistically significant self-evaluate their pain as: nonexistent, mild, moderate,
difference between Groups I-III; all showed the statistically severe and very severe, using a VAS.
significantly lowest mean scores [Table 7].
Trigger points also appear to have a positive effect on
In Groups I and II, there was no statistically significant pain, releasing a TrPs through ischemic spots reduction,
change in mean MMO for all the time periods.
which results in reduced pain. Active MTrPs act as major
In Groups III and IV, there was a statistically significant peripheral pain generators for regional and generalized
increase in mean MMO for all time periods [Table 8]. musculoskeletal pain conditions.

Plast Aesthet Res || Vol 1 || Issue 1 || Jun 2014 25