Advertisement

Journal of Maxillofacial and Oral Surgery

, Volume 15, Issue 3, pp 376–383 | Cite as

A Comparative Study of Trigger Point Therapy with Local Anaesthetic (0.5 % Bupivacaine) Versus Combined Trigger Point Injection Therapy and Levosulpiride in the Management of Myofascial Pain Syndrome in the Orofacial Region

  • Pranav Gupta
  • Virendra Singh
  • Sujata Sethi
  • Arun Kumar
Comparative Study
  • 180 Downloads

Abstract

Aim

To compare the efficacy of combined local anesthetic injection with 0.5 % bupivacaine and levosulpiride versus local anesthetic injection alone on outcome measures including levels of pain intensity and depression in the management of myofascial pain syndrome in orofacial region.

Patients and Methods

This was a prospective, randomized, controlled and open-label comparative clinical study. Seventy-four patients diagnosed to have myofascial pain syndrome and fulfilling the inclusion criteria were enrolled for the study. Patients were randomly assigned into 2 groups. Group A received local anesthetic injection (0.5 % bupivacaine) on trigger points and Group B received combined trigger point injection therapy and 50 mg of tablet Levosulpiride orally B.I.D. They were assessed for pain intensity and depression at baseline and at follow-up of 1, 4, 6 and 12 week intervals.

Results

The mean age of patients was 44.54 + 15.977 years in group A and 39.97 + 14.107 years in group B (P value = 0.2). Group A comprised of 25 females (67.567 %) and 12 males (32.432 %) while group B had 27 females (75 %) and 9 males (25 %). 70.27 % were diagnosed with moderate depression in group A and 75 % in group B. 18.91 % in group A and 19.44 % in group B were diagnosed with severe depression. When the VAS score and BDI score was compared at the follow-up intervals with the baseline scores in both treatment groups, the mean difference was highly significant at all the follow-up intervals. However when the relative efficacies of two interventions were compared between the two groups, improvement in pain was significant at all the follow-up intervals except the 1st week follow-up whereas the improvement in depression was non-significant at 1st and 4th week interval while it was highly significant at 6th and 12th week intervals.

Conclusion

The combined therapy with trigger point injection and levosulpiride as antidepressant significantly reduces pain and depression in the study subjects suffering from chronic myofascial pain with moderate to severe depression in the orofacial region.

Keywords

Myofascial pain Temporomandibular disorders Masticatory muscles Orofacial region Depression 

References

  1. 1.
    Gerwin RD, Dommerholt J (2002) Treatment of myofascial pain syndromes. In: Weiner R (ed) Pain management; a practical guide for clinicians. CRC Press, Boca Raton, pp 235–249Google Scholar
  2. 2.
    Dommerholt J (2001) Muscle pain syndromes. In: Cantu RI, Grodin AJ (eds) Myofascial manipulation. Aspen, Gaithersburg, pp 93–140Google Scholar
  3. 3.
    Dworkin SF (2001) Psychosocial issues. In: Lund JP (ed) Orofacial pain, from basic science to clinical management – the transfer of knowledge in pain research to education. Quintessence Pub. Co. Inc., pp 115–127Google Scholar
  4. 4.
    Simons DG, Travell JG, Simons LS, Travell JG (1999) Travell & Simons’ myofascial pain and dysfunction: the trigger point manual, 2nd edn. Williams & Wilkins, BaltimoreGoogle Scholar
  5. 5.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571PubMedCrossRefGoogle Scholar
  6. 6.
    Beck AT, Steer RA (2000) Beck depression inventory (BDI). In: Rush AJ (ed) Handbook of psychiatric measures, 1st edn. American Psychiatric Press, Washington, pp 534–537Google Scholar
  7. 7.
    Graff-Radford SB (2001) Regional myofascial pain syndrome and headache: principles of diagnosis and management. Curr Pain Headache Rep 5(4):376–381PubMedCrossRefGoogle Scholar
  8. 8.
    Rollman GB, Lautenbacher S (2001) Sex differences in musculoskeletal pain. Clin J Pain 17:20–24PubMedCrossRefGoogle Scholar
  9. 9.
    Drangsholt M, LeResche L (1999) Temporomandibular disorder pain. In: Crombie IK et al (eds) Epidemiology of pain. IASP Press, Seattle, pp 203–233Google Scholar
  10. 10.
    Yap AUJ, Dworkin SF, Chua EK, List T, Tan KBC, Tan HH (2003) Prevalence of temporomandibular disorders subtypes, psychologic distress and psychosocial dysfunction in Asian patients. J Orofac Pain 17:21–28PubMedGoogle Scholar
  11. 11.
    Reiter S, Eli I, Gravish A et al (2006) Ethnic difference in temporomandibular disorders between arab and jewish population in Israel according to RDC/TMD evaluation. J Orofac Pain 20(1):36–43PubMedGoogle Scholar
  12. 12.
    Warren MP, Fried JL (2001) Temporomandibular disorders and hormones in women. Cells Tissues Organs 169:187–192PubMedCrossRefGoogle Scholar
  13. 13.
    Ferrando M, Andreu Y, Galdon MJ, Durà E, Poveda R, Bagan JV (2004) Psychological variables and temporomandibular disorders: distress, coping and personality. Oral Surg Oral Med Oral Pathol 98:153–160CrossRefGoogle Scholar
  14. 14.
    Auerbach S, Laskin D, Frantseve LME, Orr T (2001) Depression, pain, exposure to stressful life events and long term outcomes in temporomandibular disorder patients. J Oral Maxillofac Surg 59(4):628–633PubMedCrossRefGoogle Scholar
  15. 15.
    Meldolesi GN, Picardi A, Accivile E, Toraldo di Francia R, Biondi M (2000) Personality and psychopathology in patients with temporomandibular joint pain-dysfunction syndrome. Psychother Psychosom 69:322–328PubMedCrossRefGoogle Scholar
  16. 16.
    Michelotti A, Martina R, Russo M, Romeo R (1998) Personality characteristics of temporomandibular disorder patients using MMPI. Cranio 16(2):119–125PubMedCrossRefGoogle Scholar
  17. 17.
    Nifosi F, Guarda Nardini L, Vilato E et al (2007) Psychopathology and clinical features in an Italian sample of patients with myofascial and temporomandibular joint pain: preliminary data. Int J Psychiatry Med 37(3):283–300PubMedCrossRefGoogle Scholar
  18. 18.
    Altindag O, Gur A, Altindag A (2008) The relationship between clinical parameters and depression level in patients with myofascial pain syndrome. Pain Med 9(2):161–165PubMedCrossRefGoogle Scholar
  19. 19.
    Manfredini D, Marini M, Pavan C et al (2009) Psychosocial profiles of painful TMD patients. J Oral Rehabil 36:193–198PubMedCrossRefGoogle Scholar
  20. 20.
    Ay S, Evcik D, Tur BS (2010) Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol 29:19–23PubMedCrossRefGoogle Scholar
  21. 21.
    Hyuk G, Ji-Ho C, Chang-Hae P, Hyun-Jung Y (2007) Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients. Acupunct Med 25(4):130–136CrossRefGoogle Scholar
  22. 22.
    Esenyel M, Caglar N, Aldemir T (2000) Treatment of myofascial pain. Am J Phys Med Rehabil 79:48–52PubMedCrossRefGoogle Scholar
  23. 23.
    Ay S, Evcik D, Tur BS (2010) Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol 29:19–23PubMedCrossRefGoogle Scholar
  24. 24.
    Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS (1998) Do antidepressants have an analgesic effects in psychogenic pain and somatoform disorders. Psychosom Med 60:503–509PubMedCrossRefGoogle Scholar
  25. 25.
    Verdu B, Decosterd I, Buclin T et al (2008) Antidepressants for the treatment of chronic pain. Drugs 68(18):2611–2632PubMedCrossRefGoogle Scholar
  26. 26.
    Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS (1996) Chronic pain-associated depression: antecedent or consequence of chronic pain. A review. Clin J Pain 13:116–137CrossRefGoogle Scholar
  27. 27.
    Keefe FJ, Dolan E (1986) Pain behavior and pain coping strategies in low back pain and myofascial pain dysfunction syndrome patients. Pain 24:49–56PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Oral and Maxillofacial Surgeons of India 2015

Authors and Affiliations

  • Pranav Gupta
    • 1
  • Virendra Singh
    • 2
  • Sujata Sethi
    • 3
  • Arun Kumar
    • 4
  1. 1.Department of DentistrySHKM Govt. Medical CollegeMewatIndia
  2. 2.Department of Oral and Maxillofacial SurgeryPGIDS, Pt. B.D. Sharma University of Health SciencesRohtakIndia
  3. 3.Department of PsychiatryPGIMS, Pt. B.D. Sharma University of Health SciencesRohtakIndia
  4. 4.Department of Community MedicineSHKM Govt. Medical CollegeMewatIndia

Personalised recommendations