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Therapie bei Schmerzen der Kaumuskulatur

Aktualisierung der Empfehlungen

Clinical management of masticatory muscle pain

An update of the recommendations

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Zusammenfassung

Kaumuskelschmerzen sind nach Zahnschmerzen die häufigsten Schmerzen in der Kiefer-Gesichts-Region. Nach einer Zusammenfassung der vom Interdisziplinären Arbeitskreis für Mund- und Gesichtsschmerzen der Deutschen Schmerzgesellschaft im Jahre 2007 veröffentlichten Therapieempfehlungen wird anhand einer Literaturrecherche der Kenntnisstand von Ätiologie, Diagnostik und therapeutischen Möglichkeiten aktualisiert. Es erfolgte eine systematische Literatursuche in PubMed, der Cochrane Library und der Verlagsdatenbank der Deutschen Zahnärztlichen Zeitschrift. Die Ergebnisse bestätigen unsere früheren Empfehlungen, dass bei der überwiegenden Zahl der Patienten mit nichtinvasiven, reversiblen Maßnahmen Schmerzlinderung bzw. Schmerzfreiheit erreicht werden kann. Kurz- und Langzeitstudien haben weitere Belege dafür geliefert, dass verschiedene Behandlungsverfahren vergleichbar wirksam sind. Bei chronischen Verläufen ist neben der biomedizinischen Standardtherapie eine schmerzpsychologische Betreuung obligat. Als empfehlenswert wurden Aufklärung, Okklusionsschienen, physiotherapeutische Selbstbehandlung und Akupunktur, als eingeschränkt empfehlenswert physikalische Therapie, Pharmakotherapie und psychologische Schmerztherapie beurteilt.

Abstract

Besides the different forms of odontalgia, myalgias of the masticatory muscles are the most frequent noninfectious complaints in the orofacial region. After summarizing the recommendations set forth by the Interdisciplinary Working Group of Orofacial Pain within the German Chapter of the IASP (German Pain Society), we present the current state of knowledge regarding the etiology, diagnosis, and therapeutic options, based on an extensive literature search. A systematic literature search was carried out in PubMed, the Cochrane Library, and the database of the Deutsche Zahnärztliche Zeitschrift. The results corroborate our previous recommendations that for the majority of patients pain reduction or pain relief can be achieved with noninvasive, reversible methods. Short- and long-term trials have added more evidence to the fact that different therapeutic measures have similar efficacy. In patients with chronic myalgias of the jaw muscles, involvement of a psychotherapist is crucial. Patient education, oral appliances, physiotherapeutic exercises, and acupuncture are recommended therapeutic measures, while physical therapy, pharmacotherapy, and psychological therapy received a limited recommendation.

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  1. Poliklinik für Zahnärztliche Prothetik, Universität Heidelberg, Heidelberg, Deutschland

    H.J. Schindler

  2. Klinik für Rekonstruktive Zahnmedizin und Myoarthropathien, Universitätskliniken für Zahnmedizin, Universität Basel, Hebelstr. 3, 4056, Basel, Schweiz

    J.C. Türp

  3. DRK-Schmerzzentrum Mainz, Mainz, Deutschland

    P. Nilges

  4. Poliklinik für Zahnärztliche Prothetik, Westdeutsche Kieferklinik, Universität Düsseldorf, Düsseldorf, Deutschland

    A. Hugger

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  4. A. Hugger
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J.C. Türp ist stellvertretender Vorsitzender des Interdisziplinären Arbeitskreises für Mund- und Gesichtsschmerzen der Deutschen Schmerzgesellschaft. Die Autoren schreiben im Namen des Interdisziplinären Arbeitskreises für Mund- und Gesichtsschmerzen der Deutschen Schmerzgesellschaft.

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Schindler, H., Türp, J., Nilges, P. et al. Therapie bei Schmerzen der Kaumuskulatur. Schmerz 27, 243–252 (2013). https://doi.org/10.1007/s00482-013-1329-7

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