Additional Effect of Pain Neuroscience Education to Orofacial and Neck Exercises in Temporomandibular Disorders
Condition: Temporomandibular Disorders
MeSH terms: Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome
Study type: Interventional

Summary: 
      The objective of this study will be to verify the additional effect of Pain Neuroscience
      Education program to orofacial manual therapy and orofacial and neck motor control exercises
      for pain intensity and disability and for the secondary outcomes pain self-efficacy,
      kinesiophobia, and overall perception of improvement in patients with Temporomandibular
      Disorders (TMD). This study will be a randomized clinical trial comprising a sample of 148
      participants. Subjects will undergo a screening process to verify those presenting a
      diagnosis of painful TMD confirmed by the Research Diagnostic Criteria (RDC/TMD), between 18
      and 55 years of both genders, and then the volunteers will be randomized into two groups (G1:
      Pain Neuroscience Education + Orofacial Manual Therapy/orofacial exercises/neck motor control
      exercises vs. G2: Orofacial Manual Therapy/orofacial exercises/neck motor control exercises).
      These volunteers will be recruited at the Dentistry Clinic of the University of São Paulo's
      School of Dentistry of Ribeirão Preto - University of São Paulo. The intervention will be
      administered twice a week for 6 weeks by a single therapist lasting 1 hour per session. The
      primary outcome will be pain intensity and disability and the secondary outcomes will be pain
      self-efficacy, kinesiophobia and overall perception of improvement. The participants will be
      assessed immediate after the last session and at one and three-month follow-ups.
    


Intervention name(s): Pain Neuroscience Education (PNE); Orofacial Manual Therapy; Orofacial Exercises; Neck Motor Control Exercises
Intervention type(s): Other; Other; Other; Other
Intervention description(s): A power-point presentation with metaphors and animated videos will be employed. The PNE program will be held in 2 sessions of 30 minutes each. The intervention program will be divided into 17 thematic topics according to Explain Pain.; A protocol of Orofacial Exercises and Manual Therapy will be adopted in the present study. The manual therapy techniques will be: Intraoral temporalis release, Intraoral medial and lateral pterygoid (origin) technique and Intraoral sphenopalatine ganglion technique.; Two mandibular exercises: Mandibular body-condylar cross-pressure chewing technique and Post-isometric relaxation stretches-laterotrusion and opening. Each exercise will be executed 10 times per session for 10 seconds.; A protocol of neck motor control protocol will be adopted in our study. The exercises included bracing exercises (six hierarchical levels) in neurodevelopment stages for the cervical spine. Extremity range of motion exercises will be conducted while maintaining a stable spine at the specific positions. Also, cervical isometric exercises (five hierarchical levels) will be carried out directly forward, obliquely, toward right and left, and directly backward by maintaining a stable spine with elastic resistive bands. Finally, exercises also included functional training with elastic resistance and exercise balls on unstable surfaces (eight hierarchical levels). The criteria to progress in each exercise domain (bracing, isometric exercises or functional training) will be sustain the contraction for 10 seconds, 10 times.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Pain Neuroscience Education; Chronic Pain; Orofacial Manual Therapy; Orofacial exercises; Neck Motor Control Exercises