Clinical Evaluation Of Amitriptyline For The Control Of Chronic Pain Caused By Temporomandibular Joint Disorders

Temporomandibular disorder (TMD) is characterized by a combination of symptoms affecting the temporomandibular joint and/or chewing muscles. The two most common clinical TMD symptoms are pain and dysfunction. Pain is usually caused by dysfunction, and emergency therapy has focused on controlling it. Recent investigations into TMD have led to the recommendation of antidepressants as a supporting treatment against constant neuralgic pain. The aim of this double-blind study was to verify the efficiency of antidepressants (amitriptyline) as a support in the treatment of chronic TMD pain. Twelve female volunteers presenting chronic TMD pain were divided into two groups and treated for 14 days: Group 1 with 25 mg/day of amitriptyline and Group 2 with a placebo. The intensity of pain and discomfort was evaluated daily, using a visual analog scale (VAS), over a period of seven days preceding the treatment (baseline), during the 14-day treatment, and for seven days after the treatment. The results revealed a significant reduction of pain and discomfort in Group 1 (75%) compared to Group 2 (28%) during the three weeks beginning at baseline (p< 0.01). Amitriptyline proved to be an efficient alternative treatment for chronic pain in TMD patients. Copyright © 2003 by CHROMA, Inc.213221225Haber, J.D., Moss, R.A., Kuczmierczyk, A.R., Garrett, J.C., Assessment and treatment of stress in myofascial pain-dysfunction syndrome: A model for analysis (1983) J Oral Rehabil, 10, pp. 187-196Laskin, D.M., Etiology of the pain-dysfunction syndrome (1969) JADA, 79, pp. 147-153Rugh, J.D., Solberg, W.K., Psychological implications in temporomandibular pain and dysfunction (1976) Oral Sci Rev, 7, pp. 3-30Sarnat, B., Laskin, D.M., (1980) The Temporomandibular Joint: A Biological Base for Clinical Practice, , Springfield, Illinois: Charles C. ThomasAndrade, E.D., (1998) Drug Therapy in Dentistry, pp. 185-188. , Sao Paulo: Artes MedicasBlank, L.W., Clinical guidelines for managing mandibular dysfunction (1998) Gen Dent, 46, pp. 592-597Gil, I.A., Barbosa, C.M., Monteiro, V.M., Silverio, K.C., Goldfarb, D.P., Fusco, V., Navarro, C.M., Multidisciplinary approach to chronic pain from myofascial pain dysfunction syndrome: A four-year experience at a Brazilian center (1998) J Craniomandib Pract, 16, pp. 17-25Sharav, Y., Singer, E., Schmidt, E., Dionne, R.A., Dubner, R., The analgesic effect of amitriptyline on chronic facial pain (1987) Pain, 31, pp. 199-209McQuay, H.J., Carroll, D., Glynn, C.J., Low dose amitriptyline in the treatment of chronic pain (1992) Anesthesia, 47, pp. 646-652Zitman, F.G., Linssen, A.C., Edelbroek, P.M., Stijnem, T., Low dose amitriptyline in chronic pain: The gain is modest (1990) Pain, 42, pp. 35-42Dionne, R.A., Pharmacologic treatments for temporomandibular disorders (1997) Oral Surg Oral Med Oral Pathol Oral Radiol Oral Endod, 83, pp. 134-142McQuay, H.J., Carroll, D., Glynn, C.J., Dose-response for analgesic effect of amitriptyline in chronic pain (1993) Anesthesia, 48, pp. 281-28