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Existem muitas maneiras de diagnóstico mediante questionários, relatórios, exames clínicos e o uso de ferramentas como polissonografia, eletromiograma e dispositivos orais. Se complementarmos vários desses métodos teremos um diagnóstico mais confiável e válido. Atualmente não há cura definitiva para o bruxismo, mas o seu aparecimento pode ser prevenido e seus efeitos reduzidos/evitados. O objetivo deste estudo é realizar uma revisão sistemática, fazendo uma comparação entre dois tipos de tratamentos para o bruxismo noturno, tratamento com goteiras oclusais e tratamento com injeções de toxina botulínica nos músculos masséter e temporal, avaliando a sua eficácia na redução dos sintomas gerados pelo bruxismo (redução da dor, prevenção do desgaste dentário, danos na musculatura orofacial, redução da atividade muscular, cefaleia). A pesquisa identificou 142 artigos, dos quais 12 foram considerados relevantes para este estudo. O bruxismo é um fenómeno multifatorial que afeta a maioria da população, é uma atividade muscular mastigatória repetitiva, caracterizado por ranger ou apertar os dentes, pode ocorrer durante o dia (consciente/inconscientemente) ou de noite (inconscientemente). A etiologia exata é desconhecida. Com base nos artigos analisados, não podemos provar que um tratamento é superior ao outro, mais o tratamento de primeira escolha até o momento é o uso de goteira oclusal, precisamos de analisar mais estudos ao longo do tempo e com uma amostra maior no futuro. There are many ways of diagnosis through questionnaires, reports, clinical examinations and the use of tools such as polysomnography, electromyogram and oral devices. If we complement several of these methods, we will have a more reliable and valid diagnosis. Currently there is no definitive cure for bruxism, but its appearance can be prevented and its effects reduced/avoided. The objective of this study is to perform a systematic review, making a comparison between two types of treatments for nocturnal bruxism, treatment with occlusal drips and treatment with botulinum toxin injections in the masseter and temporalis muscles, evaluating their efficacy in reducing the symptoms generated by bruxism (reduction of pain, prevention of dental wear, damage to the orofacial musculature, reduction of muscular activity, headache). The search identified 142 articles, 12 of which were considered relevant for this study. Bruxism is a multifactorial phenomenon that affects the majority of the population, it is a repetitive masticatory muscle activity, characterized by grinding or clenching the teeth, it can occur during the day (consciously/unconsciously) or at night (unconsciously). The exact aetiology is unknown. Based on the articles analysed, we cannot prove that one treatment is superior to another, but the treatment of first choice so far is the use of an occlusal tray.

Introducción: La zona dorsal es un área muy compleja de movilidad reducida con influencia directa en las alteraciones de la región cervical y lumbar y que con frecuencia presenta dolor localizado de características propias ocasionando desarreglos en la estática. El síndrome de dolor miofascial (SDM) es un trastorno no inflamatorio que se manifiesta por dolor localizado, rigidez y como característica principal la presencia de PGM con frecuenta afectación de la musculatura cérvicodorsal que es susceptible a padecer dolor miofascial (Gerwin R, 2005). Para la desactivación del PGM una de las técnicas utilizadas es la PS. El propósito de este estudio radica en valorar si la Punción Seca es efectiva en el tratamiento de las dorsalgias. Hipótesis: Se planteó si la PS disminuye el dolor y la contractura muscular para inactivar los PG. Objetivos: Valorar la influencia en las modificaciones del dolor, repercusión psicológica, movilidad articular y capacidad funcional de la espalda. Material y Método: La muestra la constituyeron 100 personas con dolor dorsal, divididas aleatoriamente en dos grupos. Todos los sujetos fueron tratados con 5 sesiones de fisioterapia a ritmo de una sesión semanal durante 5 semanas consecutivas. Al grupo A se les aplicó 20 minutos de masoterapia y 10 minutos de estiramientos donde la duración de las sesiones fueron de 30 minutos. En el grupo B se utilizó Punción Seca sobre los PGM de los músculos trapecio medio, romboides, infraespinoso y longísimo torácico, más 20 minutos de masoterapia y 10 minutos de estiramientos y la duración de cada sesión fue de 45 minutos. A todos los sujetos se les hizo una valoración inicial y final del estudio. El algómetro de presión se empleó para observar las modificaciones del dolor objetivo, la Escala Analógica Visual para valorar el dolor subjetivo, la goniometría para la movilidad articular, el cuestionario de Roland Morris para el grado de discapacidad de la columna, el cuestionario de Holmes y Rahe para observar el grado de estrés, el test de Schober para valorar el grado de flexibilidad de la columna lumbar, el test de Ott para la movilidad de la columna dorsal y la prueba de Barlow para observar la variación de la protusión de la cabeza. Resultados: La aplicación de PS mejora el dolor muscular en las dorsalgias crónicas en sujetos con una edad media de 44,6 años. Se observa un aumento del descanso, disminución del dolor subjetivo y del dolor a la presión, aumento en la funcionalidad de la columna, de la retracción del cuello y del estrés psicosocial. Los resultados encontrados en este estudio son similiares a anteriores en los que se compara la terapia por Punción Seca con otras terapias conservadoras como son los estiramientos (Tekin L, 2013; Roca J, 2014). Conclusiones: La aplicación de PS con masoterapia y estiramientos en dorsalgias se muestra más efectiva que la terapia donde solo se emplea masoterapia y estiramientos, facilita el descanso, aumenta el umbral de tolerancia al dolor, reduce el dolor subjetivo, la inactivación de puntos gatillo por la PS mejora la funcionalidad de columna, retracción del cuello, disminuyendo el estrés. En cuanto a la flexibilidad de columna no existen diferencias entre la técnica de Punción Seca con masoterapia y estiramientos frente a la aplicación de masoterapia y estiramientos exclusivamente., Introduction: The dorsal area is a very complex area of mobility with direct influence on the changes in the cervical and lumbar region and often presents localized characteristics causing disruption in the static pain. The myofascial pain syndrome (SDM) is a non-inflammatory disorder manifested by localized pain, stiffness and as main characteristic the presence of PGM with frequent involvement of the cervical and dorsal musculature is likely to suffer myofascial pain (Gerwin R, 2005). For deactivating the PGM one of the techniques used is the PS. The purpose of this study is to assess whether dry needling is effective in the treatment of back pain. Hypothesis: It was considered whether the PS reduces pain and muscle contracture to inactivate PG. Objectives: To evaluate the influence on changes of pain, psychological impact, joint mobility and functional capacity of the back. Material and Methods: The sample comprised 100 people with back pain were randomly divided into two groups. All subjects were treated with 5 sessions of physiotherapy to the rhythm of a weekly session for 5 consecutive weeks. Group A was applied 20 minutes massage therapy and 10 minutes of stretching where the duration of the sessions were 30 minutes. Dry needling was used on the PGM middle trapezius muscles, rhomboids, infraspinatus and longissimus thoracic. In group B, plus 20 minutes of massage therapy and 10 minutes of stretching and duration of each session was 45 minutes. All subjects were given a start and end point of the study. The pressure algometer was used to observe the changes of the target pain, Visual Analog Scale to assess subjective pain, direction finding for joint mobility, the Roland Morris questionnaire to the degree of disability of the column, the questionnaire Holmes and Rahe to observe the degree of stress test Schober to assess the degree of flexibility of the lumbar spine, the test Ott for the mobility of the spine and test Barlow to observe the variation of the protrusion of the head. Results: Application of PS improves muscle pain chronic back pain in subjects with an average age of 44.6 years. Increased rest, reduced subjective pain and pressure pain, increased functionality of the spine, neck retraction and psychosocial stress is observed. The results found in this study are similiar to earlier in PS with other conservative therapies such as stretching (Tekin, 2013, Roca, 2014) is compared. Conclusions: The application of PS with massage therapy and stretching in back pain more effectively shown that therapy where only massage therapy and stretching is used, facilitates the break, increases the threshold of pain tolerance, reduces subjective pain, inactivation of trigger points PS improves functionality column neck retraction, decreasing stress. As for the column flexibility there is no difference between dry neddling with massage therapy and stretching against the application of massage therapy and stretching alone.

O uso de opiáceos para o controle da dor crônica não relacionada ao câncer é controverso. Avaliar o alívio da dor e as mudanças nas atividades de vida diária advindas da infusão intratecal de opiáceos em 11 doentes, com dor crônica não neoplásica, foram os objetivos deste estudo. Todos os doentes haviam previamente sido submetidos a diversas modalidades terapêuticas sem alívio significativo. Os doentes foram solicitados a avaliar as características da dor e as atividades de vida diária comparando-as antes e após o tratamento com opiáceo intratecal por meio de sistemas implantados. Observou-se alívio da dor. No entanto, melhora da funcionalidade não foi observada com a mesma magnitude. Opioids for non cancer pain control are controversial. The evaluation of the pain relief, changes in quality of life and complications due to long term infusion of opioids in the lumbar subarachnoid space in 11 patients with non cancer pain were the goals of this study. Patients were previously treated with drugs and surgical procedures, without significant pain relief. Patients were asked to compare pain characteristics and daily life activities before and after this treatment. The long term spinal opioids through implantable pumps for non-oncologic pain produced pain relief but did not improve the quality of life in the majority of the cases. El uso de opiáceo para el control del dolor crónico no relacionado al cáncer es controvertido. Evaluar el alivio del dolor y los cambios en las actividades de la vida diaria debidas a la infusión intratecal de opiáceos, en 11 pacientes con dolor crónico no neoplásico fue el objetivo de este estudio. Todos los pacientes habían previamente sido sometidos a las diversas modalidades terapéuticas sin alivio significativo del dolor. Los pacientes fueron entrevistados y se les solicitó evaluar el dolor y las actividades de la vida diaria, comparando antes y después del tratamiento con opiáceo intratecal. La infusión de opiáceo intratecal resulto en alivio del dolor. Sim embargo, la mejoría de la funcionalidad no fue observada con la misma magnitud.

O uso de agentes morfínicos para o controle da dor crônica não relacionada a câncer é controverso. Este estudo aferiu o alívio da dor e as mudanças nas atividades de 11 doentes com dor crônica não associada ao câncer, tratados pela infusão intratecal de fármacos morfínicos através de bombas implantáveis. A dor era neuropática em 5 doentes e miofascial em 6. A duração média da queixa álgica foi 5,3 anos. A média da intensidade da dor antes da infusão foi 8,6. Sete doentes apresentavam dor durante 6 ou mais horas por dia. Após o tratamento, a média de intensidade da dor reduziu-se para 3,9. Somente 1 doente manteve dor com duração superior a 6 horas. O tratamento melhorou o desempenho de 36,36% dos aspectos funcionais avaliados. O tempo médio de tratamento foi 19,6 meses. A infusão crônica de agentes morfínicos por via intratecal proporcionou alívio da dor, mas não melhorou a funcionalidade com a mesma magnitude.The use of opioids for treatment of non-malignant pain is controversial. The evaluation of pain relief and of the quality of life of 11 severely incapacitated chronic non-cancer pain patients treated with long term intrathecal infusion of opioids trought implantable pumps was performed. The mean duration of pain complaints was 5.3 years. The mean pain intensity was 8.6. In 7 patients, pain episodes lasted at least 6 hours daily. The mean duration of the therapy was 19.6 months. After the treatment the mean pain score became 3.9. In only 1 patient, the duration of pain episodes was still longer than 6 hours. Quality of life improved in 36.36% of the cases. The long term spinal opioids through implantable pumps for non-malignant pains results in pain relief but not necessarily improves the quality of life.

JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular (DTM) é um termo que descreve um grupo de doenças que afetam funcionalmente o aparelho mastigatório, particularmente a musculatura mastigatória e a articulação temporomandibular (ATM). Tem etiologias múltiplas e tratamentos específicos, entre os quais a estimulação elétrica nervosa transcutânea (TENS). O objetivo deste artigo é o de revisar a literatura científica sobre o uso da TENS em pacientes com DTM. CONTEÚDO: Estudos epidemiológicos mostram que aproximadamente 75% da população apresentam algum sinal de DTM, enquanto 33% possuem ao menos um sintoma. Sempre que possível deve-se tratar a causa da dor, caso não se consiga estabelecer a sua etiologia, inicia- -se com procedimentos menos invasivos e reversíveis, especialmente nos casos de dor e disfunção muscular. A terapia com TENS consiste na administração de corrente elétrica na superfície cutânea, de modo a relaxar os músculos hiperativos e promover o alívio da dor. CONCLUSÃO: Embora existam controvérsias quanto ao uso de TENS para o controle da dor crônica, seu uso na dor muscular mastigatória continua relevante. Entretanto, é fundamental o diagnóstico preciso para evitar uso inadequado. São necessários ainda estudos randomizados controlados que incluam amostras selecionadas para homogeneizar o uso de TENS em pacientes com DTM. BACKGROUND AND OBJECTIVES: Temporomandibular joint dysfunction (TMJD) is a term to describe a group of diseases functionally affecting the masticatory system, especially masticatory muscles and the temporomandibular joint (TMJ). It has different etiologies and specific treatments, among them the transcutaneous electrical nerve stimulation (TENS). This article aimed at reviewing the scientific literature on the use of TENS in TMJD patients. CONTENTS: Epidemiological studies show that approximately 75% of people have some TMJD sign, while 33% have at least one symptom. Whenever possible, one should treat the cause of pain. When it is impossible to determine its etiology, one should start with less invasive and reversible procedures, especially for pain and muscle dysfunction. TENS therapy consists of administering electrical current to the skin surface, to relax hyperactive muscles and promote pain relief. CONCLUSION: Although there are controversies about the use of TENS to control chronic pain, its use for masticatory muscle pain is still relevant. However, an accurate diagnosis is needed to prevent its inadequate use. We still need controlled randomized studies including selected samples to homogenize the use of TENS in TMJD patients.

Made available in DSpace on 2013-09-27T14:52:51Z (GMT). No. of bitstreams: 1 WOS000285686700017.pdf: 209049 bytes, checksum: 2d38cf84a3d26c601380b7b909a0ad84 (MD5) Previous issue date: 2010-01-01 Made available in DSpace on 2013-09-30T19:23:57Z (GMT). No. of bitstreams: 1 WOS000285686700017.pdf: 209049 bytes, checksum: 2d38cf84a3d26c601380b7b909a0ad84 (MD5) Previous issue date: 2010-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:34:21Z No. of bitstreams: 1 WOS000285686700017.pdf: 209049 bytes, checksum: 2d38cf84a3d26c601380b7b909a0ad84 (MD5) Made available in DSpace on 2014-05-20T15:34:21Z (GMT). No. of bitstreams: 1 WOS000285686700017.pdf: 209049 bytes, checksum: 2d38cf84a3d26c601380b7b909a0ad84 (MD5) Previous issue date: 2010-01-01 Background: Canine hip dysplasia (HD) is characterized by hip joint laxity and subluxation. It is the most common cause of osteoarthritis in dogs, especially in larger breeds. Its management includes nutritional supplements, nonsteroidal anti-inflammatory drugs, physical therapy, acupuncture or surgical procedures. Implantation of gold beads in acupuncture points and trigger points around a joint has been used in the treatment of osteoarthritis in dogs for at least 30 years. Gold bead implants(GBI) acts as continuous acupuncture stimulation and trigger point treatment in canine HD with long lasting results. Electrophysiological investigations of trigger points reveal dysfunctional muscle spindles which indicate that the electrical activity of active loci arises from extrafusal motor endplates.Case: This is a report on the use of acupuncture and GBI for bilateral HD in a nine year old female German Shepherd. The patient has a HD non-responsive to anti-inflammatory drugs and was unable to stand up or walk by its own. Radiographs showed marked dysplasia, significant subluxation with the femoral head partly out of a shallow acetabulum and massive secondary arthritic bone changes, mainly on the right side. The animal was submitted to eight acupuncture sessions with seven days interval. After the first acupuncture session the use of NSAID was interrupted. After eight weeks the dog was considered rehabilitated and underwent GBI in acupoints and trigger points as maintenance treatment. During the one-year follow-up period the improvement remained unchanged with no need of analgesics.Discussion: It has been suggested that acupuncture or GBI can treat the chronic pain resulting from osteoarthritis induced by HD. According to AP theory, GBI is permanent and long-lasting acupoint stimulation. Moreover, the method is inexpensive, quick and easy to perform, with no postoperative pain or need of exercise restriction. Although gold is extremely corrosion-resistant, the surface of the gold implants stimulates a reaction from the immune system causing an oxidative liberation of gold ions with anti-inflammatory actions. It is well known that gold ions are effective inhibitors of the respiratory burst of neutrophils and monocytes and the proliferation of lymphocytes. These findings suggest that gold implantation, on a local scale, mimics the anti-inflammatory and pain-relieving effect of drugs with chemically bound gold ions. The relatively slow speed of the process results in a limited liberation of gold ions securing that they are taken up almost exclusively by cells close to the implant. The nine year old female German shepherd had a positive response to acupuncture with pain relieve and locomotor rehabilitation. For the nine year old female German shepherd previous acupuncture sessions to GBI resulted in no post-implant worsening period. Indeed, the association acupuncture/GBI does not have the anti-inflammatory drugs undesirable effects and brings long lasting results. In conclusion, GBI therefore should be considered for canine HD when conservative or medical treatments fail to give the desired effect. Univ Estadual Paulista, FMVZ, DCAV, Programa Posgrad Acupuntura Vet, BR-18618000 São Paulo, Brazil Universidade Federal de Uberlândia (UFU), Fac Med Vet, BR-38400 Uberlandia, MG, Brazil Univ Estadual Paulista, FMVZ, DCAV, Programa Posgrad Acupuntura Vet, BR-18618000 São Paulo, Brazil

La Fibromialgia (FM) es una enfermedad que afecta entre el 3 y el 5% de la población mundial está caracterizada por dolor músculo - esquelético generalizado y características similares a algunos problemas de trastornos Témporo Mandibulares, la correcta anamnesis y examen clínico facilitan su detección y la factibilidad de auxilio en el tratamiento, mediante el uso de placas blandas miorelajantes. En este trabajo fueron examinados 22 pacientes con sintomatología coincidente a la Fibromialgia, reduciéndose la muestra a 12 en los cuales se diagnosticó de la enfermedad, obteniéndose resultados positivos al uso de la placa miorelajante. Fibromyalgia (FM) is a widespread musculoskeletal pain and fatigue disorder that affects between 3 and 5% of the world. It’s symptoms are similar to Temporomandibular disorders. The anamnesis and clinical examination help us to detect it and made possible the dental treatment with soft splints. In this study 22 patients with Facial, TMJ or Cervical pain was examinated only 12 shows coincident symptoms with Fibromialgia. We obtain good results in those patients decreasing the facial and neck pain, using the soft splint.

Opioids for non cancer pain control are controversial. The evaluation of the pain relief, changes in quality of life and complications due to long term infusion of opioids in the lumbar subarachnoid space in 11 patients with non cancer pain were the goals of this study. Patients were previously treated with drugs and surgical procedures, without significant pain relief. Patients were asked to compare pain characteristics and daily life activities before and after this treatment. The long term spinal opioids through implantable pumps for non-oncologic pain produced pain relief but did not improve the quality of life in the majority of the cases. El uso de opiáceo para el control del dolor crónico no relacionado al cáncer es controvertido. Evaluar el alivio del dolor y los cambios en las actividades de la vida diaria debidas a la infusión intratecal de opiáceos, en 11 pacientes con dolor crónico no neoplásico fue el objetivo de este estudio. Todos los pacientes habían previamente sido sometidos a las diversas modalidades terapéuticas sin alivio significativo del dolor. Los pacientes fueron entrevistados y se les solicitó evaluar el dolor y las actividades de la vida diaria, comparando antes y después del tratamiento con opiáceo intratecal. La infusión de opiáceo intratecal resulto en alivio del dolor. Sim embargo, la mejoría de la funcionalidad no fue observada con la misma magnitud. O uso de opiáceos para o controle da dor crônica não relacionada ao câncer é controverso. Avaliar o alívio da dor e as mudanças nas atividades de vida diária advindas da infusão intratecal de opiáceos em 11 doentes, com dor crônica não neoplásica, foram os objetivos deste estudo. Todos os doentes haviam previamente sido submetidos a diversas modalidades terapêuticas sem alívio significativo. Os doentes foram solicitados a avaliar as características da dor e as atividades de vida diária comparando-as antes e após o tratamento com opiáceo intratecal por meio de sistemas implantados. Observou-se alívio da dor. No entanto, melhora da funcionalidade não foi observada com a mesma magnitude.

O uso de agentes morfínicos para o controle da dor crônica não relacionada a câncer é controverso. Este estudo aferiu o alívio da dor e as mudanças nas atividades de 11 doentes com dor crônica não associada ao câncer, tratados pela infusão intratecal de fármacos morfínicos através de bombas implantáveis. A dor era neuropática em 5 doentes e miofascial em 6. A duração média da queixa álgica foi 5,3 anos. A média da intensidade da dor antes da infusão foi 8,6. Sete doentes apresentavam dor durante 6 ou mais horas por dia. Após o tratamento, a média de intensidade da dor reduziu-se para 3,9. Somente 1 doente manteve dor com duração superior a 6 horas. O tratamento melhorou o desempenho de 36,36% dos aspectos funcionais avaliados. O tempo médio de tratamento foi 19,6 meses. A infusão crônica de agentes morfínicos por via intratecal proporcionou alívio da dor, mas não melhorou a funcionalidade com a mesma magnitude. The use of opioids for treatment of non-malignant pain is controversial. The evaluation of pain relief and of the quality of life of 11 severely incapacitated chronic non-cancer pain patients treated with long term intrathecal infusion of opioids trought implantable pumps was performed. The mean duration of pain complaints was 5.3 years. The mean pain intensity was 8.6. In 7 patients, pain episodes lasted at least 6 hours daily. The mean duration of the therapy was 19.6 months. After the treatment the mean pain score became 3.9. In only 1 patient, the duration of pain episodes was still longer than 6 hours. Quality of life improved in 36.36% of the cases. The long term spinal opioids through implantable pumps for non-malignant pains results in pain relief but not necessarily improves the quality of life.