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Myofacial pain, a chronic painful condition of muscle origin, has numerous precipitating factors, if undiagnosed or left untreated could lead to compromised function and poor quality of life. In this case report, a female patient giving a history of 10 years of pain in the head and neck region was eventually diagnosed with myofacial pain secondary to bowing posture. The patient was successfully treated with combination of treatment modalities (TENS therapy, exercises, occlusal splint, etc.), which resulted in relief from chronic pain and improvement in quality of life. [ABSTRACT FROM AUTHOR]

Myofacial pain is a common form of temporomandibular disorders. It is manifested by a sensory, motor and autonomous symptoms caused by trigger points. These pains can significantly affect patients' quality of life, when they persist. Several etiological factors have been implicated in the genesis of the myofacial pain: muscle overload, emotional tension, harmful postural habits, fatigue, and hypovitaminosis... The diagnosis of myofacial pain is based on a pertinent history and clinical examination. Several therapeutic options alone or in combination have proven their effectiveness. This article aims, through a clinical case, to focus on myofacial pain, possible therapeutics, by focusing on the contribution of the occlusal appliance in the management of these pains. [ABSTRACT FROM AUTHOR]

Introduction/Objective. Low-level laser therapy has been suggested as an alternative pain relief therapy in temporomandibular disorder patients. The aim of this study was to examine the effects of low-level laser therapy on reducing pain intensity in temporomandibular disorder patients, compared to nonsteroidal anti-inflammatory drugs. Methods. A total of 63 patients diagnosed with Research Diagnostic Criteria for Temporomandibular Disorders were divided into two groups. In the first group of 35 patients, low-level laser therapy was applied three times a week, 15 treatment sessions during five weeks (wavelength: 780 nm; power density: 70 mW/ cm2; radiant energy: 4.2 J; energy density: 4.2 J/cm2; total treatment dose: 16.8 J/cm2). The second group included 28 participants subjected to nonsteroidal anti-inflammatory drugs therapy (ibuprofen) during two weeks (first three days 3 × 400 mg, remaining time 2 × 400 mg per day). Pain was evaluated using 100 mm visual analog scale, at the baseline, during therapy, two weeks and three months after treatments. Results. Statistically significant reduction of pain intensity was achieved in both low-level laser therapy and in nonsteroidal anti-inflammatory drugs therapy groups and remained steady in the follow-up period of three months (p < 0.01). Differences in visual analog scale scores between the observed groups were not statistically significant in each of the evaluation periods, (p = 0.375, p = 0.665, p = 0.52, respectively). Conclusion. The low-level laser therapy protocol applied in this research was efficient in reducing pain in patients with temporomandibular disorders.

Abstract Background The efficacy of stabilization appliance therapy for masticatory muscle pain is debated. Therefore, there are currently no clear usage standards. We analyzed patient factors influencing its efficacy and characterized masticatory muscle pain subtypes to determine appropriate therapy candidates. Methods This case series study recruited patients diagnosed with local myalgia or myofascial pain and used variables related to temporomandibular disorders in the analysis. We used temporary appliance to screen patients for sleep bruxism for 2 weeks. Afterwards, we initiated therapy with stabilization appliances. Efficacy was evaluated via tenderness intensity during muscle palpation and the treatment satisfaction score after 2 months of treatment. Results We analyzed 62 (91%) patients. Tenderness upon muscle palpation was mitigated in 27 patients. Mitigated tenderness odds ratios were 0.035 for myofascial pain, 0.804 for 15‐item Patient Health Questionnaire scores, and 1.915 for facet length. Thirty‐nine patients expressed satisfaction; satisfaction odds ratios were 0.855 for 9‐item Patient Health Questionnaire scores, 1.606 for facet length, and 4.023 for awake bruxism awareness. Conclusions Stabilization appliance therapy is most effective for patients with awake bruxism awareness, local myalgia, long facets, and no psychosocial risk factors.

Background and Objectives: The objective of our clinical trial was to determine the effectiveness of the deep dry needling technique (DDN) (neuromuscular deprogramming) as a first step in the treatment of temporomandibular disorders. Methods and Materials: The double-blind randomized clinical trial comprised 36 patients meeting the inclusion criteria who had signed the corresponding informed consent form. The participants were randomly distributed into two groups, the Experimental group (Group E) and the Control group (Group C). Group E received bilateral DDN on the masseter muscle, while Group C received a simulation of the technique (PN). All the participants were evaluated three times: pre-needling, 10 min post-needling, and through a follow-up evaluation after 15 days. These evaluations included, among other tests: pain evaluation using the Visual Analog Scale (VAS) and bilateral muscle palpation with a pressure algometer; evaluation of the opening pattern and range of the mouth, articular sounds and dental occlusion using T-scans; and electromyography, which was used to evaluate the muscle tone of the masseter muscles, in order to control changes in mandibular position. Results: Digital control of occlusion using Tec-Scan (digital occlusion analysis) showed a significant reduction both in the time of posterior disclusion and in the time needed to reach maximum force in an MI position after needling the muscle, which demonstrated that there were variations in the static position and the trajectory of the jaw. The symmetry of the arch while opening and closing the mouth was recovered in a centric relation, with an increase in the opening range of the mouth after the procedure. Conclusions: facial pain is significantly reduced and is accompanied by a notable reduction in muscle activity after needling its trigger points.

Diathermy is a therapeutic technique utilizing electromagnetic waves that is widely used in the medical field, especially for orthopedic injuries such as musculoskeletal disorders. Shortwave diathermy (SWD), microwave diathermy (MWD), sonic therapy or ultrasound (US), and long-wave diathermy are the various types, out of which shortwave diathermy is most commonly used in medical fields. However, diathermy has not been explored much in dentistry. This literature review aims to discuss the various applications of diathermy and its potential use in dentistry with the existing scarce literature and further emphasize its role as a recommendation in the management of orofacial pain in dental practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Amani et al.)

Background: The efficacy of stabilization appliance therapy for masticatory muscle pain is debated. Therefore, there are currently no clear usage standards. We analyzed patient factors influencing its efficacy and characterized masticatory muscle pain subtypes to determine appropriate therapy candidates. Methods: This case series study recruited patients diagnosed with local myalgia or myofascial pain and used variables related to temporomandibular disorders in the analysis. We used temporary appliance to screen patients for sleep bruxism for 2 weeks. Afterwards, we initiated therapy with stabilization appliances. Efficacy was evaluated via tenderness intensity during muscle palpation and the treatment satisfaction score after 2 months of treatment. Results: We analyzed 62 (91%) patients. Tenderness upon muscle palpation was mitigated in 27 patients. Mitigated tenderness odds ratios were 0.035 for myofascial pain, 0.804 for 15‐item Patient Health Questionnaire scores, and 1.915 for facet length. Thirty‐nine patients expressed satisfaction; satisfaction odds ratios were 0.855 for 9‐item Patient Health Questionnaire scores, 1.606 for facet length, and 4.023 for awake bruxism awareness. Conclusions: Stabilization appliance therapy is most effective for patients with awake bruxism awareness, local myalgia, long facets, and no psychosocial risk factors. [ABSTRACT FROM AUTHOR]

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Background:Temporomandibular joint disorder is defined as a dysfunctional temporomandibular joint resulting from myoarthropathy of the masticatory system because of possible multifactorial nature of the disorder . Use of botulinum toxin A injections in treatment temporomandibular joint disorder that caused locally reduction of muscle activity by inhibiting acetylcholine release at the neuromuscular junction leading to decreases the muscle contractions, relief of myofacial pain and relieve the tenderness and restore functions of the temporo mandibular joint . The current study aim to evaluate the effect and duration of botulinum toxin type A (BTX-A) injections in the masseter, temporalis and lateral pterygoid muscles to treat Temporomandibular joint disorder symptoms in terms of pain intensity, maximum mouth opening, joint click and deviation on opening, with correlation of the patients age during three months following injection. Materials and Method :The human sample consists of 28 patients suffered from myofacial pain, trismus, and TMJ sounds related to temporomandibular joint dysfunction, males and females, with age range of (16-42) years. The subjects recruited for the study were patients attending and whose get treatment with 100 U dose of botulinum toxin type A (BTX-A) was injected with 100 mL at sites per masseter,temporalis and lateral pterygoid muscles that carried out at the dental clinics. The subjects were divided into four groups:Group I : consisted of 7 males and females patients, with age 16-22.Group II : consisted of 7 males and females patients with age 23-29.Group III : consisted of 7 males and females patients with age 30-36. Group IV : consisted of 7 males and females patients with age 37-43,all of these patients had symptoms of myofacial pain with Temporomandibular joint disorders of whole groups. The clinical evaluation:An intraoral examination was performed to assess the dental occlusion and teeth and periodontal damage caused by bruxism or parafunction. The existence of dentoskeletal dysmorphosis was also evaluated. The initial and follow-up reports after the BTX-A injection identified four main TMD symptoms: pain intensity, maximum mouth opening, joint click, and deviation on opening, and clinical evaluation of efficacy and tolerance was performed at 10 days, 1 month and 3 months after the injection. Patients were re-examined to assess the pain intensity, maximum mouth opening, joint click, and deviation on opening, the symptom release, and average duration of the BTX effect. Results: The mean age of patients was 29.4 ±7.879 years (ranged from 16.2 to 42.0 years). A detailed sex and age distribution . Highest mean and ±SD(standard deviation)values of the pain intensity, maximum mouth opening, joint click and deviation on opening were recorded in Group IV(older age ),followed by Group III then Group II and Group I (youner age)in the initial(pre-treatment visit) and follow-up visits after the BTX-A injection.Inter study visits comparisons of each group regarding of the pain intensity, maximum mouth opening,, joint click, and deviation on opening revealed, HS differences between the initial (pretreatment visit) and follow-up visits after the BTX-A injection. Conclusions: Aging process leads to change physiology of neuromuscular junctions and distinct muscle mass and strength loss. The decline of the effectiveness and duration of BTX-A used as same dosage in the older group than the younger group, so that mean BTX-A dosages of the older group was little higher required than those used of the younger group in treatment of temporomandibular joint disorders and pain relief. [ABSTRACT FROM AUTHOR]

Masticatory muscle pain is the second most frequent cause of orofacial pain after dental pain. Myofascial pain dysfunction syndrome (MPDS) is the most common form of temporomandibular joint dysfunction. MPDS is a pain that triggers from [sensitive] points in the muscles and fascia and is followed by spasm, tenderness to palpation, restricted movement, fatigue, and sometimes dysfunction. The researchers intended to collect comprehensive information about therapeutic interventions for myofascial pain through the conduction of a critical study based on evidence in the literature. In this review, 51 English articles, published between 1981 and 2013, were extracted from PubMed, Medline, Ovid, and Google Scholar. These articles were then reviewed in detail in two categories, namely pharmaceutical and non-pharmaceutical treatments. MPDS treatment should be first focused on the identification and correction of underlying causes. Thiocolchicoside (TCC), non-steroidal anti-inflammatory drugs (NSAIDs), and Cox-2 inhibitors are among promising pharmaceutical methods. On the other hand, ultrasound and laser therapy are among promising non-pharmaceutical methods. The complex mechanism of MPDS, along with its underlying peripheral and central nervous mechanisms may make MPDS, difficult to treat, especially in its chronic form.

This article reviews the diagnoses and treatment of temporomandibular disorders (TMD) and outlines of the role of botulinum toxin (BoNT) in the treatment of myofacial TMD. This manuscript includes a brief history of the use of BoNT in the treatment of pain, the mechanism of action of BoNT, and the techniques for injections, adverse effects and contraindications when using BoNT to treat mayofacial pain caused by TMD.

The dentoskeletal malocclusions etiology is multifactorial, being one of the etiological factors the maxillofacial traumatisms; among them the most common are the madibular fractures, which are related to temporomandibular joint pain or myofacial pain of occlusal origin. The patients request and demand a treatment that eliminates the symptomatology and guaranteed in the long term, besides correcting the facial aesthetics and the dental function altered by traumatisms. Occasionally, conservative therapy with mandibular repositioning occlusal splints is the treatment of choice prior to orthodontic correction, since it is necessary to initially reposition the mandibular anatomical structures in a centric relation that allows an orthopedically stable position independently of the altered occlusion, and based on this position, perform the necessary dental movements by means of orthodontic mechanics, maintaining the articulated anatomical structures of the mandible in centric relation and seeking a coincidence in maximum intercuspation. [ABSTRACT FROM AUTHOR]

Masticatory muscle pain is the second most frequent cause of orofacial pain after dental pain. Myofascial pain dysfunction syndrome (MPDS) is the most common form of temporomandibular joint dysfunction. MPDS is a pain that triggers from [sensitive] points in the muscles and fascia and is followed by spasm, tenderness to palpation, restricted movement, fatigue, and sometimes dysfunction. The researchers intended to collect comprehensive information about therapeutic interventions for myofascial pain through the conduction of a critical study based on evidence in the literature. In this review, 51 English articles, published between 1981 and 2013, were extracted from PubMed, Medline, Ovid, and Google Scholar. These articles were then reviewed in detail in two categories, namely pharmaceutical and non-pharmaceutical treatments. MPDS treatment should be first focused on the identification and correction of underlying causes. Thiocolchicoside (TCC), non-steroidal anti-inflammatory drugs (NSAIDs), and Cox-2 inhibitors are among promising pharmaceutical methods. On the other hand, ultrasound and laser therapy are among promising non-pharmaceutical methods. The complex mechanism of MPDS, along with its underlying peripheral and central nervous mechanisms may make MPDS, difficult to treat, especially in its chronic form. [ABSTRACT FROM AUTHOR]

Objective Temporomandibular disorder (TMD) is a multifactorial disease that is classified into muscular and joint disorders. The etiology of TMD is unknown but it is related to various factors such as bruxism, uncorrected high dental restorations, and occlusal prematurities. This study aims to provide treatment modalities for TMD patients with supraerupted and/or distoverted maxillary third molars that have premature contact with the opposing arch. Methods A total of 430 subjects diagnosed with TMD were included in the study and randomized into study and control groups based on their treatment needs. A detailed case history was taken, and findings of intra and extra oral examination were recorded along with other investigations such as study model analysis, orthopantomogram (OPG), cone-beam computed tomography (CBCT), and MRI. The multiphase treatment included counseling in phase I, extraction in phase II (only for the study group), and oral appliance in the third phase. The final phase involved the restoration of edentulous areas or reduced vertical dimension. Results Extraction of supraerupted and/or distoverted maxillary third molars in the study group during phase II showed a 96% reduction in TMD when compared to the control group who did not undergo extraction. Conclusion TMD is a repetitive motion disorder, and the success of treatment relies on the elimination of causative factors, the type of appliance used, and the establishment of ideal occlusion. This study suggests that the extraction of supraerupted and/or distoverted maxillary third molars is a prerequisite for treating TMD patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Gururaj et al.)

This article reviews the diagnoses and treatment of temporomandibular disorders (TMD) and outlines of the role of botulinum toxin (BoNT) in the treatment of myofacial TMD. This manuscript includes a brief history of the use of BoNT in the treatment of pain, the mechanism of action of BoNT, and the techniques for injections, adverse effects and contraindications when using BoNT to treat mayofacial pain caused by TMD. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to test the null hypothesis that there was no relationship between increased vertical overlap (vertical overlap ≥4 mm) with minimal horizontal overlap (horizontal overlap ≤2 mm) and the signs of temporomandibular disorders. Materials and Methods Thirty participants (20 women, aged 20 to 45 years) with increased vertical overlap and minimal horizontal overlap, and 30 participants (20 women, aged 20 to 45 years) with no contact between the anterior teeth (control group) were examined. Diagnoses, psychological status (depression and nonspesific physical symptoms), and chronic pain severity were judged according to the Research Diagnostic Criteria for Temporomandibular Disorders and then compared. For statistical analysis of quantitative data, along with the descriptive statistical methods (mean, standard deviation, frequency), Student's t-test was used to compare parameters that reflected a normal distribution. Comparison of qualitative data between groups was performed using Chi-square and Fisher's exact tests. The level of significance was set at p < 0.05. Results In this study, deviation upon maximum opening was found significantly more frequently in the increased vertical overlap group than in the control group ( p < 0.05). Tenderness upon palpation of lateral pterygoid muscles was observed more often in the increased vertical overlap group compared with the control group ( p < 0.05). Opening-closing joint sounds occurred significantly more often in the increased vertical overlap group than in the control group ( p = 0.050). Conclusion Within the limitations of this study, deviation upon maximum opening, tenderness of lateral pterygoid muscles (upon palpation), and opening-closing joint sounds occurred more often in the increased vertical overlap occlusions with minimum horizontal overlap compared to the control groups. These results indicated that clinicians should pay special attention to the tempormandibuar joint status of patients with significant vertical overlap anteriorly and position of the incisors when performing dental treatments that require reestablishment of incisor relationships. [ABSTRACT FROM AUTHOR]

Low-level laser therapy (LLLT) has been commonly used for the treatment of painful musculoskeletal conditions, but the results of previous studies on this subject are controversial. The aim of this study was to evaluate the efficacy of LLLT in the management of patients with myogenic temporomandibular joint disorders (TMDs). In this randomized, double-blind clinical trial, 20 patients with myogenic TMD were randomly divided into laser and placebo groups. In the laser group, a pulsed 810-nm low-level laser (average power 50 mW, peak power 80 W, 1,500 Hz, 120 s, 6 J, and 3.4 J/cm per point) was used on painful muscles three times a week for 4 weeks. In the placebo group, the treatment was the same as that in the laser group, but without energy output. The patients were evaluated before laser therapy (T1), after six sessions of laser application (T2), at the end of treatment (T3), and 1 month after the last application (T4), and the level of pain and the amount of mouth opening were measured. There was a significant increase in mouth opening and a significant reduction of pain symptoms in the laser group ( p < 0.05). A similar improvement was not observed in the placebo group ( p > 0.05). Between-group comparisons revealed no significant difference in pain intensity and mouth opening measurement at any of the evaluation time points ( p > 0.05). LLLT can produce a significant improvement in pain level and mouth opening in patients affected with myogenic TMD. [ABSTRACT FROM AUTHOR]

Background and Objectives: The objective of our clinical trial was to determine the effectiveness of the deep dry needling technique (DDN) (neuromuscular deprogramming) as a first step in the treatment of temporomandibular disorders. Methods and Materials: The double-blind randomized clinical trial comprised 36 patients meeting the inclusion criteria who had signed the corresponding informed consent form. The participants were randomly distributed into two groups, the Experimental group (Group E) and the Control group (Group C). Group E received bilateral DDN on the masseter muscle, while Group C received a simulation of the technique (PN). All the participants were evaluated three times: pre-needling, 10 min post-needling, and through a follow-up evaluation after 15 days. These evaluations included, among other tests: pain evaluation using the Visual Analog Scale (VAS) and bilateral muscle palpation with a pressure algometer; evaluation of the opening pattern and range of the mouth, articular sounds and dental occlusion using T-scans; and electromyography, which was used to evaluate the muscle tone of the masseter muscles, in order to control changes in mandibular position. Results: Digital control of occlusion using Tec-Scan (digital occlusion analysis) showed a significant reduction both in the time of posterior disclusion and in the time needed to reach maximum force in an MI position after needling the muscle, which demonstrated that there were variations in the static position and the trajectory of the jaw. The symmetry of the arch while opening and closing the mouth was recovered in a centric relation, with an increase in the opening range of the mouth after the procedure. Conclusions: facial pain is significantly reduced and is accompanied by a notable reduction in muscle activity after needling its trigger points. [ABSTRACT FROM AUTHOR]

The purpose of this study was to address the following question: among patients with acute or chronic temporomandibular disorders (TMD), does low-level laser therapy (LLLT) reduce pain intensity and improve maximal mouth opening? The sample comprised myogenic TMD patients (according Research Diagnostic Criteria for TMD). Inclusion criteria were: male/female, no age limit, orofacial pain, tender points, limited jaw movements and chewing difficulties. Patients with other TMD subtypes or associated musculoskeletal/rheumatologic disease, missing incisors teeth, LLLT contra-indication, and previous TMD treatment were excluded. According to disease duration, patients were allocated into two groups, acute (<6 months) and chronic TMD (≥6 months). For each patient, 12 LLLT sessions were performed (gallium-aluminum-arsenide; λ = 830 nm, P = 40 mW, CW, ED = 8 J/cm). Pain intensity was recorded using a 10-cm visual analog scale and maximal mouth opening using a digital ruler (both recorded before/after LLLT). The investigators were previously calibrated and blinded to the groups (double-blind study) and level of significance was 5% ( p < 0.05). Fifty-eight patients met all criteria, 32 (acute TMD), and 26 (chronic TMD). Both groups had a significant pain intensity reduction and maximal mouth opening improvement after LLLT (Wilcoxon test, p < 0.001). Between the groups, acute TMD patient had a more significant pain intensity reduction (Mann-Whitney test, p = 0.002) and a more significant maximal mouth opening improvement (Mann-Whitney test, p = 0.011). Low-level laser therapy can be considered as an alternative physical modality or supplementary approach for management of acute and chronic myogenic temporomandibular disorder; however, patients with acute disease are likely to have a better outcome. [ABSTRACT FROM AUTHOR]

Objectives: Occlusal stabilization splints are commonly used for temporomandibular disorders (TMD) related to muscular origins. The aim of the study was to assess the vertical thickness of occlusal stabilization splints under the aspect of maximal therapeutic effectiveness. An attempt was made to establish optimal jaw separation for vertical thickness of occlusal stabilization splints based on bite force (BF) and facial skeletal morphology. Methods: A total of 28 patients diagnosed as having myofascial pain (MFP) were eligible for this study and 3 acrylic occlusal stabilization splints of different vertical thickness were fabricated for each patient. Clinical and subjective examinations were carried out to assess the treatment effectiveness of the splints. Using in-house methods the BF was measured in different vertical jaw separations (VJS). The lateral cephalograms of selected factors were assessed. The relationship between splint thickness, BF and facial skeletal morphology was evaluated. Results: There was statistically significant correlation between vertical thickness of the splint and treatment effectiveness as well as between the VJS at which the first minimum BF generated in patients was measured and the VJS for the vertical thickness of the splint with maximum therapeutic effectiveness. Conclusions: The VJS for vertical thickness of occlusal stabilization splints should be established individually for each patient. The VJS at the first minimum BF is essential for establishing the vertical thickness of occlusal stabilization splints to obtain the maximum treatment effectiveness. Clinical Significance: It is possible to establish the VJS for vertical thickness of occlusal stabilization splints individually for each patient using a formula generated from BF measurements and lateral cephalometric analyses. [ABSTRACT FROM AUTHOR]

Myofacial pain dysfunction syndrome (MPDS) is the most common reason for pain and limited function of the masticatory system. The effects of low-level lasers (LLLs) for controlling the discomfort of patients are investigated frequently. However, the aim of this study was to evaluate the efficacy of a particular source producing 660 nm and 890 nm wavelengths that was recommended to reduce of the pain in the masticatory muscles. This was a double-blind and placebo-controlled trial. Sixteen MPDS patients were randomly divided into two groups. For the laser group, two diode laser probes (660 nm (nanometers), 6.2 J/cm(2), 6 min, continuous wave, and 890 nm, 1 J/cm(2) (joules per square centimetre), 10 min, 1,500 Hz (Hertz)) were used on the painful muscles. For the control group, the treatment was similar, but the patients were not irradiated. Treatment was given twice a week for 3 weeks. The amount of patient pain was recorded at four time periods (before and immediately after treatment, 1 week after, and on the day of complete pain relief). A visual analog scale (VAS) was selected as the method of pain measurement. Repeated-measures analysis of variance (ANOVA), the t-test and the paired t-test were used to analyze the data. In each group the reduction of pain before and after the treatment was meaningful, but, between the two groups, low-level laser therapy (LLLT) was more effective (P = 0.031) According to this study, this type of LLLT was the effective treatment for pain reduction in MPDS patients. [ABSTRACT FROM AUTHOR]

The aim of this review is to establish the effectiveness of stabilization splint (SS) therapy in reducing symptoms in patients with myofascial pain. Searching of electronic databases, handsearching of relevant key journals, and screening of reference lists of included studies were undertaken. There was no language restriction, and unpublished research was sought. The selection criteria were randomized controlled trials comparing splint therapy to either no treatment or another active treatment. Data extraction and validity assessment were carried out independently and in duplicate. Studies were grouped according to treatment type. Twenty potentially relevant Randomized Controlled Trials (RCTs) were identified. Only twelve met the inclusion criteria. There is insufficient evidence either for or against the use of stabilization splint therapy over other active interventions for the treatment of temporomandibular myofascial pain. However, it appears that stabilization splint therapy may be beneficial for reducing pain severity at rest and on palpation and depression when compared to no treatment. The authors suggested the need for well conducted RCTs that pay attention to method of allocation, blind outcome assessment, sample size, and duration of follow-up. Various measures were adopted to assess the outcomes of treatment. Standardization of the methods used to measure outcomes of the treatment of myofascial pain should be established in future RCTs. [ABSTRACT FROM AUTHOR]