EVALUATION OF THE CLINICAL EFFECTIVENESS OF ULTRAPHONOPHORESIS OF A BIOREGULATORY DRUG IN THE COMPREHENSIVE TREATMENT OF MYOFASCIAL PAIN SYNDROME IN PATIENTS WITH DYSFUNCTION OF THE TEMPOROMANDIBIDAL JOINTS

Abstract

Introduction. In patients with musculo-articular dysfunction of the TMJ, spasmodic nodular areas of nodular indurations and fibrous bands are formed in the spasmodic masticatory muscles, in which trigger points are localized, which are capable of spontaneously provoking the appearance of pain syndrome. Effective treatment of myofascial pain syndrome is based on the elimination of general and local etiological factors of this disease, drug and physiotherapeutic effects on its pathophysiological mechanisms. Nonsteroidal anti-inflammatory drugs do not completely stop the inflammatory process in the masticatory muscles, slowly eliminate spasmodic nodes and latent trigger points in spasmodic muscle fibers. To solve this problem, we have proposed the local application of the bioregulatory drug “Traumeel C”. The aim of the study is to assess the clinical effectiveness of ultraphonophoresis of the bioregulatory drug “Traumeel C” in the complex treatment of myofascial pain syndrome in patients with temporomandibular joint dysfunction. Research materials and methods. 35 patients aged 30 to 60 years (18 women and 17 men) with acute manifestations of myofascial pain syndrome in the maxillofacial region on the background of temporomandibular joint dysfunction of varying severity participated in clinical observations. Patients were generally prescribed antistress therapy – the drug “Gamalate B6”, the non-steroidal anti-inflammatory drug “Indomethacin” and the longacting muscle relaxant “Miorix”, relaxing dental splints were made. After the acute manifestations of myofascial pain syndrome were relieved, patients were divided into two clinical groups, depending on the locally applied pharmacological drugs for the treatment of damaged masticatory muscles. In the main group (18 people), daily sessions of ultraphonophoresis of Traumeel C ointment were performed on the areas of spasmodic masticatory muscles and their trigger points. In the comparison group (17 people), sessions of ultraphonophoresis of 10 % Indomethacin ointment were similarly performed. Results. For the first time, the clinical effectiveness of the combined effect of ultrasound and local bioregulatory therapy on the focus of neurogenic inflammation in spasmodic masticatory muscles was studied and compared with the local effect of a nonsteroidal anti-inflammatory drug on this pathological process. On the background of ultraphonophoresis of drugs, there was a gradual regression of local clinical symptoms of reactive myositis of the masticatory muscles. In 15 patients (83,3%) of the main group and in 10 patients (58,8 %) of the comparison group, who had TMJ dysfunction of moderate severity according to the Helkimo M. index, after 5–6 sessions of ultraphonophoresis, a complete reduction of clinical manifestations of the inflammatory process in the masticatory muscles was observed – painful tension disappeared in them, nodular indurations and fibrous bands, trigger points were resolved. In recovering patients, the intensity of noise manifestations of dislocation of the articular disc (clicking, popping) decreased in the temporomandibular joints during movement of the lower jaws. In patients with severe dysfunction of the TMJ, local application of “Traumeel C” is more effective (χ2 – 2,574, р = 0,109) compared to ultraphonophoresis of “Indomethacin” ointment. On the background of local bioregulatory therapy, the treatment of myofascial pain syndrome lasts an average of 6,3 days, with local therapy with a nonsteroidal anti-inflammatory drug – 8,5 days. Conclusions. During the complex treatment of patients with TMJ dysfunction of moderate severity under the influence of ultraphonophoresis of ointments “Traumeel C” and “Indomethacin”, there is a steady regression of local clinical symptoms of the inflammatory process in the masticatory muscles (myositis) in the same terms – after 5–6 sessions of physiotherapy procedures. During the complex treatment of patients with severe TMJ dysfunction, local application of “Traumeel C” is more effective compared to ultraphonophoresis of ointment “Indomethacin” – on average, the treatment period for myofascial pain syndrome in the maxillofacial region is reduced by 2 times.