Reply to ‘letter to the editor concerning ‘effects of physical therapy for temporomandibular disorders on headache pain intensity: A systematic review’ by Castien & Scholten-Peeters

Abstract Background Dysmenorrhea is a health problem with a high impact on health and society. Some drugs have been shown to be effective at treating dysmenorrhea. Therapeutic exercise is another option for reducing the symptomatology of this health problem, with a low cost and the absence of side effects. Purpose The purposes of this review were to study the efficacy of physical exercise for pain intensity in primary dysmenorrhea and to assess its effectiveness in decreasing the duration of pain and improving quality of life. Data Sources Searches were conducted between February 2017 and May 2017 in the databases Web of Science, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, CINAHL, and Dialnet, using the terms dysmenorrhea, exercise therapy, exercise movement technique, exercise, physical therapy, physical therapy speciality, treatment, primary dysmenorrhea, prevention, etiology, epidemiology, and pain. Study Selection We included randomized controlled trial studies conducted on women who were 16 to 25 years old and had primary dysmenorrhea, studies that included exercise as a type of therapy, studies that assessed the intensity and duration of pain and quality of life, and studies published in English or Spanish. Studies that included women with irregular cycles, women diagnosed with a gynecological disease, women who had had surgery, women with serious diseases, or women who used intracavitary or oral contraceptives were excluded. We started with 455 studies; 16 were included in the systematic review, and 11 were included in the 3 meta-analyses that were carried out. Data Extraction Two authors selected the studies and extracted their characteristics (participants, intervention, comparators, and outcomes) and results. The evaluation of the methodological quality of the studies was carried out by PEDro scale. Data Synthesis There was moderate evidence that therapeutic exercise can be considered a useful tool in the treatment of primary dysmenorrhea in terms of a reduction in pain intensity. Regarding the duration of pain and quality of life, there was low evidence and very low evidence, respectively. In the 3 meta-analyses, the results were significantly positive in favor of exercise for decreases in both the intensity and the duration of pain. Limitations Limitations of this study include the great heterogeneity of the interventions applied in the studies in terms of type of exercise, in combination or alone, and dosage. This review includes a small number of studies with risk of bias, so the present findings must be interpreted with caution. Conclusions Therapeutic exercise reduces pain intensity in patients with primary dysmenorrhea.

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Dry Needling for the Treatment Of Tension-Type, Cervicogenic, or Migraine Headaches: a Systematic Review and Meta-Analysis

Physical Therapy ◽

10.1093/ptj/pzab068 ◽

2021 ◽

Author(s):

Mohammadreza Pourahmadi ◽

Jan Dommerholt ◽

César Fernández-de-Las-Peñas ◽

Bart Willem Koes ◽

Mohammad Ali Mohseni-Bandpei ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Pain Intensity ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Dry Needling ◽

Short Term ◽

Patient Will ◽

Headache Pain ◽

Better Than

Abstract Objective Dry needling is a treatment technique used by clinicians to relieve symptoms in patients with tension-type headache (TTH), cervicogenic headache (CGH), or migraine. This systematic review's main objective was to assess the effectiveness of dry needling on headache pain intensity and related-disability in patients with TTH, CGH, or migraine. Methods Medline/PubMed, Scopus, Embase®, PEDro, WoS, Ovid, AMED/EBSCO, CENTRAL, Google Scholar, and trial registries were searched until April 1, 2020, along with reference lists of eligible studies and related reviews. Randomized clinical trials or observational studies that compared the effectiveness of dry needling with any other interventions were eligible for inclusion. Three reviewers independently selected studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed to produce pooled-effect estimates (Morris’s dppc2) and their respective confidence intervals. Results Of 2715 identified studies, 11 randomized clinical trials were eligible for qualitative synthesis and 9 for meta-analysis. Only four trials were of high quality. Very low-quality evidence suggested that dry needling is not statistically better than other interventions for improving headache pain intensity at short-term in patients with TTH (SMD −1.27, 95% CI −3.56 to 1.03, n = 230), CGH (SMD −0.41, 95% CI −4.69 to 3.87, n = 104), or mixed headache (TTH and migraine; SMD 0.03; 95% CI −0.42 to 0.48, n = 90). Dry needling provided significantly greater improvement in related-disability at short-term in patients with TTH (SMD −2.28, 95% CI −2.66 to −1.91, n = 160) and CGH (SMD −0.72, 95% CI −1.09 to −0.34, n = 144). The synthesis of results showed that dry needling could significantly improve headache frequency, health-related quality of life, trigger point tenderness, and cervical range of motion in TTH and CGH. Conclusions Dry needling produces similar effects to other interventions for short-term headache pain relief, whereas dry needling seems to be better than other therapies for improvement in related-disability in the short-term. Impact Although further high methodological quality studies are warranted to provide a more robust conclusion, our systematic review suggested that for every one to two patients with TTH treating by dry needling, one patient will likely show decreased headache intensity (NNT = 2; large effect) and improved related-disability (NNT = 1; very large effect). In CGH, for every three to four patients treating by dry needling, one patient will likely exhibit decreased headache intensity (NNT = 4; small effect) and improved related-disability (NNT = 3; medium effect).

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Effect of Manual Therapy and Therapeutic Exercise Applied to the Cervical Region on Pain and Pressure Pain Sensitivity in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis

Pain Medicine ◽

10.1093/pm/pnaa021 ◽

2020 ◽

Vol 21 (10) ◽

pp. 2373-2384 ◽

Cited By ~ 1

Author(s):

Roy La Touche ◽

Sergio Martínez García ◽

Beatriz Serrano García ◽

Alejandro Proy Acosta ◽

Daniel Adraos Juárez ◽

...

Keyword(s):

Systematic Review ◽

Pain Intensity ◽

Manual Therapy ◽

Temporomandibular Disorders ◽

Randomized Clinical Trials ◽

Clinical Effect ◽

Meta Analysis ◽

Cervical Region ◽

Pressure Pain ◽

Pressure Pain Thresholds

Abstract Objective To assess the effectiveness of cervical manual therapy (MT) on patients with temporomandibular disorders (TMDs) and to compare cervico-craniomandibular MT vs cervical MT. Design Systematic review and meta-analysis (MA). Methods A search in PubMed, EMBASE, PEDro, and Google Scholar was conducted with an end date of February 2019. Two independent reviewers performed the data analysis, assessing the relevance of the randomized clinical trials regarding the studies’ objectives. The qualitative analysis was based on classifying the results into levels of evidence according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results Regarding cervical MT, MA included three studies and showed statistically significant differences in pain intensity reduction and an increase in masseter pressure pain thresholds (PPTs), with a large clinical effect. In addition, the results showed an increase in temporalis PPT, with a moderate clinical effect. MA included two studies on cervical MT vs cervico-craniomandibular MT interventions and showed statistically significant differences in pain intensity reduction and pain-free maximal mouth opening, with a large clinical effect. Conclusions Cervical MT treatment is more effective in decreasing pain intensity than placebo MT or minimal intervention, with moderate evidence. Cervico-craniomandibular interventions achieved greater short-term reductions in pain intensity and increased pain-free MMO over cervical intervention alone in TMD and headache, with low evidence.

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Methodological quality of a systematic review on physical therapy for temporomandibular disorders: influence of hand search and quality scales

Clinical Oral Investigations ◽

10.1007/s00784-010-0490-y ◽

2010 ◽

Vol 16 (1) ◽

pp. 295-303 ◽

Cited By ~ 6

Author(s):

Bart Craane ◽

Pieter Ubele Dijkstra ◽

Karel Stappaerts ◽

Antoon De Laat

Keyword(s):

Systematic Review ◽

Physical Therapy ◽

Temporomandibular Disorders ◽

Methodological Quality ◽

Hand Search

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A Systematic Review of the Effectiveness of Physical Therapy Interventions for Temporomandibular Disorders

Physical Therapy ◽

10.1093/ptj/86.5.710 ◽

2006 ◽

Vol 86 (5) ◽

pp. 710-725 ◽

Cited By ~ 171

Author(s):

Margaret L McNeely ◽

Susan Armijo Olivo ◽

David J Magee

Keyword(s):

Systematic Review ◽

Physical Therapy ◽

Temporomandibular Disorders ◽

Sham Acupuncture ◽

Biofeedback Training ◽

Low Level Laser Therapy ◽

Exercise Interventions ◽

Oral Opening ◽

Pain Outcomes ◽

Therapy Interventions

Abstract Background and Purpose. The purpose of this qualitative systematic review was to assess the evidence concerning the effectiveness of physical therapy interventions in the management of temporomandibular disorders. Methods. A literature search of published and unpublished articles resulted in the retrieval of 36 potential articles. Results. Twelve studies met all selection criteria for inclusion in the review: 4 studies addressed the use of therapeutic exercise interventions, 2 studies examined the use of acupuncture, and 6 studies examined electrophysical modalities. Two studies provided evidence in support of postural exercises to reduce pain and to improve function and oral opening. One study provided evidence for the use of manual therapy in combination with active exercises to reduce pain and to improve oral opening. One study provided evidence in support of acupuncture to reduce pain when compared with no treatment; however, in another study no significant differences in pain outcomes were found between acupuncture and sham acupuncture. Significant improvements in oral opening were found with muscular awareness relaxation therapy, biofeedback training, and low-level laser therapy treatment. Discussion and Conclusion. Most of the studies included in this review were of very poor methodological quality; therefore, the findings should be interpreted with caution.

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Fear of pain and pain intensity: Meta-analysis and systematic review.

Psychological Bulletin ◽

10.1037/bul0000228 ◽

2020 ◽

Vol 146 (5) ◽

pp. 411-450 ◽

Cited By ~ 2

Author(s):

Tobias Markfelder ◽

Paul Pauli

Keyword(s):

Systematic Review ◽

Pain Intensity ◽

Meta Analysis ◽

Fear Of Pain

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