Comparison between sensory and motor transcutaneous electrical nervous stimulation on electromyographic and kinesiographic activity of patients with temporomandibular disorder: a controlled clinical trial

Annalisa Monaco, Fabrizio Sgolastra, Davide Pietropaoli, Mario Giannoni, Ruggero Cattaneo, Annalisa Monaco, Fabrizio Sgolastra, Davide Pietropaoli, Mario Giannoni, Ruggero Cattaneo

Abstract

Background: The purpose of the present controlled clinical trial was to assess the effect of a single 60 min application of transcutaneous electrical nervous stimulation (TENS) at sensory stimulation threshold (STS), compared to the application of motor stimulation threshold (MTS) as well as to untreatment, on the surface electromyographic (sEMG) and kinesiographic activity of patients with tempormanbibular disorder (TMD).

Methods: Sixty female subjects, selected according to the inclusion/exclusion criteria, suffering from unilateral TMD in remission were assigned to MTS, STS or untreatment. Pre- and post-treatment differences in the sEMG activity of temporalis anterior (TA), masseter (MM), digastric (DA) and sternocleidomastoid muscles (SCM), as well in the interocclusal distance (ID), within group were tested using the Wilcoxon test, while differences among groups were assessed by Kruskal-Wallis test; the level of significance was set at p≤0.05.

Results: Significant pre- and post-treatment differences were observed in MTS and STS groups, for TA and MM of both sides; no significant difference was detected between MTS and STS groups. Kinesiographic results showed that the vertical component of ID was significantly increased after TENS in MTS and STS groups.

Conclusions: STS TENS could be effective, as well as MTS, in reduce the sEMG activity of masticatory muscles and to improve the ID of TMD patients in remission. Future studies are needed to confirm the results of the present study. Clinical relevance. The present study demonstrates that the application of TENS is effective in reduce the sEMG activity, as well as in increasing the ID of patients with TMD; our study did not support superior effectiveness of MTS or STS.

Trial registration: ClinicalTrials.gov: NCT01832207.

Figures

Figure 1
Figure 1
Kinesiographic track. Ver (Verticality/Blu line) refer to vertical component of the interocclusal distance; AP (Anterior-Posteriority/Red line) refer to anterio-posterior component of interocclusal distance. Lat (Laterality/Green line) refer to lateral component of interocclusal distance. Line at the beginnig of the track refer to basal position of the mandible at rest position.
Figure 2
Figure 2
sEMG and TENS electrodes positioning.
Figure 3
Figure 3
K7 electromyographic and kinesiographic instruments.

References

    1. De Leeuw R. Orofacial pain: guidelines for assessment, diagnosis and management. Quintessence; 2008.
    1. Dahan J, Boitte C. Chicago.2. Comparison of the reproducibility of EMG signals recorded from human masseter and lateral pterygoid muscles. J Dent Res. 1986;65:441–447. doi: 10.1177/00220345860650031401.
    1. Dahlstrom L. Electromyographic study of CMD: a review of literature. J Oral Rehab. 1989;16:1–20. doi: 10.1111/j.1365-2842.1989.tb01312.x.
    1. Farina D, Merletti R, Enoka RM. The extraction of neural strategies from the surface EMG. J Appl Physiol. 2004;96:1486–1495. doi: 10.1152/japplphysiol.01070.2003.
    1. Merletti R. Surface electromyography: possibilities and limitations. J Rehab Sci. 1994;7:24–34.
    1. Castroflorio T, Farina D, Bottin A, Piancino MG, Bracco P, Merletti R. Surface EMG of jaw elevator muscles: effect of electrode location and inter-electrode distance. J Oral Rehabil. 2005;32:411–417. doi: 10.1111/j.1365-2842.2005.01442.x.
    1. Tartaglia GM, Lodetti G, Paiva G, De Felicio CM, Sforza C. Surface electromyographic assessment of patients with long lasting temporomandibular joint disorder pain. J Electromyogr Kinesiol. 2011;21:659–664. doi: 10.1016/j.jelekin.2011.03.003.
    1. Ferrario VF, Tartaglia GM, Luraghi FE, Sforza C. The use of surface electromyography as a tool in differentiating temporomandibular disorders from neck disorders. Man Ther. 2007;12:372–379. doi: 10.1016/j.math.2006.07.013.
    1. Jankelson B. Electronic control of muscular contraction. A new clinical era in occlusion and prosthodontics. Sci Ed Bull Int Coll Dent. 1969;2:29–31.
    1. Jankelson B, Swain CW. Physiological aspect of masticatory muscles stimulation: the Myomonitor. Quint Int. 1972;12:57–59.
    1. Talley RL, Murphy GJ, Smith SD, Baylin MA, Haden JL. Standards for the history, examination, diagnosis and treatment of temporomandibular disorders (TMD): a position paper. J Craniomandib Pract. 1990;8:60.
    1. Gold N, Greene C, Laskin D. TENS therapy for treatment of MPD syndrome. J Dent Res. 1983;62:244.
    1. Coyne PJ, MacMurren M, Izzo T, Kramer T. Transcutaneous electrical nerve stimulator for procedural pain associated with intravenous needlesticks. J Intraven Nurs. 1995;18:263–267.
    1. De Angelis C, Perrone G, Santoro G, Nofroni I, Zichella L. Suppression of pelvic pain during hysteroscopy with a transcutaneous electrical nerve stimulation device. Fertil Steril. 2003;79:1422–1427. doi: 10.1016/S0015-0282(03)00363-7.
    1. Cooper BC, Kleinberg I. Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients. J Craniomandib Prac. 2008;26:104–117.
    1. Rodrigues D, Siriani AO, Bérzin F. Effect of conventional TENS on pain and electromyographic activity of masticatory muscles in TMD patients. Braz Oral Res. 2004;18:290–295. doi: 10.1590/S1806-83242004000400003.
    1. Monaco A, Sgolastra F, Ciarrocchi I, Cattaneo R. Effects of transcutaneous electrical nervous stimulation on electromyographic and kinesiographic activity of patients with temporomandibular disorders: a placebo-controlled study. J Electromyogr Kinesiol. 2012;22:463–468. doi: 10.1016/j.jelekin.2011.12.008.
    1. Oosterhof J, Samwel HJ, de Boo TM, Wilder-Smith OH, Oostendorp RA, Crul BJ. Predicting outcome of TENS in chronic pain: a prospective, randomized, placebo controlled trial. Pain. 2008;136:11–20. doi: 10.1016/j.pain.2007.06.009.
    1. Rakel B, Frantz R. Effectiveness of transcutaneous electrical nerve stimulation on postoperative pain with movement. J Pain. 2003;4:455–464. doi: 10.1067/S1526-5900(03)00780-6.
    1. Rakel B, Cooper N, Adams HJ, Messer BR, Frey Law LA, Dannen DR. A new transient sham TENS device allows for investigator blinding while delivering a true placebo treatment. J Pain. 2010;11:230–238. doi: 10.1016/j.jpain.2009.07.007.
    1. Moran F, Leonard T, Hawthorne S, Hughes CM, McCrum-Gardner E, Johnson MI, Rakel BA, Sluka KA, Walsh DM. Hypoalgesia in response to transcutaneous electrical nerve stimulation (TENS) depends on stimulation intensity. J Pain. 2011;12:929–935. doi: 10.1016/j.jpain.2011.02.352.
    1. Svensson P, Wang K, Sessle BJ, Arendt-Nielsen L. Associations between pain and neuromuscular activity in the human jaw and neck muscles. Pain. 2004;109:225–232. doi: 10.1016/j.pain.2003.12.031.
    1. Sarlani E, Greenspan JD. Why look in the brain for answers to temporomandibular disorder pain? Cell Tissue Org. 2005;180:69–75. doi: 10.1159/000086200.
    1. Fogle LL, Glaros AG. Contributions of facial morphology, age, and gender to EMG activity under biting and resting conditions: a canonical correlation analysis. J Dent Res. 1995;74:1496–1500. doi: 10.1177/00220345950740081001.
    1. Del Palomar AP, Santana-Penín U, Mora-Bermúdez MJ, Doblaré M. Clenching TMJ loads increases in partial edentates: a 3D finite element study. Ann Biomed Eng. 2008;36:1014–1023. doi: 10.1007/s10439-008-9487-y.
    1. Pirttiniemi P. Normal and increased functional asymmetries in the craniofacial area. Acta Odontol Scand. 1998;56:342–345. doi: 10.1080/000163598428284.
    1. Oldfiel RC. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia. 1971;9:97–113. doi: 10.1016/0028-3932(71)90067-4.
    1. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomand Dis Facial Oral Pain. 1992;6:301–355.
    1. Epker J, Gatchel R, Ellis E III. A model for predicting chronic TMD. J Am Dent Assoc. 1999;130:1470–1475.
    1. Van der Bilt A, Weijnen FG, Bosman F, Ven der Glas HW, Kuks JBM. Controlled study of EMG activity of the jaw closers and openers mastication in patients with myastenia gravis. Eur J Oral Sci. 2001;109:160–164. doi: 10.1034/j.1600-0722.2001.00030.x.
    1. Tecco S, Crincoli V, Di Bisceglie B, Caputi S, Festa F. Relation between facial morphology on lateral skull radiographs and sEMG activity of head, neck, and trunk muscles in Caucasian adult females. J Electromyogr Kinesiol. 2011;21:298–310. doi: 10.1016/j.jelekin.2010.10.014.
    1. Castro HA, Resende LA, Bérzin F, König B. Electromyographic analysis of the superior belly of the omohyoid muscle and anterior belly of the digastric muscle in tongue and head movements. J Electromyogr Kinesiol. 1999;9:229–232. doi: 10.1016/S1050-6411(98)00033-9.
    1. Falla D, Dall'Alba P, Rainoldi A, Merletti R, Jull G. Repeatability of surface EMG variables in the sternocleidomastoid and anterior scalene muscles. Eur J Appl Physiol. 2002;87:542–549. doi: 10.1007/s00421-002-0661-x.
    1. Falla D, Dall'Alba P, Rainoldi A, Merletti R, Jull G. Location of innervation zones of sternocleidomastoid and scalene muscles–a basis for clinical and research electromyography applications. Clin Neurophysiol. 2002;113:57–63. doi: 10.1016/S1388-2457(01)00708-8.
    1. Kamyszek G, Ketcham R, Garcia R Jr, Radke J. Electromyographic evidence of reduced muscle activity when ULF-TENS is applied to the Vth and VIIth cranial nerves. J Craniomandib Prac. 2001;19:162–168.
    1. Tracey K. Awareness/relaxation training and transcutaneous electrical neural stimulation in the treatment of bruxism. J Oral Rehabil. 1999;26:280–287. doi: 10.1046/j.1365-2842.1999.00381.x.
    1. Al-Saleh MA, Armijo-Olivo S, Flores-Mir C, Thie NM. Electromyography in diagnosing temporomandibular disorders. J Am Dent Assoc. 2012;143:351–362.
    1. Castroflorio T, Icardi K, Becchino B, Merlo E, Debernardi C, Bracco P. Reproducibility of surface EMG variables in isometric sub-maximal contractions of jaw elevator muscles. J Electromyogr Kinesiol. 2006;16:498–505. doi: 10.1016/j.jelekin.2005.08.007.
    1. Bartko JJ. The intraclass correlation coefficient as a measure of reliability. Psychol Rep. 1966;19:3–11. doi: 10.2466/pr0.1966.19.1.3.
    1. Lund JP, Donga R, Widmer CG, Stohler CS. The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol. 1991;69:683–694. doi: 10.1139/y91-102.
    1. Monaco A, Cattaneo R, Mesin L, Ciarrocchi I, Sgolastra F, Pietropaoli D. Dysregulation of the Autonomous Nervous System in Patients with Temporomandibular Disorder: A Pupillometric Study. PLoS One. 2012;7:e45424. doi: 10.1371/journal.pone.0045424.
    1. Monaco A, Cattaneo R, Spadaro A, Giannoni M. Surface electromyography pattern of human swallowing. BMC Oral Health. 2008;8:6. doi: 10.1186/1472-6831-8-6.
    1. Suvinen TI, Reade PC, Kononen M, Kemppainen P. Vertical jaw separation and masseter muscle electromyographic activity: a comparative study between asymptomatic controls and patients with temporomandibular pain and dysfunction. J Oral Rehabil. 2003;30:765–772. doi: 10.1046/j.1365-2842.2003.01114.x.
    1. Bush FM, Harkins SW, Harrington WG, Price DD. Analysis of gender effects on pain perception and symptom presentation in temporomandibular pain. Pain. 1993;53:73–80. doi: 10.1016/0304-3959(93)90058-W.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa