El objetivo de este estudio será verificar el efecto adicional de la Educación en Neurociencia del Dolor, la Imaginería Motora y la Observación de la Acción sobre los resultados primarios de intensidad del dolor e incapacidad craneofacial en pacientes con trastornos temporomandibulares (TTM) crónicos. Los resultados secundarios serán el umbral de dolor a la presión, la sumación temporal, la modulación condicionada del dolor, la sensibilización central, la catastrofización del dolor y la kinesofobia. Este estudio será un ensayo clínico aleatorizado doble ciego que comprende una muestra de 50 participantes con dolor orofacial de ambos sexos y con edades entre 18 y 60 años. Los sujetos serán sometidos a un proceso de tamizaje para identificar a quienes presentan un diagnóstico de TTM doloroso confirmado por los Criterios Diagnósticos para Trastornos Temporomandibulares (DC/TTM), y luego serán aleatorizados en dos grupos (G1: Férula Oclusal, Consejería y Ejercicios de Mandíbula y Cuello versus G2: Férula Oclusal, Ejercicios de Mandíbula y Cuello más Educación en Neurociencia del Dolor, Imaginería Motora y Observación de la Acción). Estos voluntarios serán reclutados en la Clínica Odontológica Grupo Alisos y en la Universidad de Gran Rosario (Rosario, Argentina). Todos los pacientes utilizarán una férula oclusal diseñada por odontólogos. Las intervenciones serán administradas dos veces por semana durante 5 semanas por un único terapeuta. Posteriormente, se darán instrucciones a los pacientes para realizar los ejercicios en casa durante 5 semanas. Los resultados primarios y secundarios se medirán al inicio, a las 6 semanas, a las 12 semanas y a los 3 meses tras la finalización del tratamiento (seguimiento). Todas las evaluaciones serán realizadas por un fisioterapeuta cegado.
OS will be made of heat-cured acrylic by the same specialized dentist. These intraoral devices will be flate, rigid, will cover the entire dental arch, and will have the lowest possible height. The perimeter of the splint will have at least 11 dental contacts, light, symmetrical and pinpoint as possible. The patients will be instructed to use the splint every night during the study Two supervisions will be carried out 30 and 60 days after the use of the OS, in order to stabilize the contact points.
A power point presentation with metaphors and animated videos will be used. The PNE will be held in 10 sessions of 20 minutes each. The intervention will be developed using content according to the book "Explain Pain" and the web page www.retrainpain.org.
The participants will have to judge the laterality of different cervical images presented on the screen of a cell phone. The laterality task will be executed using an application called Recognize Neck, developed by the NOI group. The procedure will begin with a familiarization test with the "Basic" level followed by a laterality discrimination task. It will be performed using 20 images, with 5 seconds for each image, beginning with the "Vanilla" program and progressively increasing the difficulty using the "Context" and "Abstract" programs. The estimated time to complete the task will be about 10 minutes per session.
The patients will see videos showing the jaw and cervical exercises with the same series and repetitions that they will actively perform in the session. Therefore, the training of the action observation will be carried out dynamically. The patient will be asked to think and visualize the movement that he/she will have to perform later. It is estimated 10 minutes per session for the AO.
A jaw and neck exercise program will be carried out in 3 series of 10 repetitions per session will be planned with 1minute rest between exercise. The exercises will be executed with a total time per session of 20 minutes, initially in the clinic and later at home. In the clinic, verbal and tactile instructions will be provided for the correct execution of the exercises and later they will be sent through WhatsApp and / or mail to perform them at home.
Counselling include education about the anatomical, biomechanical and psychosocial factors relationed with temporomandibular disorders, guidance regarding the parafunction jaw activities for eg will be taught the resting postural position of the mandible (teeth apart, lips slightly touching and tongue not pushing against the teeth).
Rosario, Santa Fe Province, Argentina