Intervenções fisioterapêuticas em indivíduos com dor persistente diagnosticados com DTM em acompanhamento odontológico

Abstract

Temporomandibular disorders (TMD) are considered a common condition of persistent non odontogenic orofacial pain, of a nociplastic nature. This pain profile involves not only the physical dimension but also affective-behavioral aspects, which impact the quality of life of these individuals. The aim of this study was to evaluate the change in outcomes related to pain intensity and emotional aspects after physiotherapeutic intervention. Seven volunteers of both sexes, aged between 18 and 60 years, with a clinical diagnosis of TMD, received individualized, symptom-based physiotherapy treatment and responded to the following: Numeric Pain Rating Scale (NPRS), Pain Catastrophizing Scale (PCS), Central Sensitization Inventory (CSI), and Tampa Scale for Kinesiophobia for TMD (TSK/TMD). The treatment lasted approximately one year, and these scales were collected at three points during the intervention: baseline assessment (1st measurement – pre-intervention); intermediate assessment (2nd measurement); and final assessment (3rd measurement – post-intervention). After the second assessment, a pain education intervention was introduced in addition to the treatment being carried out. For data analysis, Friedman’s non-parametric test for dependent samples was used. No differences were found between the groups when the three measurements were compared jointly. However, when comparing the post-intervention measurement with the baseline, there was a trend toward reduction in catastrophizing and kinesiophobia (Fr = 3.5; p = 0.0058). It should be noted that the very small sample size may explain the lack of statistical significance. The results suggest that physical intervention alone, even when symptom-based, was not sufficient to promote an effective change in the patients’ clinical condition. Adding pain education appears to contribute to the reduction of catastrophizing and kinesiophobia indices, especially in the short term. Considering that physiotherapeutic treatment for nociplastic pain should involve biopsychosocial strategies in order to modify emotional aspects that impact the individual’s life, the introduction of a cognitive-behavioral intervention strategy such as pain education may improve the outcomes of the rehabilitation process in this population.