Background & Aims
The regular practice of physical exercise would, in theory, have a beneficial effect as an adjuvant in the control of chronic pain. However, there is still insufficient data to explain this relationship, specifically in patients with chronic myofascial masticatory pain (CMMP). One way to measure such an impact is through changes in the endogenous pain modulation profile (PMP), determined by methods that use tests of inhibition and excitation of painful stimuli. Furthermore, efforts are made to understand the best measurement technique for these methods and whether alternative modalities can alter this modulatory profile. The overall objective of this study is to assess the qualitative variation of PMP, physical conditioning, and pain perception among asymptomatic individuals and those with CMMP after three months of a controlled and individualized aerobic exercise (AE) program.
Methods
Controlled randomized clinical trial study with 45 sedentary volunteers (IPAQ questionnaire) (21 asymptomatic (A) individuals and 24 individuals diagnosed with chronic myofascial masticatory pain (CMMP) according to DC-TMD). The individuals were randomly allocated into 4 groups (A/C n=9; A/Ex n=12; CMMP/C n=9; CMMP/EX n=15, “C” group for control and “Ex” group for 3 months of AE). Conditioned pain modulation [(CPM) sequential protocol], pain perception through visual analog scale (VAS), training heart rate (THR), and body mass index (BMI) were analyzed at baseline and after 3 months in all groups. Wind-up ratio (WUR) was measured to trace PMP. All the individuals underwent Conconi test to determine an ideal AE HR (80% from HR max), but only to the EX group received a HR monitor for THR maintenance during exercise (instructions to engage in the AE at least 3x a week for 30 minutes). Parametric and non-parametric paired tests were conducted for statistical analysis with p=0.05.
Results
Mean age was 29.4 years in A group and 28.3, CMMP group. The VAS mean in CMMP group was 5.35. “A” group BMI mean was 24.7, and 26.1 CMMP group. At baseline, CPM A group was 13.6%; and CMMP group, 6.7%. PMP has 4 profiles (PMP I: Double pronociception, PMP II: Inhibitory pronociception, PMP III: Facilitatory pronociception and PMP IV: Antinociception). At baseline in A group, 4.4% individuals were PMP I; 24.4% PMP II; 2.2% PMP III, and 15.6% PMP IV. At baseline in CMMP group, PMP I 6.7%; PMP II 8.9%; PMP III 2.2%, and PMP IV 15.6%. After 3 months, PMPs were mostly PMP II (A/C and A/EX=13.3%, CMMP/C=11.1%, and CMMP/Ex=17.8%). There was a statistically significant reduction in VAS after 3 months in CMMP group that underwent only conservative treatment (CT) (p=0.039). Exercise frequency mean was 2x week. In CMMP/EX (CT + AE), there was no difference (p=0.32). There was no statistically significant difference in CPM, BMI, and training HR among the 4 groups from baseline to 3-month period.
Conclusions
It is concluded that, with the sample data, despite the study’s limitations, aerobic exercise in sedentary individuals did not influence the improvement in CPM or the improvement in the individuals’ perception of pain and did not condition the individuals in relation to the improvement in HR. It is known that regular physical exercise has a beneficial effect as an adjuvant in controlling chronic pain, however, this effect depends on the patient’s commitment to performing physical exercise correctly and with a certain frequency. It is also concluded that the PMP changes individuals in different situations and is therefore data that should be used with caution and be based on many other psychosocial and behavioral factors.
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Presenting Author
Carolina Ortigosa Cunha
Poster Authors
Carolina Cunha
MD, PhD
Sacred Heart University Center
Lead Author
Tatiana da Fonte
University of São Paulo
Lead Author
Maria Emilia Servin Berden
Bauru School of Dentistry, University of São Paulo
Lead Author
Samilla Braga
Universidade de São Paulo
Lead Author
Paulo Conti
University of São Paulo
Lead Author
Dyanne Medina Flores
Bauru School of Dentistry, Universidade de São Paulo
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Orofacial Pain