Efficacy of Therapeutic Exercise and Pain Neurophysiology Education in Temporomandibular Disorders

Objective: To evaluate the differences in pain intensity by performing isolated therapeutic exercise (TE) versus performing the same exercise combined with pain neurophysiology education (PNE) in patients with temporomandibular disorders (TMD).

Design: Single-blind randomized controlled trial. Setting: Faculty of Physical Therapy of Alcalá de Henares. Participants: Subjects with TMD lasting more than 6 months (N= 36). Interventions: Participants will be randomly assigned to receive a TE program consisting of stretching, coordination and strengthening exercises (n= 18) or the same TE program in addition to a PNE program (n= 18), performed in two sessions of 40 minutes in groups of 6 participants. The intervention will last 12 weeks, where all participants must complete the exercise program daily, one year later they will be evaluated again.

Main outcome measures: The primary outcome will be pain intensity through the visual analogue scale (VAS) which will be completed at baseline, immediately after treatment, at 4 and 12 weeks and one year after treatment. Secondary outcome measures include pain-free mouth opening, Craniofacial Pain and Disability Inventory (CF-PDI), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-11), pressure pain thresholds (PPT) and Patient Global Impression of Change (PGIC). They will be recorded through blinded assessments performed by 2 physiotherapists at baseline, immediately after treatment, 4 and 12 weeks after treatment. Student's t test will be used to determine differences between group interventions.

Inclusion criteria

• Over 18 years of age
• Limitation of mouth opening and/or jaw pain lasting more than 6 months
• Being able to understand the objective and carry out the study procedures
• Sign the informed consent.

Exclusion criteria

• Suffer from any underlying disease
• Pain due to tumors or infections, metastases, osteoporosis, inflammatory arthritis or fractures
• Be receiving any other treatment for TMD or consuming some type of substance that alters muscle tone.
• Patients with myopathies, diseases of the Peripheral Nervous System, mental disorders diagnosed by a doctor
• Inability to collaborate
• Any other situation in which the evaluation could be altered.