Efeito da educação em dor com base em neurociência associada à administração de ciclobenzaprina em pacientes com dor miofascial mastigatória: um ensaio clínico controlado duplo cego aleatorizado

Abstract

Myofascial orofacial pain related to Temporomandibular Disorders (TMD) poses a significant clinical challenge due to its multifactorial complexity and negative impact on quality of life. Characterized by persistent symptoms often refractory to traditional therapeutic approaches, chronic pain in TMD demands strategies beyond isolated symptomatic control, integrating educational and psychosocial components. This study evaluated the clinical effects of an integrated intervention combining Pain Neuroscience Education (PNE) with pharmacotherapy (cyclobenzaprine), compared to a control group receiving the same medication associated only with basic medication instructions. A randomized, double-blind, parallel clinical trial was conducted, including 70 women equally divided into intervention and control groups. Assessments occurred before treatment and at one week, one month, and three months after treatment initiation. The results showed the intervention group experienced a clinically significant pain reduction from the first week post-intervention, maintained throughout the follow-up, according to IMMPACT criteria (≥30% reduction defined as clinically meaningful). Alongside pain reduction, sustained improvements were observed in essential psychosocial parameters, including vitality, social and emotional aspects, and reductions in somatization and pain catastrophizing. Conversely, the control group achieved only partial initial benefits that were less consistent over time, highlighting limitations of an isolated pharmacological approach, particularly in maintaining medium-term outcomes. Despite these substantial symptomatic improvements in the intervention group, formal diagnostic classifications according to DC/TMD (Diagnostic Criteria for Temporomandibular Disorders) criteria remained relatively stable over the three-month follow-up. This outcome underscores the complexity inherent to TMD, where meaningful changes in psychological and behavioral variables may not immediately lead to diagnostic reclassification. Study limitations include the relatively short follow-up duration and a dropout rate slightly higher than anticipated, factors recommending caution in generalizing the findings. Nonetheless, these limitations do not undermine the study’s relevance, reinforcing the perspective that educational and multidimensional strategies are essential for effectively managing chronic pain related to TMD. In conclusion, this thesis confirms the clinical and psychosocial effectiveness of the integrated approach adopted, emphasizing that educational interventions combined with pharmacotherapy are crucial for sustainably improving quality of life and reducing symptoms associated with chronic orofacial myofascial pain. Future studies with longer follow-up periods are recommended to further confirm and deepen these findings.