Comparison of the effectiveness of psycho-behavioral-relaxation and occlusal splint therapy in the treatment of myalgia

BACKGROUND: The current treatment for patients with myalgia comprises splint therapy (ST), cognitivebehavioral therapy (CBT), psychological treatment, and education. OBJECTIVES: The aim of the present study was to compare the effectiveness of relax-psycho-breathing therapy (RPB) and ST in women with myalgia, and to evaluate the efficacy of occlusal splint and/or behavioral therapy in the management of muscle pain. MATERIAL AND METHODS: The study, designed as a randomized controlled trial (RCT), involved 105 women aged 25-55 years with pain in the masticatory muscles during the 30 days prior to examination. Myalgia was diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I. The clinical examination assessed muscle and temporomandibular joint (TMJ) pain intensity, TMJ sounds, maximum mouth opening (MMO), and deviation in mouth opening and mandibular movement. After an initial assessment, at the 2nd visit (V2), the 25 patients from the 1st group were introduced to RPB: relaxation techniques; breathing patterns; psychological-behavioral instruction; muscle exercise therapy; puffing therapy; and self-massage. The 2nd group of patients received a custom-made, thermoplastic, flatplane relaxation splint placed on the mandible. The efficacy of treatment in all subjects was evaluated at 2 follow-up visits (V3 and V4). RESULTS: In cases of muscle pain, pain during function, TMJ and muscle tenderness, and headache attributed to TMD, a statistically significant difference between the RPB and ST groups was observed only at the final follow-up visit. No significant differences between the 2 groups were found for MMO. CONCLUSIONS: The reduction in myalgia following treatment suggests that both RPB exercises and ST are equally effective. However, considering the cost and duration of myalgia therapy, comprehensive care incorporating relaxation techniques may be a preferable first-line approach rather than ST alone.