Title Učinak amitriptilina u liječenju kroničnih temporomandibularnih poremećaja Title (english) The effect of amitriptyline in chronic temporomandibular disorders treatment Author Ratka Borić Brakus Mentor Iva Alajbeg (mentor)Committee member Tomislav Badel (predsjednik povjerenstva)Committee member Sonja Kraljević-Šimunković (član povjerenstva)Committee member Asja Čelebić (član povjerenstva)Committee member Ivan Kovačić (član povjerenstva)305616922 Committee member Ivana Šutej (član povjerenstva)Granter University of Zagreb Defense date and country 2019-04-12, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 616.31 - Stomatology Abstract Temporomandibularni poremećaji (TMP) najčešći su poremećaji žvačnoga sustava nedentalnoga porijekla. Najčešći simptom je bol u području čeljusnoga zgloba i/ili žvačnih mišića, a traje li kontinuirano šest mjeseci ili duže, postaje kronična. Cilj ove prospektivne dvostruko slijepe placebo studije bio je ustanoviti mogu li niske doze amitriptilina (triciklički antidepresiv) umanjiti kroničnu bol u pacijenata s TMP-om te ima li kronična bol utjecaja na kvalitetu života. Od sveukupno 40 uključenih pacijenata, 31 (prosječne dobi 48 godina) je završio istraživanje. Dijagnoza kroničnog TMP-a postavljena je pomoću dijagnostičkoga kriterija za istraživanje temporomandibularnih poremećaja. Pacijenti su nasumično podijeljeni u dvije skupine: ispitanici ispitne skupine primali su 25 mg amitriptilina, a ispitanici kontrolne skupine placebo lijek. Terapija se provodila 2 mjeseca, a mjere ishoda (bol prema VAS-skali, OHIP-14, iznosi kretnji donje čeljusti) procjenjivane su na početku te prvi i drugi mjesec od početka terapije. Vrijednosti VAS-a bile su značajno niže u obje skupine nakon 2 mjeseca (ispitna skupina P<0,001; kontrolna skupina P=0,009). Ukupan postotni pad vrijednosti VAS-a u odnosu na početne vrijednosti u ispitnoj skupini iznosio je 63,3 %, a u kontrolnoj skupini 16,2 %. Kvaliteta života procjenjivana OHIP-14 upitnikom značajno je poboljšana u ispitnoj skupini (P˂0,001) dok u kontrolnoj skupini promjena ukupnog OHIP-a nije bila statistički značajna (P=0,184). Nakon 2 mjeseca iznos bezbolnoga otvaranja usta
povećao se za 20,5 % u ispitnoj skupini, a u kontrolnoj skupini taj je iznos povećan za 3,22 %. Zaključno, amitriptilin može umanjiti kroničnu bol u pacijenata s TMP-om, ali ju ne može u potpunosti ukloniti. Amitriptilin značajno utječe na poboljšanje mandibularne dinamike i kvalitete života u pacijenata s kroničnim TMP-om.
Abstract (english) Objective of work: Temporomandibular disorders (TMD) are most common orofacial pain conditions of nondental origin. It is not a unique diagnosis, but a group of various problems which manifest by similar symptoms. The most frequent symptom of TMD is pain, usually located in the masticatory muscles and/or temporomandibular joint. When this pain lasts for 6 months or longer, it becomes chronic and can thereby significantly affect normal daily functioning of an individual. Considering the fact that the effects of changes at the central nervous system level can play a role in the etiology of chronic painful conditions, in treatment of these disorders it would be justified to use drugs with systemic effects, e.g. anti-depressants. The purpose of this study was to determine whether amitriptyline (tricyclic antidepressant) can reduce chronic
pain in patients with temporomandibular disorder, and if so, for how long .Also, it sought to determine if amitriptyline affects patients’ functional limitations and whether it can improve/positively affect the quality of life.
Materials and Methods: The study encompassed 40 test subjects and ended up with 31 of them, with average age of 48
years ((±18.43 years). The diagnosis of chronical TMD was set using a diagnostics criteria for the research of temporomandibular disorders (RDC/TMD protocol). Study was conducted as a prospective double-blind placebo study. Patients were randomly divided in two groups: test subjects in the first group received 25 mg of amitriptyline, while test subjects in the control group received a placebo. Treatment was applied during a period of 2 months, while resulting
parameters (pain per VAS, OHIP 14, amount of movement of the mandibula, presence/existence of deviation / deflection, joint sounds) have been assessed at check-ups undertaken in first and second month starting from therapy commencement.
Results: Results of this research have shown significant pain reduction after two months in both test groups (amitryptiline group P 0,001, control group P=0,009), with significant difference appearing between groups after 2 months of therapy, in favour of the amitriptyline group. Pain was not completely removed, but was reduced by 63.3 % in amitryptiline group versus control group in which reduction of pain was only 16.2 %. Life quality was assessed using the OHIP-14 questionnaire which contains 7 subgroups of questions. After 2 months of therapy, in all questionnaire subgroups there was a significant improvement of quality of life in favour of the amitriptyline group. The overall OHIP value was reduced by 67.85 % in amitriptyline group (P 0,001), and there was no such difference in control group (P=0,184). After 2 months of therapy, subjects of amitryptiline group had 20.5 % greater painless jaw opening versus control group in which improvement was greater for 3.22 %.
Keywords
temporomandibularni poremećaj
amitriptilin
kvaliteta života
kronična bol
Keywords (english)
temporomandibular disorder
amitriptyline
quality of life
chronic pain
Language croatian URN:NBN urn:nbn:hr:127:671885 Study programme Title: dental medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2020-01-22 12:39:19
