Do Occlusal Splints Have an Effect on Complex Regional Pain Syndrome? A Randomized, Controlled Proof-of-concept Trial : The Clinical Journal of Pain

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Do Occlusal Splints Have an Effect on Complex Regional Pain Syndrome? A Randomized, Controlled Proof-of-concept Trial

Fischer, Michael J. MD* †; Reiners, Anselm MD‡; Kohnen, Ralf PhD§; Bernateck, Michael MD∥; Gutenbrunner, Christoph MD, PhD*; Fink, Matthias MD, PhD*; Svensson, Peter DDS, PhD¶ ♯

Author Information

*Departments of Physical and Rehabilitation Medicine

∥Department of Anesthesiology, Pain Clinic, Hanover Medical School, Hanover

†Department of Neurology, Friedrich Baur Institute, Ludwig Maximilians University

‡Department of Physical and Rehabilitation Medicine, Bogenhausen Academic Teaching Hospital, Technical University of Munich, Munich

§IMEREM-Institute for Medical Research Management and Biometrics, Nuremberg, Germany

Department of Clinical Oral Physiology, School of Dentistry, University of Aarhus

♯Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus C, Denmark

Supported by a research grant from the German Society of Manual Medicine–Forschungsgemeinschaft für Arthrologie und Chirotherapie (FAC). Results from this pilot study were presented as a Poster at the International Association for the Study of Pain Research Symposium 2007 in Aalborg, Denmark.

Reprints: Dr Michael J. Fischer, MD, Department of Physical and Rehabilitation Medicine, OE8300, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany (e-mail: [email protected]).

Received for publication February 10, 2008; revised March 28, 2008; accepted March 31, 2008

The Clinical Journal of Pain 24(9):p 776-783, November 2008. | DOI: 10.1097/AJP.0b013e3181790355

Abstract

Objectives 

Studies have suggested overlaps between various chronic pain conditions and painful temporomandibular disorders (TMDs). The objective of this pilot study was to assess the effectiveness of occlusal splint (OS) therapy on self-reported measures of pain in patients with chronic complex regional pain syndrome (CRPS) as compared with a nontreatment group.

Methods 

The design was a prospective randomized controlled clinical trial. Twenty patients with CRPS were randomly assigned to either the OS or control group. The patients in the OS group were asked to use the OS at nighttime and for 3 hours during daytime for a total of 7 weeks; the control group had no stomatognathic intervention. The primary outcome was self-reported assessment of CRPS-related pain on numerical rating scales. Secondary outcome measures were the Temporomandibular Index (TMI), and the Short Form 36 Health Survey (SF-36).

Results 

All patients had TMD signs and symptoms, but OS had no effect on CRPS-related pain on the numerical rating scale (P>0.100). The changes in the TMI scores over time were 16.6%±24.6% (improvement) in the OS group and −21.3%±25.9% (impairment) in the control group that was significant (P=0.004). There were no differences in the changes of SF-36 scores between groups (P=0.636).

Discussion 

The use of OS for 7 weeks has no impact on CRPS-related pain but improved signs and symptoms of TMD pain. Future studies should include an active control group and evaluate if long-term changes in measures of oral health impact general health in CRPS-related pain.

© 2008 Lippincott Williams & Wilkins, Inc.

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