Papel da fototerapia e de um programa de exercício físico na fibromialgia com disfunção temporomandibular: ensaio clínico controlado, randomizado e duplo-cego

Abstract

Introduction: Fibromyalgia (FM) is a syndrome characterized by chronic widespread pain, with prevalence in women. An important issue is that many patients with FM also have the diagnosis of temporomandibular disorders (TMD) and the coexistence of these conditions generates a clinical result of high complexity. Exercise and phototherapy (low level laser therapy / LED) are two areas used for the treatment of chronic pain and may be promising in the rehabilitation of these comorbidities. In a protocol (1) the objective was to verify if the phototherapy and exercise program in a single application can increase or decrease the sensitivity of pain in patients with FM associated with TMD. Objective of the protocol two (2) was to evaluate the potential of physical exercise program and phototherapy on condition of chronic pain in women with FM associated with TMD. Methods / Study Design: Randomized clinical trial, double-blind and controlled. Protocol 1 was conducted involving 80 women aged ≥ 35 years old with a diagnosis of FM TMD. Patients were randomly allocated to one of four groups: CON (have not undergone any operation); PHO group (intervention with phototherapy); EXT group (intervention with exercise); PHO + EXT group (more intervention exercise phototherapy). One session of the treatments and the revaluation was carried out was after thirty (30) minutes of application, with analysis of algometry. In Protocol 2 used the same methodology to protocol 1, but the revaluation was after ten (10) weeks of treatment, with addition of other evaluative tools algometry. Statistical analysis was performed using Student's t-test, one-tailed and paired and was held Gaussian distribution: Shapiro-Wilk and Kruskal Wallis test (Dunnes post-test), and even the use of the Wilcoxon test and the significance of statistical analysis 0.05 for all tests. The study protocol is registered with the World Health Organization under protocol number NCT02279225. Results: Groups with active intervention, had a good response on the group without intervention and even the combination of therapeutic resources was more effective in the two periods evaluated, there was a significant improvement from the point corresponding to DTM in the intervention groups. Discussion: This is the first randomized controlled trial to evaluate the role of phototherapy, a physical exercise program and the combination of these interventions for pain in fibromyalgia patients with TMD in assessment baseline and after longitudinal treatment. The results provide valuable clinical evidence for objective assessment of the potential benefits and risks of the procedures. Conclusion: The therapy associated with specific exercise program improves the painful condition FM patient with TMD. Perspectives: Check the role of phototherapy, the exercise program and these therapies in combination in the hormone changes that may be related to quality of life of patients.