Fotobiomodulação no controle da dor na disfunção temporomandibular: ensaio clínico controlado randomizado e análise do custo-efetividade

Abstract

Several resources have been proposed to control muscle pain in patients with temporomandibular disorder (TMD), such as occlusal splint, acupuncture, and laser therapy, also called photobiomodulation (PBM). PBM has been shown to be able to assist in symptomatic pain management, promoting a considerable degree of comfort to the patient, moments after its application. The present study aimed to perform a cost-effectiveness analysis of TMD treatment with photobiomodulation in patients with myofascial pain. As a method, was conducted a bibliographic search of the proposed theme in the PubMed and Web of Science databases in the last ten years for systematic review and meta- analysis, including only randomized trials with laser group and placebo. For the clinical trial, patients with TMD and myofascial pain were selected and divided into 2 groups: laser group (GL) (n = 12) and occlusal splint (GP) (n = 11). The patients were followed for 30 days. Twelve laser application sessions and 12 occlusal splint adjustment and follow-up sessions were performed in their respective groups. Pain decline, according to visual analogy scale, was observed for both groups before and after 1 month (GL, p = 0.008 and GP p = 0.002), but without difference between the groups. In the outcome quality of life both treatments had a positive impact, this higher impact in the laser group compared to the placebo group (p <0.05). Cost-effectiveness analysis showed that the laser was more cost-effective than occlusal splint and placebo. The incremental cost of the laser was R $ 3,483.45 compared to the occlusal splint, but it presented the cost ratio of $ 4,569.02 per controlled pain intensity while the plaque presented $ 6,691.91 per controlled pain intensity. Comparing the laser with placebo, the laser was cost-effective at $ 1,464.28 for controlled pain intensity and placebo at $ 2,866.20 for controlled pain intensity. It was concluded that photobiomodulation was more cost-effective in patients with TMD and myofascial pain.