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Comparison of efficacy of Amitryptyline and Duloxetine sodium in reduction of pain in Temporomandibular joint disorder (TMD) patients- A Systematic Review
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| Author:
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DR.YANDETI SRINIVASULU, PROF.DR.ABDUL WAHAB, DR.SENTHIL MURUGAN.P
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| Abstract:
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Background: Temporomandibular disorder (TMD) is characterized by a combination of symptoms affecting the temporomandibular joint and chewing muscles. The two most common clinical TMD symptoms are pain and dysfunction. Pain is usually caused by dysfunction. Recent studies into TMD have led to the recommendation of antidepressants as a supporting treatment against constant pain. Many simultaneous signs and symptoms are related to temporomandibular dysfunction (TMD), which can be diagnosed when at least three signs or symptoms are present.TMD patients usually suffer from pain in the temporomandibular joint (TMJ), contracture/tenderness of chewing muscles, clicking or popping condylar noise, absence of radiographie or rheumatologie signs relating to morphologie TMJ alterations, absence of tenderness in the TMJ when it is palpated via the external auditory meatus. limitation of jaw function, limited mouth opening, and pain around the neck and the pectoral arch. Pain and dysfunction are the two most common clinical findings in almost every case of TMD. They are also the main reason patients seek treatment. The pain is often a consequence of the dysfunction. Various types of occlusal splints, physical therapy, and electro modalities (ultrasound, iontophoresis, electrogalvanic stimulation) are used in the treatment of TMJ pain dysfunction.The aim of this study was to verify the efficiency of Amitriptyline and Duloxetine sodium as in the treatment of chronic TMD pain. Chronic TMD pain is usually treated with peripheral analgesics, muscle relaxants, opioids, and benzodiazepines.Recently, the use of tricyclic type antidepressants has also been proposed. Among these types of drugs, amitriptyline is administered in lower amounts than the dosage required for the treatment of TMD. Duloxetine, a potent selective serotonin and norepinephrine reuptake inhibitor may correct a functional deficit of serotonin and norepinephrine neurotransmission. It is hypothesized that potentiation of 5-HT and NE activity in the CNS results in pain inhibition.
Objectives: The aim of this systematic review is to assess efficacy of Amitryptyline and Duloxetine sodium in reduction of pain in Temporomandibular joint disorder (TMD) patients .
Materials and Methods: The Databases of PubMed, Cochrane and Google scholar were searched for the related topics along with a complimentary manual search of all oral surgery journals till September 2019. Articles were selected based on the inclusion criteria, which included all RCTs.
Results: From this study it is concluded that Duloxetine sodium is more effective in lowering the Temporomandibular joint pain than that of Amitryptyline in the patients who are suffering from chronic Temporomandibular joint disorders.
Conclusion: The current study compared the efficacy and safety of duloxetine with amitriptyline head to head in patients with TMD .Both drugs demonstrated comparable efficacy and safety as per the established pain rating scales for TMD . Numerically, more patients preferred duloxetine.In the present trial, both duloxetine and amitriptyline demonstrated similar efficacy. More than 50% improvement in pain score was observed in patients with duloxetine, compared with various placebo-controlled trials. and 45% with amitriptyline, compared with other placebo-controlled and active-control trials.
Improvement in reduction of pain was significant with Duloxetine sodium as per patient assessment by the Visual Analogue Scale.
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| Keyword:
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Duloxetine, sodium
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| EOI:
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| DOI:
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https://doi.org/10.31838/ijpr/2020.12.01.359
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| Download:
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