Auriculoterapia francesa por fotobiomodulação a LASER na dor, ansiedade e atividade cortical em pessoas com disfunção temporomandibular: ensaio clínico randomizado crossover duplo-cego

Abstract

Temporomandibular disorders are characterized by episodes of musculoskeletal pain that affect the stomatognathic system and psychoemotional aspects. Although it is a challenge to find an effective treatment due to the complexity of the factors involved, auriculotherapy, which uses the French technique, is a therapeutic option to reduce symptoms. In addition, continuous LASER photobiomodulation therapy has proven effects on musculoskeletal pain due to its antiinflammatory and analgesic properties. However, few studies have been conducted with pulsed LASER in individuals with Temporomandibular Dysfunction (TMD). Objective: To verify the effects of auriculotherapy by pulsed LASER photobiomodulation on pain intensity, anxiety symptoms and brain electrical activity in people with Temporomandibular Dysfunctions (TMDs). Methodology: The study design consists of a Double-blind Randomized Crossover Clinical Trial. The sample consisted of men and women diagnosed with TMD by the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) AXIS I, aged over 18 years, recruited from Family Health Units in the city of Alfenas/MG and by invitation on social media. The subjects were randomized into two groups: the Experimental Group (EG = 13), which received auriculotherapy by photobiomodulation with low-intensity pulsed LASER at the following points: O', toxic scar, cervical rib, dental entrance, ACTH (adenocorticotropic hormone), cortisol, TMJ and Shemnen; and the Placebo Group (PG = 12), which underwent the same therapeutic intervention, but with the replacement of the LASER pen by the electric detection pen, following the same protocol for both groups. Therapeutic interventions were performed twice a week, for a period of 4 weeks. The volunteers were evaluated using the Diagnostic Criteria for Temporomandibular Dysfunction DC/TMD - AXIS II - Graded Chronic Pain Scale - version 2 (GCPS) and the Generalized Anxiety Disorder Scale - (GAD-7). Brain electrical activity was assessed using the Electroencephalogram (EEG), applied pre-intervention and post-intervention. The washout period was 15 days, which was used to cross-reference the groups. Then, for data analysis, 21 data from the PG and 23 data from the EG were counted. The Kolmogorov- Smirnov test was used to analyze the Gaussian distribution. The delta calculation was performed for intergroup analysis. The comparison between groups was performed using the independent t-test for parametric data and the MannWhitney test for nonparametric data. Results: The anthropometric and clinical characteristics of the sample presented normal distribution in the comparison between the groups (p> 0.05). The EEG outcome showed a significant reduction in the values for the F8 (p=0.04) and C4 (p=0.00) 9 channels when comparing the placebo and experimental groups. The GCPS and GAD7 outcomes showed similarity between the groups with p>0.05 and p=0.18, respectively, with no statistical difference. Conclusion: Auriculotherapy by photobiomodulation with pulsed LASER had a positive effect on brain electrical activity, showing a reduction in the values in the F8 and C4 channels. However, pain intensity and anxiety symptoms remained constant after treatment in individuals with temporomandibular disorders.