Acupuncture in treatment of facial muscular pain. Efficacy of Chinese acupuncture on postoperative oral surgery pain. The efficacy of dry needling and procaine in the treatment of myofascial pain in the jaw muscles. Acupuncture in patients with tension-type headache: randomised controlled trial Acupuncture and occlusal splint therapy in the treatment of craniomandibular disorders. Part I. A comparative study. Interrater reliability in myofascial trigger point examination Acupuncture for patients with migraine: a randomized controlled trial. [Clinical observation on warming needle moxibustion plus exercise for treatment of temporomandibular joint dysfunction syndrome]. Auricular electrical stimulation and dental pain threshold. Oral acupuncture in the therapy of craniomandibular dysfunction syndrome – a randomized controlled trial Initial management of temporomandibular disorders. Pain threshold responses to two different modes of sensory stimulation in patients with orofacial muscular pain: psychologic considerations. A Randomized Clinical Trial of Acupuncture Compared with Sham Acupuncture in Fibromyalgia Pressure pain thresholds in patients with craniomandibular disorders before and after treatment with acupuncture and occlusal splint therapy: a controlled clinical study. The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain Acupuncture and occlusal splint therapy in the treatment of craniomandibular disorders. II. A 1-year follow-up study. The use of acupuncture in dentistry: a review of the scientific validity of published papers. Evaluation of acupuncture and occlusal splint therapy in the treatment of temporomandibular joint disorders. Acupuncture and chronic pain mechanisms Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists. Randomized clinical trial of acupuncture for myofascial pain of the jaw muscles. Low Intensity Laser Application in Temporomandibular Disorders: A Phase I Double-Blind Study Counseling and physical therapy as treatment for myofascial pain of the masticatory system. The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: a randomised controlled trial. Acupuncture and sham acupuncture reduce muscle pain in myofascial pain patients. The short-term effects of acupuncture on myofascial pain patients after clenching. [Acupuncture and ultrasound therapy for temporomandibular disorders]. Clinical significance of reported changes in pain severity. Acupuncture compared with stomatognathic treatment for TMJ dysfunction. Part III: Effect of treatment on mobility.
Forty-five individuals with long-st and ing facial pain or headache of muscular origin were r and omly allocated into three groups . The first group was treated with acupuncture , the second group received an occlusal splint , and the third group served as controls . Both acupuncture and occlusal splint therapy significantly reduced subjective symptoms and clinical signs from the stomatognathic system . No differences between these two groups were found with regard to treatment effects . It is concluded that acupuncture is an alternative method to conventional stomatognathic treatment for individuals with craniom and ibular disorders of muscular origin One of the challenges of acupuncture research is design ing appropriate control groups . To address this problem , after surgical third molar extraction s 19 patients were r and omly assigned to an acupuncture group ( n = 11 ) or a placebo acupuncture group ( n = 8) . The length of time for reaching moderate pain and pain intensity after oral surgery were recorded by st and ard patient self-report . The results indicated that subjects treated with acupuncture reported longer pain-free duration times ( mean , 181 versus 71 minutes ; p < or = 0.046 ) and experienced less pain intensity than those who received placebo acupuncture . This study provides a model for an acupuncture control that could examine the placebo effect in clinical acupuncture research In patients with myofascial pain , painful trigger points are often treated using dry needling and local anesthetic injections . However , the therapeutic effect of these treatments has been poorly quantified , and the mechanism underlying the effect is poorly understood . In a r and omized , double-blind , double-placebo clinical trial , a pressure algometer was used to measure pain-pressure thresholds in the masseter and temporalis muscles of 30 subjects aged 23 to 53 years with myofascial pain in the jaws , before and after a series of dry needling treatments , local anesthetic injections , and simulated dry needling and local anesthetic treatments ( treatment group A : Procaine + simulated dry needling ; treatment group B : dry needling + simulated local anesthetic ; control group C : simulated local anesthetic + simulated dry needling ) . Subjects rated pain intensity and unpleasantness using visual analogue scales , and the data were analyzed using analysis of variance . Pain pressure thresholds increased slightly after treatment , irrespective of the treatment modality . Pain intensity and unpleasantness scores decreased significantly at the end of treatment in all groups . There were no statistically significant between-group differences in pain pressure thresholds and visual analogue scale scores at the end of treatment . The findings suggest that the general improvement in pain symptoms was the result of nonspecific , placebo-related factors rather than a true treatment effect . Thus , the therapeutic value of dry needling and Procaine in the management of myofascial pain in the jaw muscles is question able Abstract Objective To investigate the effectiveness of acupuncture compared with minimal acupuncture and with no acupuncture in patients with tension-type headache . Design Three armed r and omised controlled multicentre trial . Setting 28 outpatient centres in Germany . Participants 270 patients ( 74 % women , mean age 43 ( SD 13 ) years ) with episodic or chronic tension-type headache . Interventions Acupuncture , minimal acupuncture ( superficial needling at non-acupuncture points ) , or waiting list control . Acupuncture and minimal acupuncture were administered by specialised physicians and consisted of 12 sessions per patient over eight weeks . Main outcome measure Difference in numbers of days with headache between the four weeks before r and omisation and weeks 9 - 12 after r and omisation , as recorded by participants in headache diaries . Results The number of days with headache decreased by 7.2 ( SD 6.5 ) days in the acupuncture group compared with 6.6 ( SD 6.0 ) days in the minimal acupuncture group and 1.5 ( SD 3.7 ) days in the waiting list group ( difference : acupuncture v minimal acupuncture , 0.6 days , 95 % confidence interval -1.5 to 2.6 days , P = 0.58 ; acupuncture v waiting list , 5.7 days , 3.9 to 7.5 days , P < 0.001 ) . The proportion of responders ( at least 50 % reduction in days with headache ) was 46 % in the acupuncture group , 35 % in the minimal acupuncture group , and 4 % in the waiting list group . Conclusions The acupuncture intervention investigated in this trial was more effective than no treatment but not significantly more effective than minimal acupuncture for the treatment of tension-type headache . Trial registration number IS RCT N9737659 One hundred and ten patients , 23 males and 87 females , participated in a comparative study of the effect of acupuncture and occlusal splint therapy .  All the patients exhibited signs and symptoms of craniom and ibular disorders ( CMD ) and had had pain for more than six months . The participants were r and omly assigned to three groups ; acupuncture treatment , occlusal splint therapy or control . The patients were evaluated before and immediately after treatment/control time . Ten different subjective and /or clinical assessment variables were used in the evaluation of the treatment effects . Both acupuncture and occlusal splint therapy  reduced the symptoms as compared with the control group in which the symptoms remained essentially unchanged . In this short-term study , acupuncture gave better subjective results ( p < 0.001 ) than the occlusal splint therapy Abstract The myofascial trigger point ( MTrP ) is the hallmark physical finding of the myofascial pain syndrome ( MPS ) . The MTrP itself is characterized by distinctive physical features that include a tender point in a taut b and of muscle , a local twitch response ( LTR ) to mechanical stimulation , a pain referral pattern characteristic of trigger points of specific areas in each muscle , and the reproduction of the patient 's usual pain . No prior study has demonstrated that these physical features are reproducible among different examiners , thereby establishing the reliability of the physical examination in the diagnosis of the MPS . This paper reports an initial attempt to establish the interrater reliability of the trigger point examination that failed , and a second study by the same examiners that included a training period and that successfully established interrater reliability in the diagnosis of the MTrP. The study also showed that the interrater reliability of different features varies , the LTR being the most difficult , and that the interrater reliability of the identification of MTrP features among different muscles also varies CONTEXT Acupuncture is widely used to prevent migraine attacks , but the available evidence of its benefit is scarce . OBJECTIVE To investigate the effectiveness of acupuncture compared with sham acupuncture and with no acupuncture in patients with migraine . DESIGN , SETTING , AND PATIENTS Three-group , r and omized , controlled trial ( April 2002-January 2003 ) involving 302 patients ( 88 % women ) , mean ( SD ) age of 43 ( 11 ) years , with migraine headaches , based on International Headache Society criteria . Patients were treated at 18 outpatient centers in Germany . INTERVENTIONS Acupuncture , sham acupuncture , or waiting list control . Acupuncture and sham acupuncture were administered by specialized physicians and consisted of 12 sessions per patient over 8 weeks . Patients completed headache diaries from 4 weeks before to 12 weeks after r and omization and from week 21 to 24 after r and omization . MAIN OUTCOME MEASURES Difference in headache days of moderate or severe intensity between the 4 weeks before and weeks 9 to 12 after r and omization . RESULTS Between baseline and weeks 9 to 12 , the mean ( SD ) number of days with headache of moderate or severe intensity decreased by 2.2 ( 2.7 ) days from a baseline of 5.2 ( 2.5 ) days in the acupuncture group compared with a decrease to 2.2 ( 2.7 ) days from a baseline of 5.0 ( 2.4 ) days in the sham acupuncture group , and by 0.8 ( 2.0 ) days from a baseline if 5.4 ( 3.0 ) days in the waiting list group . No difference was detected between the acupuncture and the sham acupuncture groups ( 0.0 days , 95 % confidence interval , -0.7 to 0.7 days ; P = .96 ) while there was a difference between the acupuncture group compared with the waiting list group ( 1.4 days ; 95 % confidence interval ; 0.8 - 2.1 days ; P<.001 ) . The proportion of responders ( reduction in headache days by at least 50 % ) was 51 % in the acupuncture group , 53 % in the sham acupuncture group , and 15 % in the waiting list group . CONCLUSION Acupuncture was no more effective than sham acupuncture in reducing migraine headaches although both interventions were more effective than a waiting list control OBJECTIVE To search for a better therapy for temporom and ibular joint dysfunction syndrome . METHODS Two hundred and ten cases of temporom and ibular joint dysfunction syndrome were r and omly divided into a treatment group , a control group I and a control group II , 70 cases in each group . The treatment group were treated with warming needle moxibustion plus exercise , with Hegu ( LI 4 ) , Xiaguan ( ST 7 ) , Yifeng ( TE 17 ) and so on selected , in combination with opening and closing the mouth ; the control group I were treated with simple filiform needle needling , and the control group II with local blocking therapy . The therapeutic effects of the 3 groups were compared . RESULTS The total effective rate was 94.3 % in the treatment group , 87.1 % in the control group I and 85.7 % in the control group II with a significant difference among the 3 groups , the treatment group being better than the two control groups ( P < 0.05 ) . CONCLUSION Warming needle moxibustion plus exercise has a good therapeutic effect on temporom and ibular joint dysfunction syndrome A modified double-blind evaluation of naloxone reversibility of dental analgesia produced by auricular electrical stimulation ( AES ) was examined in 40 subjects assigned r and omly to one of four groups :  AES followed by saline ( AS ) , AES followed by naloxone ( AN ) , placebo AES followed by saline ( PS ) , and placebo AES followed by naloxone ( PN ) . Dental pain threshold was tested using a h and -held dental pulp tester . A second investigator administered the true or placebo AES using an electrical stimulator . A third investigator injected intravenously saline or naloxone . The subjects and investigators 1 and 3 were blind to all treatment conditions . A repeated measures analysis of variance revealed a significant difference among the four groups . The AES groups exhibited a statistically significant 18 % elevation of pain threshold , whereas the two placebo stimulation groups ( PS and PN ) remained essentially unchanged . The mean pain threshold increased to more than 23 % for group AS , but fell to less than 12 % for the subjects in group AN , who were given naloxone . These findings indicate a small but significant elevation of pain threshold by AES , an effect partially blocked by naloxone , suggesting an endogenous opioid system as one mechanism for AES analgesia Summary CONTEXT : Patients with disorders of the stomatognathic system describe pain and clicking phenomena as primary symptoms . Rapid improvement of the pain is required to ensure and maintain adequate patient compliance . OBJECTIVE : The study was intended to assess the effects of acupuncture in patients with temporom and ibular disorders as compared to placebo therapy ( sham laser ) ; the primary target parameter was the subjective pain sensation . DESIGN : R and omized , placebo-controlled trial . PATIENTS AND METHODS : 23 patients were enrolled and r and omly assigned to one of the two groups . One group received acupuncture treatment according to the very-point technique , the other group received sham laser treatment . The following observer-blinded findings were evaluated before and after treatment : subjective pain , mouth opening , and muscular tenderness and pain on pressure . In addition , m and ibular joint movement pathways were recorded using electronic axiography . OUTCOMES : Improvements in pain scores ( scale , 0–100 ) in the acupuncture group ( 19.1 ± 11.9 ) were significant ( p = 0.03 ) versus those in the placebo group ( 6.2 ± 14.8 ) . Mouth opening showed an insignificant trend towards improvement ( p > 0.1 ) in the acupuncture ( 5.0 ± 6.2 mm ) versus the placebo group ( 1.0 ± 4.7 mm ) , differences in tenderness and pain on pressure in neck and masticatory muscles were significant ( p < 0,05 ) for most of the muscles having shown pretreatment tenderness or pain . The axiographic tracings were assessed for quality , symmetry and curve characteristics . Recordings of the opening and closing movement in the acupuncture group showed an increased frequency of improvements of curve characteristics as compared to the placebo group . The acupuncture group also showed an increased frequency of improvement in protrusion and retrusion movements , though no statistical significance could be obtained . CONCLUSION : On the basis of the results of the present study , acupuncture may be recommended as acute treatment of craniom and ibular disorders , but studies with larger numbers of patients as well as about long-term treatment outcomes should be conducted . ZusammenfassungEINFÜHRUNG : Patienten mit Störungen des stomatognathen Systems beschreiben als Hauptsymptome Schmerzen und Knackphänomene . Eine rasche Besserung des Schmerzes soll eine gute Patientencompliance sicherstellen . FRAGESTELLUNG : Ziel dieser Studie ist es , die Effekte von Akupunktur in der Akutbeh and lung von Schmerzpatienten mit Störungen i m  craniom and ibulären System  i m Vergleich zu einer Placebogruppe zu untersuchen , wobei die subjektive Schmerzintensität die Hauptzielgröße darstellt . DESIGN : R and omisierte , Placebo-kontrollierte Studie . PATIENTEN UND METHOD EN : 23 Patienten mit Störungen des craniom and ibulären Systems wurden ausgewählt und r and omisiert den beiden Gruppen zugeteilt . Die eine Gruppe erhielt eine Akupunkturtherapie nach der Very-Point- Method e , die and ere eine Laserplacebotherapie . Vor und nach der Beh and lung wurden bei beiden Gruppen folgende Befunde für den Befundenden verblindet erhoben : subjektiver Schmerz , Mundöffnung in Millimetern und Druckdolenzen der Gesichts- und Nackenmuskulatur . Weiters wurden die Kiefergelenksbahnen mittels elektronischer Axiographie aufgezeichnet . ERGEBNISSE : Die Verbesserungen des Schmerzscores ( Skala , 0–100 ) in der Akupunkturgruppe ( 19,1 ± 11,9 ) waren gegenüber der Placebogruppe ( 6,2 ± 14,8 ) signifikant ( p = 0,03 ) . Bei der Mundöffnung lässt sich ein Trend zur Verbesserung in der Akupunkturgruppe ( 5,0 ± 6,2 mm ) i m Gegensatz zur Placebogruppe ( 1.0 ± 4.7 mm ) erkennen , der aber nicht signifikant war ( p > 0,1 ) . Die Unterschiede der Druckdolenzen der Nacken- und Kaumuskulatur sind bei den meisten vor der Beh and lung druckdolenten Muskeln in der Akupunkturgruppe signifikant ( p < 0,05 ) . Die Axiographiekurven wurden auf die Merkmale Qualität , Symmetrie und Charakteristik der Kurven ausgewertet . Es lassen sich bei Aufzeichnung der Öffnungs- und Schließbewegung in der Akupunkturgruppe vermehrt Verbesserungen in den Kurvenparametern i m Vergleich zur Placebogruppe erkennen . Auch bei der Protrusions- und Retrusionsbewegung zeigen sich in der Akupunkturgruppe vermehrt Verbesserungen , allerdings sind diese nicht statistisch signifikant . KONKLUSION : Aufgrund der Ergebnisse der vorliegenden Studie scheint die Akupunktur ein geeignetes Mittel zur Akuttherapie bei craniom and ibulären Störungen zu sein , allerdings sollten weitere Studien mit größerer Patientenzahl und Untersuchungen der Langzeitwirkungen angeschlossen werden The existing dental literature does not support the superiority of any one type of treatment to manage TMD . Few studies meet rigorous scientific st and ards of the r and omized clinical trial . This has led to enormous controversy . The initial management of TMD does not have to be controversial . Noninvasive , reversible modalities can be employed that carry very little risk and a high degree of success ( Table 4 ) . The success rate of this approach has been studied and determined to be 75 % to 90 % . Of course , not every patient will get better with this approach . For those who do not improve more advanced techniques must be used , and referral to specialists in TMD , neurology , and rehabilitation medicine may be required . A few patients will need surgery . Initial treatment of TMD requires relatively simple modalities , such as  patient education , adherence to a soft diet , reducing oral habits , self-directed home physical therapy , muscle relaxation , the use of medication , and the proper use of bite plates .  The majority of TMD patients will respond successfully to these basic treatments This study focuses on the influence of trait anxiety and mood variables on changes in tooth pain threshold following two similar methods of somatic afferent stimulation , one familiar ( manual acupuncture ) and one unfamiliar ( low-frequency transcutaneous electrical nerve stimulation [ low-TENS ] ) .  Twenty-one acupuncture responders , treated for long-lasting orofacial muscular pain but naive to low-TENS , were selected for the study . In an experimental session , acupuncture and low-TENS were r and omly given during two periods separated by a rest interval . Tooth pain thresholds ( PT ) were measured before and after stimulation with a computerized electrical pulp tester .  Trait anxiety and depression were assessed with psychometric forms before the experimental session in all patients , whereas momentary mood was assessed in 10 r and omly selected patients with visual analogue scales during and after the two types of stimulation . Following acupuncture , the group average PT increased significantly , whereas no significant change was observed following low-TENS . Higher scores on trait anxiety correlated significantly with a low PT increase following low-TENS , and higher ratings of stress correlated significantly with a low PT increase following acupuncture . This indicates that the magnitude of analgesia induced by these methods may be modified by psychologic factors like anxiety and stress Context A substantial number of patients use acupuncture to treat the symptoms of fibromyalgia , but previous r and omized trials of this intervention are inconclusive , in part because of control groups that did not permit adequate blinding of the patients . Contribution This study r and omly assigned 100 patients with fibromyalgia to 12 weeks of either true acupuncture treatment or one of 3 types of sham acupuncture . No differences in pain were identified between acupuncture and sham acupuncture . Caution s The study had too few patients to detect small differences between the groups . Patients could use other fibromyalgia therapies , so this study evaluates acupuncture as adjunctive treatment . The Editors Fibromyalgia is a condition of unknown cause that is characterized by chronic , diffuse pain and tenderness to palpation at specific musculoskeletal sites ( 1 ) . It is the second most common rheumatologic condition after osteoarthritis , afflicting 2 % to 4 % of the U.S. population ( 2 ) . Most r and omized , controlled trials of allopathic interventions have not demonstrated sustained benefit , and use of complementary and alternative medicine for fibromyalgia is common ( 3 ) . For example , 60 % to 90 % of patients with fibromyalgia report using 1 or more complementary or alternative treatments ( 4 , 5 ) , and 22 % of these patients have tried acupuncture ( 6 ) . Despite skepticism in western cultures , the literature suggests that acupuncture may alleviate chronic pain ( 7 ) . R and omized , controlled trials of acupuncture face many method ologic challenges , including the identification of appropriate treatment and control groups , blinding of study participants , and the inability to blind practitioners ( 8) . Needle placement and the extent to which needle insertion and stimulation is necessary are also controversial ( 7 - 9 ) . In the only rigorous r and omized , controlled trial of acupuncture for fibromyalgia , 7 of 8 outcome measures significantly improved after 3 weeks of treatment with electroacupuncture ( 10 ) . However , because blinding was not assessed and electroacupuncture involves perceptible current , these promising results could reflect a lack of blinding to treatment condition . Moreover , the study followed patients only during treatment . Because fibromyalgia is a chronic condition , longer-term outcomes should be examined . To address these method ologic problems , we performed a r and omized , controlled trial of acupuncture to treat fibromyalgia that included 3 sham acupuncture treatments to account for the effects of needle insertion and placement . The adequacy of participant blinding was carefully evaluated . We sought to determine whether directed acupuncture that is design ed to treat fibromyalgia relieves pain better than does sham acupuncture in adults with fibromyalgia . On the basis of the scant literature and our clinical experience , we hypothesized a priori that directed acupuncture would result in the greatest clinical improvement . Methods Participants Participants were recruited from the greater Seattle , Washington , metropolitan area between January 2001 and September 2002 . Recruitment strategies included dissemination of information on the study through newspapers , television , advertisements , signs posted at university-affiliated hospitals , and letters to local fibromyalgia support groups and health care providers with large caseloads of patients with fibromyalgia . Potential participants were told that they had an equal chance of being assigned to 1 of 4 acupuncture interventions , none of which have been proven but 1 of which was believed to have the most potential to improve the symptoms of fibromyalgia . The institutional review boards at the participating institutions approved the study , and participants provided written informed consent . Eligible participants were English-speaking adults 18 years of age or older in whom fibromyalgia was diagnosed by a physician and who had a prer and omization global pain score of 4 or greater on a visual analogue scale ( 0 = no pain , 10 = worst pain ever ) . Participants agreed to undergo r and omization and kept use of any fibromyalgia-related pharmacologic and nonpharmacologic therapies constant throughout the study . At the baseline evaluation before r and omization , a research coordinator trained in tender-point examination confirmed the diagnosis of fibromyalgia by using the 1990 criteria of the American College of Rheumatology ( 1 ) . Participants were excluded if they reported other pain-related medical conditions or potential contraindications to acupuncture treatment ( such as bleeding disorders or severe needle phobia ) , were pregnant or breastfeeding , used narcotics ( which could blunt the effects of acupuncture ) , were involved in litigation related to fibromyalgia ( which might reduce their incentive for improvement ) , or had previously received acupuncture ( to maximize blinding ) . R and omization Procedure A research coordinator screened and enrolled participants at an academic research center . After participants completed a baseline evaluation , another research coordinator who was uninvolved with data collection r and omly assigned them to 1 of 4 treatment groups by using a computer-generated , blocked r and om-allocation sequence with a block size of 4 . This research coordinator informed the acupuncture clinic of the treatment assignment . Intervention Eight U.S.-trained and licensed acupuncturists with a median of 10 years of experience ( range , 4 to 18 years ) provided study treatments in their private offices . One investigator trained the acupuncturists in the study procedures to increase their comfort with delivering all 4 treatments and monitored compliance with the protocol throughout the study . Participants were assigned an acupuncturist according to geographic convenience and schedule availability , and every effort was made to have them treated by the same acupuncturist for the entire 12 weeks . The primary acupuncturist was defined as the practitioner from whom a participant received the most treatments . In all groups , participants were asked to attend treatment sessions twice weekly for 12 weeks ( 24 treatments ) . We considered participants who attended 80 % or more ( 19 of 24 ) of acupuncture appointments to have completed a full course of treatment . Outcome measures were collected at regularly scheduled time points from participants who discontinued treatment . Participants received directed acupuncture design ed to treat fibromyalgia according to the practice of Traditional Chinese Medicine or 1 of 3 sham acupuncture treatments . One sham intervention , a control for acupoint specificity , involved acupuncture typically used to treat irregular menses or early menses due to Blood Heat ( an unrelated condition ) according to Traditional Chinese Medicine . Another sham intervention , which was also a control for acupoint specificity , used body locations not recognized as true acupoints or meridians for needling ( sham needling ) . The third sham treatment , a control for needle insertion , consisted of noninsertive simulated acupuncture at the same acupoints used in directed acupuncture ( simulated acupuncture ) . This technique , in which a toothpick in a needle guide-tube is used to mimic needle insertion and withdrawal , has been shown to be indistinguishable from true acupuncture in acupuncture-nave patients with back pain ( 9 ) . Simulated acupuncture more closely duplicates the needle insertion experience than do techniques using placebo needles that require placing adhesive or plastic foam on the skin ( 11 , 12 ) . Acupoints and sham points ( Appendix Figure ) were chosen by a study acupuncturist with 15 years of experience in treating fibromyalgia and were approved by 3 other senior acupuncturists . In all groups that underwent needle insertion , needles were retained at st and ard depths ( 13 ) for 30 minutes at each acupoint . Disposable Chinese , Japanese , or Korean needles ( 34 to 40 gauge ) were used , depending on the practitioner 's preference . In the simulated acupuncture group , participants remained on the table for 30 minutes after simulated insertion and then underwent simulated needle withdrawal . Efforts were made to imitate the sounds of opening needle packs and needle disposal . Acupuncturists were not blinded to the treatments they delivered . To maximize participant blinding , we included only acupuncture-nave persons who could not compare their treatment with previous experiences with acupuncture , limited contact among study participants , restricted conversation between acupuncturists and participants , and blindfolded participants during treatment . All research personnel who collected or analyzed data were unaware of treatment group . At the end of 12 weeks , we collected data to assess the adequacy of blinding . Outcome Measures Demographic measures collected at the baseline evaluation included age , sex , race , education , marital status , and duration of pain and diagnosis of fibromyalgia . Participants also listed the types of therapies they had previously tried for their pain . We grouped this information into manual therapies ( physical , ergonometric , chiropractic , or massage therapy ) , mental health therapies ( psychotherapy or cognitive behavioral therapy ) , dietary changes , or other therapies ( nerve blocks , hypnosis , or biofeedback ) . Outcome measures were collected at baseline ; after 1 , 4 , 8 , and 12 weeks of acupuncture treatment ; and 3 and 6 months after completion of treatment ( weeks 24 and 36 ) . The primary outcome was subjective pain , as measured by a st and ard 10-cm visual analogue scale ( 0 = no pain , 10 = worst pain ever ) . Other outcomes measured by using a visual analogue scale were intensity of fatigue ( 0 = none , 10 = worst ever ) , sleep quality ( 0 = worst ever , 10 = best ever ) , and overall well-being ( 0 = worst ever , 10 = best ever ) . We assessed physical and mental functioning by using the Medical Outcomes Study 36-item Short-Form Health Survey ( 14 ) , which has high reliability and validity in many patient groups , including Fifty-five patients ( 46 women and 9 men ) with craniom and ibular disorders and a history of pain of at least 6 months ' duration participated in this trial . The patients were r and omly assigned to three groups : one group to receive acupuncture ; one group to receive occlusal splint therapy ; and one group to act as controls .  Pressure pain threshold , clinical dysfunction score , and visual analog scale measures were used to evaluate patients before , immediately after , and 6 months after treatment . A moderate , but statistically significant , correlation was found between pressure pain threshold and the number of tender spots in the masticatory muscles ( tau = -.43 ; P < .001 ) , degree of tenderness in the masticatory muscles ( tau = -.43 ; P < .001 ) , clinical dysfunction score ( tau = .32 ; P < .001 ) , and the visual analog scale ( tau = -.25 ; P < .01 ) . The short-term results showed a statistically significant improvement in all evaluations for both treatment groups . No significant differences were found in the control group . The improvements result ed in significant differences between the control and each treatment group immediately after treatment . At the 6-month follow-up , no significant differences in pressure pain threshold or clinical dysfunction score were found in the two treatment groups compared with the short-term results Abstract In a pooled analysis of four r and omized controlled trials of acupuncture in patients with migraine , tension‐type headache , chronic low back pain , and osteoarthritis of the knee we investigated the influence of expectations on clinical outcome . The 864 patients included in the analysis received either 12 sessions of  acupuncture or minimal ( i.e. sham ) acupuncture ( superficial needling of non‐acupuncture points ) over an 8 week period . Patients were asked at baseline whether they considered acupuncture to be an effective therapy in general and what they personally expected from the treatment . After three acupuncture sessions patients were asked how confident they were that they would benefit from the treatment strategy they were receiving . Patients were classified as responders if the respective main outcome measure improved by at least fifty percent . Both univariate and multivariate analyses adjusted for potential confounders ( such as condition , intervention group , age , sex , duration of complaints , etc . ) consistently showed a significant influence of attitudes and expectations on outcome . After completion of treatment , the odds ratio for response between patients considering acupuncture an effective or highly effective therapy and patients who were more sceptical was 1.67 ( 95 % confidence interval 1.20–2.32 ) . For personal expectations and confidence after the third session , odds ratios were 2.03 ( 1.26–3.26 ) and 2.35 ( 1.68–3.30 ) , respectively . Results from the 6‐month follow‐up were similar . In conclusion , in our trials a significant association was shown between better improvement and higher outcome expectations Eighty patients , of whom 22 were men and 58 women , participated in a 1-year follow-up study . All participants in the study showed signs and symptoms of craniom and ibular disorders ( CMD ) and had had pain for more than 6 months at treatment start . The patients were r and omly assigned to either acupuncture or occlusal splint therapy . Those patients who did not respond to either of the treatment modes were offered various additional therapies . The result showed that 57 % of the patients who received acupuncture and 68 % of the patients treated with occlusal splint therapy benefited subjectively ( p < 0.01 ) and clinical ly ( p < 0.001 ) from the treatment over a 12-month period . No statistically significant difference was found between the two groups as to the assessment variables . Those patients who received various additional therapies after acupuncture and /or occlusal splint therapy  responded favorably to additional treatment in only a few instances . The study showed that acupuncture gave positive results similar to those of occlusal splint therapy in patients with primarily myogenic CMD symptoms over a 1-year follow-up period OBJECTIVE To review the scientific validity of published papers on the efficacy of acupuncture in dentistry based on predefined method ological criteria . MATERIAL S A literature search performed by the Royal Society of Medicine and the University Library , Copenhagen , Denmark was able to identify 74 papers written in English , German , Danish , Swedish , Norwegian , Italian , French and Russian published between 1966 and 1996 . The search words were : acupuncture and electro-acupuncture , r and omised controlled trials ( RCT ) , dental pain , postoperative dental pain , painrelieving in dentistry , and dental analgesia . Among the 74 listed papers , 48 papers were review ed in the following language s : English , Danish , Swedish , Norwegian and German . Fifteen papers were excluded because they were written in French , Italian or Russian ; 11 papers were excluded because the abstract clearly indicated the paper was not a RCT or the paper was of a general nature without relevance to acupuncture . METHODS To assess the method ological quality of the included papers , all papers were scored on the basis of predefined criteria . A total of 92 points could be achieved and on the basis of this scale papers were rated as : Excellent ( 85 - 100 % ) , Good ( 70 - 84 % ) , Fair ( 60 - 69 % ) and Bad ( < 60 % ) . MAIN OUTCOME Fifteen out of 48 papers met the inclusion criteria . RESULTS Only one study met the criteria with more than 85 % . Five studies met the criteria with 70 - 84 % . Three studies met the criteria with 60 - 69 % . Six studies did not meet the criteria . Acupuncture in 11 out of 15 studies proved effective in the treatment of  temperom and ibular dysfunction ( TMD )  and as analgesia . Four studies showed no effect of acupuncture . CONCLUSION The value of acupuncture as an analgesic must be question ed . The effect of acupuncture in treating TMD and facial pain seems real and acupuncture could be a valuable alternative to orthodox treatment One hundred patients showed signs and symptoms of temporom and ibular joint disorder , were participated in a one year follow up study . The patients were r and omly divided into four groups : Acuhealth treatment ( group A ) , occlusal splint therapy ( group B ) , Acuhealth and occlusal splint therapy ( group C ) , and control ( group D ) . Each group comprised 25 patients . The patients were examined before and 3 , 6 , and 12 months after treatment . At the three month evaluation , the patients who were not satisfied with the treatment outcome were offered additional treatment . The result showed that 87 % of the patients treated by Acuhealth unit , 77.3 % of the patients treated with occlusal splint therapy , and 91.3 % of the patients received Acuhealth and occlusal splint therapy were improved subjectively and clinical ly after 3 months follow-up . The patients who responded well to treatment initially also responded well in the long run . The study showed that the Acuhealth unit proved to be an ideal early therapy for TMD , and complemented later with occlusal splint & NA ; Forty patients with chronic pain below the waist level not amenable to conventional medical and /or surgical treatment were r and omly assigned to one of two different methods of acupuncture , after study ing the underlying pain mechanisms using a Multidisciplinary Pain Clinic approach and the differential spinal block ( DSB ) . One group received acupuncture needling in the classical acupuncture points referred to as meridian loci needling ( MLN ) and the other group received tender area needling ( TAN ) with needles inserted in the dermatomal distribution of the painful areas . The responses between the two groups showed no significant difference . Results were then related to the predetermined somatopsychological basis of the individual 's pain problems as classified by the DSB . A group of patients in whom pain relief occurred upon subarachnoid injection of 0.25 % procaine followed by sympathetic blockade or 0.5 % procaine injection followed by hypalgesia without motor loss , also reported maximum subjective improvement in their pain level following acupuncture therapy performed at a later time . The other group of patients in whom pain persisted despite sensory and motor blockade ( 1 % procaine ) responded very poorly to acupuncture therapy . DSB was found to be complimentary to acupuncture therapy in that it facilitated patient selection for the therapy Assessing the quality of r and omized controlled trials ( RCTs ) is important and relatively new . Quality gives us an estimate of the likelihood that the results are a valid estimate of the truth . We present an annotated bibliography of scales and checklists developed to assess quality . Twenty-five scales and nine checklists have been developed to assess quality . The checklists are most useful in providing investigators with guidelines as to what information should be included in reporting RCTs . The scales give readers a quantitative index of the likelihood that the reported methodology and results are free of bias . There are several shortcomings with these scales . Future scale development is likely to be most beneficial if questions common to all trials are assessed , if the scale is easy to use , and if it is developed with sufficient rigor AIMS To evaluate the effectiveness of acupuncture in treating symptoms associated with myofascial pain of the jaw muscles . METHODS Twenty-eight subjects over the age of 18 and diagnosed with chronic myofascial pain of the jaw muscles were r and omized to receive real ( n = 16 ) or sham ( n = 12 ) acupuncture . Prior to treatment , each subject clenched his or her teeth for 2 minutes . Acupuncture or sham acupuncture was then administered at the Hegu large intestine 4 ( LI4 ) acupoint for 15 minutes . Real acupuncture was given by penetrating the needle through a sticky foam pad at the acupoint . Sham acupuncture was conducted by pricking the skin , without penetration , with a shortened , blunted acupuncture needle through a foam pad placed away from the acupoint . General head and neck pain ratings were obtained before and after treatment on a numerical rating scale . A mechanical pain stimulus on the masseter muscle was given before and after treatment and rated on a visual analog scale to measure pain tolerance level . Paired t tests were performed to detect significant changes in pain levels . RESULTS Subjects receiving real acupuncture experienced a significant reduction in jaw pain ( P = .04 ) , jaw/face tightness ( P = .04 ) , and neck pain ( P = .04 ) , and a significant increase in pain tolerance of the masseter muscle ( P = .001 ) . Subjects were not able to determine whether they received real or sham acupuncture ( P = .69 ) . No significant pain reductions were observed in the sham acupuncture group . CONCLUSION A single acupuncture session using one acupoint at Hegu large intestine 4 significantly reduced most myofascial pain endpoints when compared to sham acupuncture Abstract The purpose of this study was to evaluate the effectiveness of low intensity laser therapy ( LILT ) for the control of  pain  from temporom and ibular disorder ( TMD ) in a r and om and double-blind research design . Forty-eight ( 48 ) patients presenting temporom and ibular joint ( TMJ ) pain were divided into an experimental group ( GI ) and a placebo group ( GII ) . The sample was su bmi tted to the treatment with infrared laser ( 780 nm , 70 mW , 10 s , 89.7 J/cm2 ) applied in continuous mode on the affected temporom and ibular region , at one point : inside the external auditive duct toward the retrodiskal region , twice a week , for four weeks . For the control group , two identical probes ( one active and one that does not emit radiation ) were used unknown by the clinician and the subjects . A tip planned for laser acupuncture was used and connected to the active point of the probe . The parameter evaluated was the intensity of pain after palpation of the condylar lateral pole , pre-auricular region and external auditive duct , according to the Visual Analogue Scale ( VAS ) . Four evaluations were performed : Ev1 ( before laser application ) , Ev2 ( after 4th application ) , Ev3 ( after 8th application ) and Ev4 ( 30 days after the last application ) . Data were su bmi tted to statistical analysis . The results showed a decrease in the pain level mainly for the active probe . Among the evaluations , the Ev3 exhibited lower sensitivity to palpation . In conclusion , the results show that low intensity laser is an effective therapy for the pain control of subjects with TMD AIMS To prospect ively evaluate the effectiveness of a treatment regimen comprising counseling and physical therapy  in patients with myofascial pain of the masticatory system , and to explore whether the duration of the physical therapy offered ( 4 vs 6 weeks ) would influence the treatment result . METHODS Twenty-six patients were r and omly distributed over 2 groups . All patients received reassuring information , advice regarding relaxation of the jaws , avoiding parafunctions , and limited use of the jaws . In addition , a physical therapy program ( heat application , massage , ultrasound and muscle stretching ) was initiated 2 weeks after the start of the study ( group I , receiving 4 weeks of physical therapy ) or immediately from the start of the study ( group II , receiving 6 weeks of physical therapy ) . The following parameters were taken at baseline , 2 , 4 , and 6 weeks : visual analog scale ( VAS ) scores of present pain ; lowest and highest pain over the past period ; percentage of pain relief ; jaw function assessment by the M and ibular Function Impairment Question naire ( MFIQ ) ; and pressure pain thresholds ( PPTs ) of the masseter , temporalis , and thumb muscles . Statistical analysis used a linear mixed model and corrected for multiple testing ( Tukey test ) . RESULTS Pain and MFIQ scores decreased while PPTs increased in both groups . Only after 4 and 6 weeks , significant differences were present for the PPT of the masseter in group I ( P < .02 ) and the temporalis in both groups ( P < .01 ) . Also , the VAS scores of present ( P < .02 ) , minimal ( P < .01 ) , and maximal ( P < .0001 ) pain and the MFIQ score ( P < .001 ) improved . After 6 weeks , a mean of 60 % pain decrease was reported ( P < .0001 ) . There were no significant differences between the groups receiving 4 weeks vs 6 weeks of physical therapy . CONCLUSION A conservative approach involving counseling and physical therapy result ed in significant improvement in parameters of pain and jaw function in patients with myofascial pain . A controlled study will be necessary to eluci date the specific effectiveness of physical therapy over counseling or no treatment OBJECTIVES To compare the effect of real acupuncture and sham acupuncture in the treatment of temporom and ibulat joint myofascial pain , in order to establish the true efficacy of acupuncture . METHODS A double blind r and omised controlled trial conducted in the TMD Clinic , at the School of Dentistry , The University of Manchester . Twenty-seven patients were assigned to one of two treatment groups . Group 1 received real acupuncture treatment whilst Group 2 received a sham acupuncture intervention . Both the assessor and the patient were blinded regarding the group allocation . Baseline assessment of the outcome variables was made prior to the first treatment session , and was repeated following the last treatment . RESULTS The results demonstrated that real acupuncture had a greater influence on clinical outcome measure of TMJ MP  than those of sham acupuncture , and the majority of these reached a level of statistical significance . CONCLUSION Acupuncture had a positive influence on the signs and symptoms of TMJ MP .  In addition , this study provides evidence that the Park Sham Device was a credible acupuncture control method for trials involving facial acupoints AIMS To compare the effectiveness of dry needling in classically recognized acupuncture points ( " acupuncture " ) with dry needling in skin areas not recognized as acupuncture points ( " sham acupuncture " ) in reducing masseter muscle pain in a group of patients with myofascial pain of the jaw muscles . METHODS Eighteen patients were r and omly assigned to 1 of 2 experimental groups : Ten patients received acupuncture and 8 received sham acupuncture . A visual analog scale ( VAS ) was used to measure changes in masseter muscle pain evoked by mechanical stimulation of the masseter muscle before and after the experiment . RESULTS Both groups showed a statistically significant reduction in VAS pain scores ( P = .001 ) . Seven out of 10 acupuncture subjects had a 10 mm or greater VAS reduction in pain , while 4 out of 8 of the sham acupuncture subjects had that great a pain reduction . There was no significant difference between the 2 groups . CONCLUSION Both acupuncture and sham acupuncture reduced pain evoked by mechanical stimulation of the masseter muscles in myofascial pain patients . However , this reduction in pain was not dependent on whether the needling was performed in st and ard acupuncture points or in other areas of the skin . These results suggest that pain reduction result ing from a noxious stimulus ( i.e. , needling ) may not be specific to the location of the stimulus as predicted by the classical acupuncture literature AIM Short-term pain reduction from acupuncture in chronic myofascial pain subjects was evaluated using an 11-point ( 0 to 10 ) numeric rating scale , visual analog scale ( VAS ) , and pain rating of mechanical pressure on the masseter muscle . METHODS A single-blind , r and omized , controlled , clinical trial with an independent observer was performed . Fifteen chronic myofascial pain subjects over the age of 18 were r and omly assigned into groups : nine subjects received real acupuncture ; six subjects received sham acupuncture . Each subject clenched his/her teeth for 2 minutes . Acupuncture or sham acupuncture was administered at the Hegu Large Intestine 4 acupoint . Sham acupuncture was conducted by lightly pricking the skin with a shortened , blunted acupuncture needle through a foam pad , without penetrating the skin . The foam pad visually conceals the needle 's point of the entry , so that the subject can not discern which technique is being used . The subjects rated their general pain on a numeric rating scale . A mechanical pain stimulus was applied with an algometer and the subject rated his/her pain on a VAS . Statistical analysis was performed using the repeated measures anova , paired t-tests , and Fisher 's exact test as appropriate . RESULTS There was a statistically significant difference in pain tolerance with acupuncture ( P = 0.027 ) . There was statistically significant reduction in face pain ( P = 0.003 ) , neck pain ( P = 0.011 ) , and headache ( P = 0.015 ) with perception of real acupuncture . CONCLUSION Pain tolerance in the masticatory muscles increased significantly more with acupuncture than sham acupuncture This study was design ed to compare the therapeutic effect  acupuncture in combination with ultrasound therapy with that of ultra short-wave electrotherapy on temporom and ibular disorders ( TMD ) . Sixty-eight patients with TMD were r and omized equally into 2 groups to receive the two treatments respectively , and the therapeutic effects were found to be significantly different ( P<0.05 ) . Acupuncture combined with ultrasound therapy yielded better results in a shorter treatment course STUDY OBJECTIVE To determine the amount of change in pain severity , as measured by a visual analog scale , that constitutes a minimum clinical ly significant difference . METHODS Patients 18 years of age or older who presented with acute pain result ing from trauma were enrolled in this prospect i ve , descriptive study . The setting was an urban county hospital emergency department with a Level 1 trauma center . In the course of a brief interview , patients were asked to indicate their current pain severity with a single mark through a st and ard 100-mm visual analog scale .  At intervals of 20 minutes for the next 2 hours , patients were asked to repeat this measurement and , in addition , to contrast their present pain severity with that at the time of the previous measurement . They were to indicate whether they had " much less , " " a little less , " " about the same , " " a little more , " or " much more " pain . All contrasts were made without reference to prior visual analog scale measurements . A maximum of six measurements of pain change were recorded per patient . Measurements ended when the patient left the ED or when the patient reported a pain score of zero . The minimum clinical ly significant change in visual analog scale pain score was defined as the mean difference between current and preceding visual analog scale scores when the subject noted a little less or a little more pain . RESULTS Forty-eight subjects were enrolled , and 248 pain contrasts were recorded . Of these contrasts , 41 were rated as a little less and 39 as a little more pain . The mean difference between current and preceding visual analog scale scores in these 80 contrasts was 13 mm ( 95 % confidence interval , 10 to 17 mm ) . CONCLUSION The minimum clinical ly significant change in patient pain severity measured with a 100-mm visual analog scale was 13 mm . Studies of pain experience that report less than a 13-mm change in pain severity , although statistically significant , may have no clinical importance The purpose of this study was to compare the effects of acupuncture and stomatognathic treatment on the mobility of the m and ible in r and om sample s of patients with TMJ dysfunction . One group of 25 patients was treated with  acupuncture performed by a specialist in physical medicine and rehabilitation and a second similar group received st and ard stomatognathic treatment . All of the patients were evaluated in terms of the Helkimo dysfunction index by a dentist before treatment , within 1 week of treatment , and 3 months after treatment . No significant differences could be detected in painful movement of the m and ible except in retrusive movement , wherein stomatognathic treatment was clearly superior immediately afterward . Acupuncture seems to be a useful early form of therapy in patients with TMJ disorders that are expected to be largely functional and reversible and with evidence of psychophysiologic or neuromuscular disturbances but not of any marked occlusal interference or joint damage .  Acupuncture could well be complementary to stomatognathic treatment , either preceding or following it , to achieve full neuromuscular rehabilitation , to ease the treatment ( for example , occlusal splints ) , or to eliminate other possible contributory factors
OBJECTIVES The aim of this study is to perform a qualitative and quantitative analysis of the scientific literature regarding the use of acupuncture in the treatment of pain associated with temporom and ibular disorders ( TMDs ) .
METHODS By using electronic data bases , the goal was to search and evaluate all the r and omized controlled trials ( RCTs ) in which acupuncture was used in the management of pain attributed to these clinical entities .