3. Discussion
myofascial pain, TMD, myalgia, anxiety, neuralgias, musculoskeletal disorders, orofacial pain, pain, TMJ arthralgia, headache, depression, disability
MYOFASCIAL PAIN, SECONDARY, TMJ, MUSCULOSKELETAL DISORDERS
BoNT/A is a promising therapy used to control myofascial pain and its clinical applications to manage various types of chronic orofacial pain (TMD, secondary headache, and neuralgias) [Five weeks after surgery, our measurements showed a reduction in VAS for TMJ arthralgia and myalgia degree in both groups (It is necessary to consider that TMDs are a complex group of musculoskeletal disorders with a multifactorial etiology. The physical, behavioral, and emotional factors may overlap and interact, resulting in various signs and symptoms. Moreover, the etiology of pain and disability in myofascial pain is complex and reflects an interaction between physical, behavioral, social, and psychological factors, such as higher anxiety levels and depression [In our study, statistically significant differences between groups were observed at the six-month follow-up; more patients in the inco-BoNT/A group were symptom-free (9 joints—56.2% vs. 13 joints—92.9% in the placebo and inco-BoNT/A groups, respectively), and fewer patients required a postoperative new TMJ treatment (seven joints—44% vs. one joint—7% in the placebo and inco-BoNT/A groups, respectively). A gradual improvement in the myofascial condition can explain our results. The administration of BoNT/A can potentially result in better long-term outcomes by continuously decreasing tension in the affected muscles and gradually reducing the overload in TMJ. Therefore, a 5-week timeframe might not be sufficient to observe these effects, but they are likely to become apparent later. Similar results were found in the study by Canales et al. [Currently, there is no consensus on the most appropriate treatment protocol for myofascial pain [Numerous RCTs published in the literature have been terminated prematurely [The limitations of this study need to be addressed. First, the number of patients was small due to the study interruption in the middle. While a larger sample size may not show significant results in the short term (5 weeks), it could confirm the significant improvements in the inco-BoNT/A group observed at six months.