Amitriptyline or stabilization splint in chronic TMD patients-a pilot

Method: Thirteen patients (mean age =42.23 y) with chronic TMD were randomly allocated into 3 groups according to the prescribed therapy: 4 received active medication (25 mg of amitriptyline), 4 received placebo pills and 5 were treated with a stabilization splint. Patients were managed for 12 consecutive weeks. Follow-up evaluations were done at the 1st, 6th and 12th week of treatment. Treatment outcomes included pain as reported on visual analogue scale (VAS), pain-free maximal mouth opening (MO) and oral health related quality of life (Oral Health Impact Profile, OHIP-14). 

Result: At baseline of treatment there were no significant differences among the groups for VAS and OHIP-14 scores, as well as for mean pain duration. VAS scores improved significantly across time for the amitriptyline group (F=11.326, p=0.002, effect size =0.791) and stabilization splint group (F=7.343, p=0.005, effect size =0.647). The mean OHIP-14 scores decreased significantly over the time in the amitriptyline group only (F=4.417, p=0.036, effect size =0.596). In the placebo group, VAS and OHIP-14 scores did not change significantly over the time (p>0.05). Only in the stabilization splint group pain-free MO improved significantly in the 12th week, compared with the baseline (p=0.001). 

Conclusion: The results of this limited study support the administration of low doses of amitriptyline over a period of 12 weeks for the management of pain resulting from chronic TMD. Furthermore, stabilization splint showed to be superior in the treatment of limited mouth opening during the same period.