Comparative Effects of Naproxen, Diclofenac, and Piroxicam on Temporomandibular Disorders: A Clinical Trial
-
Ali Peimani
,
Shirin Abedini
,
Zahra Jahanshahi Afshar
,
Mohammadali Heidari Heidari
,
Zohreh Nouri
,
Mahmood Sheikh Fathollahi
Abstract
Objectives: The prevalence of temporomandibular disorders (TMDs) is increasing in adults, and they are associated with symptoms such as pain and dysfunction. Non-surgical treatment, which may include pharmacotherapy, laser therapy, and physiotherapy, is the first step in treatment of TMDs. This study aimed to compare the effects of naproxen, diclofenac, and piroxicam on TMDs.
Materials and Methods: This clinical trial was conducted on 104 patients who were randomly assigned to four groups (n=26) to receive either 500mg naproxen tablets, 50mg diclofenac tablets, 10mg piroxicam capsules, or the placebo. The patients were evaluated for pain, clicking, tenderness, and maximum mouth opening (MMO) in five stages, i.e., before starting the treatment and 1 week, 3 weeks, 5 weeks, and 6 weeks after starting the treatment. Data were analyzed by one-way repeated measures ANOVA with one repeated and one between-subject factor, Fisher's exact test, and Chi-square test (alpha=0.05).
Results: Tenderness and clicking decreased with time in all groups (P≤0.05). The mean pain intensity and tenderness were significantly lower in the naproxen group than the other groups (P<0.05).
Conclusion: Naproxen tablets can reduce pain and tenderness in TMD patients more than diclofenac tablets, piroxicam capsules, and the placebo.
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23. Singer E, Dionne R. A controlled evaluation of ibuprofen and diazepam for chronic orofacial pain. J Orofacial Pain. 1997 Spring;11(2):139-46.
24. Melis M, Di Giosia M, Zawawi KH. Low level laser therapy for the treatment of temporomandibular disorders: a systematic review of the literature. Cranio. 2012 Oct;30(4):304-12.
25. List T1, Axelsson S, Leijon G. Pharmacologic interventions in the treatment of temporomandibular disorders, atypical facial pain, and burning mouth syndrome: A qualitative systematic review. J Orofac Pain. 2003 Fall;17(4):301-10.
26. Jagger RG. Diazepam in the treatment of temporomandibular joint dysfunction syndrome--a double blind study. J Dent. 1973 Oct;2(1):37-40.
27. Ekberg EC, Kopp S, Akerman S. Diclofenac sodium as an alternative treatment of temporomandibular joint pain. Acta Odontol Scand. 1996 Jun;54(3):154-9.
28. Hotta TH, Pizzo RC. TMJ pain intensity in patients treated with GaIAs laser. Braz Dent J. 2010;20(3):340-5.
29. Kimos P, Biggs C, Mah J, Heo G, Rashiq S, Thie NM, et al. Analgesic action of gabapentin on chronic pain in the masticatory muscles: a randomized controlled trial. Pain. 2007 Jan;127(1-2):151-60.
30. Mujakperuo HR, Watson M, Morrison R, Macfarlane TV. Pharmacological interventions for pain in patients with temporomandibular disorders. Cochrane Database Syst Rev. 2010 Oct;6(10):CD004715.
31. Gil-Martínez A, Paris-Alemany A, López-de-Uralde-Villanueva I, La Touche R. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res. 2018 Mar;11:571-87.
32. Ouanounou A, Goldberg M, Haas DA. Pharmacotherapy in temporomandibular disorders: A review. J Can Dent Assoc. 2017 Jul;83(7):1-8.
33. Randhawa K, Bohay R, Côté P, van der Velde G, Sutton D, Wong JJ, et al. The effectiveness of noninvasive interventions for temporomandibular disorders: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Clin J Pain. 2016 Mar;32(3):260-78.
34. Roldan OV, Maglione H, Carreira R, Mainieri S. Piroxicam, diazepam y placebo en el tratamiento de las disfunciones de la articulación temporomandibular. Estudio doble ciego [Piroxicam, diazepam and placebo in the treatment of temporomandibular joint dysfunction. Double blind study]. Rev Asoc Odontol Argent. 1990 Apr-Jun;78(2):83-5.
35. Elder C, Ritenbaugh C, Aickin M, Hammerschlag R, Dworkin S, Mist S, et al. Reductions in pain medication use associated with traditional Chinese medicine for chronic pain. Perm J. 2012 Summer;16(3):18-23.
2. Gremillion HA. The prevalence and etiology of temporomandibular disorders and orofacial pain. Tex Dent J. 2000 Jul;117(7):30-9.
3. De Rossi SS, Greenberg MS, Liu F, Steinkeler A. Temporomandibular disorders: evaluation and management. Med Clin North Am. 2014 Nov;98(6):1353-84.
4. Okeson JP. Management of temporomandibular disorders and occlusion. In: Okeson JP. Treatment of Temporomandibular Joint Disorders. 7th ed, St. Louis, Elsevier. 2013;317-61.
5. Bender SD. Orofacial pain and headache: a review and look at the commonalities. Curr Pain Headache Rep. 2014 Mar;18(3):400.
6. Derwich M, Górski B, Amm E, Pawłowska E. Oral glucosamine in the treatment of temporomandibular joint osteoarthritis: A systematic review. Int J Mol Sci. 2023 Mar;24(5):4925.
7. Edward F. Wright, (2010). Manual of temporomandibular disorders. 2nd ed., Ames, Ia.: Wiley-Blackwell, p.321-3.
8. Altman R, Bosch B, Brune K, Patrignani P, Young C. Advances in NSAID development: evolution of diclofenac products using pharmaceutical technology. Drugs. 2015 May;75:859-77.
9. Yuasa H, Kino K, Kubota E, Kakudo K, Sugisaki M, Nishiyama A, et al. Primary treatment of temporomandibular disorders: The Japanese Society for the temporomandibular joint evidence-based clinical practice guidelines. JPN Dent Sci Rev. 2013 Aug;49(3):89-98.
10. Zhang Y, Qian Y, Huo K, Liu J, Huang X, Bao J. Efficacy of laser therapy for temporomandibular disorders: A systematic review and meta-analysis. Complement Ther Med. 2023 Jun;74:102945.
11. Dean D. The first medications in my TMD toolbox. Cranio. 2020 Jan; 38(1):1-4.
12. Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008 Dec;359(25): 2693-705.
13. Daniel EF, Robert WU. Nonsteroidal anti- inflammatory drugs. In: Katzung BT, Masters SB, Teror AG, Daniel EF, Robert WU, Chambers HF, et al. Basic and clinical pharmacology. 11th ed., London, Mc Grawhill. 2007; 573-98.
14. Hupp JR. Facial Neuropathology. In: Hupp JR, Ellis E, Tucker MR. Oral and Maxillofacial Surgery. 6th ed, St. Louis, Elsevier. 2014; 618-49.
15. Hersh EV, Balasubramaniam R, Pinto A. Pharmacologic management of temporomandibular disorders. Oral Maxillofac Surg Clin North Am. 2008 May;20(2):197-210.
16. Häggman‐Henrikson B, Alstergren P, Davidson T, Högestätt ED, Östlund P, Tranæus S, et al. Pharmacological treatment of orofacial pain: health technology assessment including a systematic review with network meta-analysis. J Oral Rehabil. 2017 Oct;44(10):800-26.
17. Ta LE, Dionne RA. Treatment of painful temporomandibular joint with a cycloxygenas-2 inhibitor: a randomized placebo-controlled comparison of celecoxib to naproxen. Pain. 2004 Sep;111(1-2): 13-21.
18. De Carli ML, Guerra MB, Nunes TB, Di Matteo RC, De Luca CE, Aranha AC, et al. Piroxicam and laser phototherapy in the treatment of TMJ arthralgia: a double-blind randomized controlled trial. J Oral Rehabil. 2013 Mar; 40(3):171-8.
19. Varoli FK, Pita MS, Sato S, Issa JP, do Nascimento C, Pedrazzi V. Analgesia evaluation of 2 NSAID drugs as adjuvant in management of chronic temporomandibular disorders. ScientificWorldJournal. 2015 Mar; 2015(1):359152.
20. Kato MT, Kogawa EM, Santos CN, Conti PC. TENS and low-level laser therapy in the management of temporomandibular disorders. J Appl Oral Sci. 2006 Apr;14(2):130-5.
21. Carrasco TG, Mazzetto MO, Mazzetto RG, Mestriner W Jr. Low intensity laser therapy in temporomandibular disorder: a phase II double-blind study. Cranio. 2008 Oct;26(4):274-81.
22. Cetiner S, Kahraman SA, Yücetaş S. Evaluation of low-level laser therapy in the treatment of temporomandibular disorders. Photomed Laser Surg. 2006 Oct;24(5):637-41.
23. Singer E, Dionne R. A controlled evaluation of ibuprofen and diazepam for chronic orofacial pain. J Orofacial Pain. 1997 Spring;11(2):139-46.
24. Melis M, Di Giosia M, Zawawi KH. Low level laser therapy for the treatment of temporomandibular disorders: a systematic review of the literature. Cranio. 2012 Oct;30(4):304-12.
25. List T1, Axelsson S, Leijon G. Pharmacologic interventions in the treatment of temporomandibular disorders, atypical facial pain, and burning mouth syndrome: A qualitative systematic review. J Orofac Pain. 2003 Fall;17(4):301-10.
26. Jagger RG. Diazepam in the treatment of temporomandibular joint dysfunction syndrome--a double blind study. J Dent. 1973 Oct;2(1):37-40.
27. Ekberg EC, Kopp S, Akerman S. Diclofenac sodium as an alternative treatment of temporomandibular joint pain. Acta Odontol Scand. 1996 Jun;54(3):154-9.
28. Hotta TH, Pizzo RC. TMJ pain intensity in patients treated with GaIAs laser. Braz Dent J. 2010;20(3):340-5.
29. Kimos P, Biggs C, Mah J, Heo G, Rashiq S, Thie NM, et al. Analgesic action of gabapentin on chronic pain in the masticatory muscles: a randomized controlled trial. Pain. 2007 Jan;127(1-2):151-60.
30. Mujakperuo HR, Watson M, Morrison R, Macfarlane TV. Pharmacological interventions for pain in patients with temporomandibular disorders. Cochrane Database Syst Rev. 2010 Oct;6(10):CD004715.
31. Gil-Martínez A, Paris-Alemany A, López-de-Uralde-Villanueva I, La Touche R. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res. 2018 Mar;11:571-87.
32. Ouanounou A, Goldberg M, Haas DA. Pharmacotherapy in temporomandibular disorders: A review. J Can Dent Assoc. 2017 Jul;83(7):1-8.
33. Randhawa K, Bohay R, Côté P, van der Velde G, Sutton D, Wong JJ, et al. The effectiveness of noninvasive interventions for temporomandibular disorders: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Clin J Pain. 2016 Mar;32(3):260-78.
34. Roldan OV, Maglione H, Carreira R, Mainieri S. Piroxicam, diazepam y placebo en el tratamiento de las disfunciones de la articulación temporomandibular. Estudio doble ciego [Piroxicam, diazepam and placebo in the treatment of temporomandibular joint dysfunction. Double blind study]. Rev Asoc Odontol Argent. 1990 Apr-Jun;78(2):83-5.
35. Elder C, Ritenbaugh C, Aickin M, Hammerschlag R, Dworkin S, Mist S, et al. Reductions in pain medication use associated with traditional Chinese medicine for chronic pain. Perm J. 2012 Summer;16(3):18-23.
| Issue | Vol 22 (Continuously Published Article-Based) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v22i18.18689 | |
| Keywords | ||
| Diclofenac Naproxen Piroxicam Temporomandibular Joint Disorders | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Peimani A, Abedini S, Jahanshahi Afshar Z, Heidari MH, Nouri Z, Sheikh Fathollahi M. Comparative Effects of Naproxen, Diclofenac, and Piroxicam on Temporomandibular Disorders: A Clinical Trial. Front Dent. 2025;22.
