Acupuncture in Temporomandibular Disorders Painful Symptomatology: An Evidence-Based Case Report

This case report presents a therapeutic approach using acupuncture for the treatment of temporomandibular disorder (TMD) with painful symptomatology. TMD is a complex, multifactorial condition that affects the temporomandibular joints, masticatory muscles, and associated structures of the head and neck, and is one of the leading causes of non-dental pain. The condition is more prevalent in women between 20 and 40 years of age, with symptoms including myofascial pain, limited mouth opening, joint sounds, headache, and neck pain. The study was conducted with a 22-year-old patient who presented with severe facial pain for two months, with a score of 10 on the visual analog scale (VAS), and who was no longer responding adequately to analgesic and anti-inflammatory medication.

The diagnosis was established through the RDC/TMD criteria, identifying a muscular disorder with myofascial pain and limited mouth opening. The treatment protocol consisted of five weekly acupuncture sessions lasting 10 minutes each. The points selected were based on traditional Chinese medicine and scientific evidence, including local points (ST-6, ST-7, SI-19, TE-21, Yintang), trigger points, and systemic points (GV-20, LI-4, SI-3, GB-34, GB-20, ST-36). The selection also considered specific points for anxiety, recognizing the emotional component of TMD.

For objective evaluation of results, electromyography (EMG) of the masseter and temporalis muscles was performed before treatment, after the first session, and after the fifth session. The results were notable, with complete pain elimination after the first session (VAS from 10 to 0) and maintenance of this result at the end of treatment. Electromyographic analysis demonstrated reduced muscle activity in most positions evaluated, confirming the muscle relaxation obtained with acupuncture. The mechanism of action proposed by Western medicine involves the activation of peripheral sensory nerves and afferent nerve pathways in the spinal cord, releasing cortisol, enkephalins, endorphins, dynorphins, and endomorphins that block painful stimuli.

This report corroborates previous evidence on the efficacy of acupuncture in pain management for TMD, offering a therapeutic alternative with few adverse effects and relatively low cost. However, the authors recognize that acupuncture alone does not cure TMD due to its multifactorial etiology, and a multidisciplinary approach is necessary that includes not only symptomatic treatment but also elimination of the causes. The patient was subsequently submitted to occlusal adjustment and prescribed a muscle-relaxing splint for protection against parafunctional activities. Limitations include the fact that this is a single case report, which prevents generalization, and the absence of a control group.

Randomized controlled trials are needed to definitively establish the efficacy of acupuncture in TMD.