Widespread pain and the effectiveness of oral splints in myofascial face pain

Background. The research literature reaches inconsistent conclusions about the efficacy of oral splints for treating myofascial face pain. This investigation hypothesizes that their effectiveness varies as a function of the presence or absence of widespread pain. Methods. In a randomized, controlled clinical trial, 63 women with myofascial face pain were assigned to use of either an active, maxillary, flat-plane, hard acrylic splint or a palatal splint that did not interfere with occlusion. Participants also were classified according to the presence or absence of widespread pain throughout the body. After six weeks, groups were compared regarding pain on palpation, self-reported pain and functional outcome. Results. Overall, the findings showed a modest tendency for subjects receiving the active vs. the palatal splint to exhibit improvement on self-reported pain and functional outcome. On further division of the sample into subjects with local vs. widespread pain, the general pattern showed that patients with widespread pain who received an active splint did not experience improvement, while patients with local pain who received the active splint did. Conclusions. The presence or absence of widespread pain may help to define the specific circumstances under which oral splints should be prescribed for patients with myofascial face pain. Clinical Implications. Clinicians should screen patients with myofascial face pain for the presence of widespread pain, since this comorbid symptom pattern may be a contraindication for the use of oral splints.