title: Patient education and self-care for the management of jaw pain upon awakening: a randomized controlled clinical trial comparing the effectiveness of adding pharmacologic treatment with cyclobenzaprine or tizanidine.
abstract: OBJECTIVE
  To compare the effectiveness of adding cyclobenzaprine, tizanidine, or placebo to patient education and a self-care management program for patients with myofascial pain and specifically presenting with jaw pain upon awakening.
  
  
  METHODS
  Forty-five patients with a diagnosis of myofascial pain based on the guidelines of the American Academy of Orofacial Pain participated in this 3-week study. The subjects were randomly assigned into one of three groups: placebo group, TZA group (tizanidine 4 mg), or CYC group (cyclobenzaprine 10 mg). Patients were evaluated for changes in pain intensity, frequency, and duration by using the modified Severity Symptoms Index and changes in sleep quality with the use of the Pittsburgh Sleep Quality Index. Data were analyzed by ANOVA and post-hoc or nonparametric statistical tests as appropriate.
  
  
  RESULTS
  All three groups had a reduction in pain symptoms and improvement of sleep quality based on a comparison of pretreatment and treatment scores. However, no significant differences among the groups were observed at the posttreatment evaluation.
  
  
  CONCLUSIONS
  The use of tizanidine or cyclobenzaprine in addition to self-care management and patient education was not more effective than placebo for the management of patients with myofascial jaw pain upon awakening.
authors.forename: Francisco Guedes Pereira
authors.initials: FG
authors.lastname: Alencar
authors.forename: Patricia Gabriela
authors.initials: PG
authors.lastname: Viana
authors.forename: Camila
authors.initials: C
authors.lastname: Zamperini
authors.forename: Anne
authors.initials: A
authors.lastname: Becker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000639:Amitriptyline / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D003000:Clonidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004311:Double-Blind Method; D005157:Facial Pain / Q000188:drug therapy / Q000628:therapy; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000627:therapeutic use*; D010147:Pain Measurement; D010353:Patient Education as Topic; D010919:Placebos; D012648:Self Care; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D009125:Muscle Relaxants, Central; D010919:Placebos; D000639:Amitriptyline; C004704:cyclobenzaprine; C023754:tizanidine; D003000:Clonidine; D007052:Ibuprofen