Effective herbal treatment for TMJ.
Article Type: Report
Subject: Medicine, Botanic (Research)
Medicine, Herbal (Research)
Temporomandibular joint disorders (Care and treatment)
Temporomandibular joint disorders (Drug therapy)
Temporomandibular joint disorders (Research)
Author: Finney-Brown, Tessa
Pub Date: 03/22/2010
Publication: Name: Australian Journal of Medical Herbalism Publisher: National Herbalists Association of Australia Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 National Herbalists Association of Australia ISSN: 1033-8330
Issue: Date: Spring, 2010 Source Volume: 22 Source Issue: 1
Topic: Event Code: 310 Science & research
Product: Product Code: 2834630 External Analgesics; 2834639 External Analgesics NEC NAICS Code: 325412 Pharmaceutical Preparation Manufacturing SIC Code: 2834 Pharmaceutical preparations
Accession Number: 223823992
Full Text: Li L, Wong R, Rabie A. 2009. Clinical effect of a topical herbal ointment on pain in temporomandibular disorders: a randomized placebo-controlled trial. JACM 15:12;1211-17.

Temporomandibular disorders (TMDs) are a cluster of diagnoses including the temporomandibular joints (TMJs), the musculature associated with the activity of mastication and associated structures. They are relatively common and potentially about 12% of the population experience TMD, with pain as one of the most predominant symptoms. At present there is no medical intervention that has been able to produce long term pain relief in all sufferers.

The study reviewed assessed the topical efficacy of Ping On, an ointment of Traditional Chinese Medicinal (TCM) herbs, (which includes peppermint oil 18%, menthol 20%, natural camphor 6%, birch oil 6%, sandalwood oil 1%, eucalyptus oil 4%, bee wax 8% and aromatic oil 3%) on the severity of TMD symptoms. There were 55 TMD patients included in the study, randomised into an active treatment group and a group treated with petroleum jelly as placebo. The participants were instructed to continue any ongoing treatment but not to commence any other treatments during the trial period.

There was a one week period of symptom assessment using a 100 mm visual analogue scale (from no pain to worst pain imaginable) prior to commencement of the study. This continued daily throughout the study. Subjects were taught how to apply the ointment over the painful area and to massage it in a circular motion for 5 minutes twice daily. They were reviewed at two weeks with a final assessment after four weeks.

Primary outcome measure was the level of pain as measured on VAS; the secondary outcome measure was the mandibular function and vertical mouth opening (measured in millimeters from incisor to incisor). Of the forty five patients who completed the study, both the placebo and active treatment group demonstrated improvements in pain intensity, but only the Ping On results were significant. These significant results appeared in the active group after about one week, which the authors suggest may be due to the analgesic and antiinflammatory effects of the oils in the ointment. Similarly only the active group had a significant increase in the secondary outcome measure of mandibular opening. This did not however meet the 9 mm standard considered clinically significant. Mild eye irritation and one case of skin irritation were reported as side effects.

Overall the results of the study indicate that these herbal oils in combination may be very valid pain relieving agents for TMD due to their central and peripheral analgesic, vasodilatory and anti-inflammatory effects. They may relieve both evoked pain and pain at rest/spontaneous pain. Further studies may be useful to shed more light on the actual mechanism of action and the role of the massage application in pain relief.

Tessa Finney-Brown MNHAA

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