***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of the present study was to compare the effect of transcutaneous electric nerve stimulation ( TENS ) with the flat occlusal splint in the treatment of temporom and ibular joint ( TMJ ) disk displacement without reduction . Thirty-one patients were included and r and omly selected to be treated 6 weeks with either TENS ( 90 Hz , 30 min , three times/day ) or with a flat occlusal splint ( 24 h/day . Those selected for the TENS group had one electrode placed over the painful TMJ and another electrode over the anterior temporal muscle . The splint group used a conventional flat occlusal splint with cuspid guidance . Both treatment groups visited the clinic once a week . Symptoms and signs were registered before and after treatment . The intensity of pain was recorded with a visual analogue scale ( VAS ) and with an electronic pocket-sized recorder ( Pain-Track ) carried 1 week before and also the last week of treatment for continuous registration of pain . Measured with the VAS , half of the patients treated with splints became pain-free or their TMJ pain improved at least 50 % both at rest and with jaw function compared with only 6 % in the TENS-treated group . With regard to strictly chewing pain , the VAS-registered pain improved in two-thirds of the splint group , compared with 50 % of the TENS group . With the Pain-Track device it was found that in most individuals pain was aggrevated at mealtimes . The conclusion was that flat occlusal splints in several respects are better than TENS in the treatment of symptoms associated with TMJ disk displacement without reduction Masticatory myofascial pain ( MFP ) condition is a musculoskeletal disorder that compromises the functional capacities of the masticatory system . As such , the incorporation of an intensive chewing test as a discriminatory exercise for the diagnosis of this condition and evaluation of treatment success has considerable potential . Various splint design s have been used successfully , which have posed a question of whether the therapeutic effect of the splint is a placebo or has some other curative properties . The purpose of this study was to evaluate the efficacy of the stabilization appliance to reduce signs and symptoms in MFP patients and to compare the pain experience during the chewing test between two groups of patients , with and without splints . Myofascial pain patients ( n = 37 ) who reported exacerbation of pain in function participated in the study . Patients perfomed a 9-min chewing test , followed by 9-min rest and marked their pain intensity on a visual analogue scale every 3 min . Of the 37 patients , 21 received a stabilization flat occlusal splint for night use and 16 were equally monitored clinical ly without a splint .  At the end of 8 weeks , a second clinical examination and chewing test were performed . Student 's t-test was used to analyse differences between study groups . Analysis of variance and covariance ( ancova ) with repeated measures was applied to analyse the effect of treatment . Level of pain at baseline prior to the chewing test ( P0 ) was introduced as a co-variant . At baseline both groups showed relatively high scores of pain intensity and did not show any significant differences among the collected variables . At the end of the experiment , the splint group had a statistically significant reduction in pain intensity , in mean muscle sensitivity to palpation and in the pain experience during the chewing test compared with no change in the controls . A stabilization splint has a therapeutic value beyond its placebo effects . Thus , it should be an integral part of the treatment modalities in MFP disorder patients . An intensive chewing test is an effective tool to evaluate the treatment modality efficacy in MFP patients AIMS To compare the short-term efficacy of treatment with a stabilization appliance compared with that of a non-occlusal , control appliance in patients with temporom and ibular disorders ( TMD ) of mainly myogenous origin . METHODS A r and omized , controlled trial was performed with 60 patients suffering from myofascial pain . Patients were r and omly assigned to a treatment or a control group . The treatment group was treated by means of a stabilization appliance and the control group by means of a non-occlusal appliance . Symptoms and signs were registered before and after 10 weeks of treatment . RESULTS Improvement of overall subjective symptoms was reported in both groups , but significantly more often in the treatment group than in the control group ( P = .000 ) . The prevalence of daily or constant pain showed a significant reduction in the treatment group ( P = .028 ) compared with the control group . There was a significant decrease in the number of tender masticatory muscles in the treatment group ( P = .018 ) compared with the control group . CONCLUSION The results of this short-term evaluation suggest that the stabilization appliance is more effective in alleviating symptoms and signs in patients with TMD of mainly myogenous origin than a control , non-occlusal appliance . The stabilization appliance can therefore be recommended for the therapy of these patients Abstract  Variability  in patients ' response to interventions in pain and other clinical setting s is large . Many explanations such as trial methods , environment or culture have been proposed , but this paper sets out to show that the main cause of the variability may be r and om chance , and that if trials are small their estimate of magnitude of effect may be incorrect , simply because of the r and om play of chance . This is highly relevant to the questions of ‘ How large do trials have to be for statistical accuracy ? ’ and ‘ How large do trials have to be for their results to be clinical ly valid ? ’ The true underlying control event rate ( CER ) and experimental event rate ( EER ) were determined from single‐dose acute pain analgesic trials in over 5000 patients . Trial group size required to obtain statistically significant and clinical ly relevant ( 0.95 probability of number‐needed‐to‐treat within ±0.5 of its true value ) results were computed using these values . Ten thous and trials using these CER and EER values were simulated using varying group sizes to investigate the variation due to r and om chance alone . Most common analgesics have EERs in the range 0.4–0.6 and CER of about 0.19 . With such efficacy , to have a 90 % chance of obtaining a statistically significant result in the correct direction requires group sizes in the range 30–60 . For clinical relevance nearly 500 patients are required in each group . Only with an extremely effective drug ( EER>0.8 ) will we be reasonably sure of obtaining a clinical ly relevant NNT with commonly used group sizes of around 40 patients per treatment arm . The simulated trials showed substantial variation in CER and EER , with the probability of obtaining the correct values improving as group size increased . We contend that much of the variability in control and experimental event rates is due to r and om chance alone . Single small trials are unlikely to be correct . If we want to be sure of getting correct ( clinical ly relevant ) results in clinical trials we must study more patients . Credible estimates of clinical efficacy are only likely to come from large trials or from pooling multiple trials of conventional ( small ) size In order to evaluate and compare the effects of biofeedback and occlusal splint therapy on m and ibular dysfunction , 30 patients were r and omly divided into two treatment groups . The patients were women aged 20 - -40 years without any obvious organic reasons for their symptoms . There were no significant differences between the two groups before the start of treatment in respect of signs and symptoms of m and ibular dysfunction . One group used full coverage splints at night for 6 weeks . The other group received biofeedback training up to six times , 30 min per session . One month after completion of the therapy the patients were re-examined . Both groups showed a significant reduction in symptoms , both subjectively and clinical ly . No significant differences between the groups were found . The two treatments were thus equally effective in the short-term perspective in patients with signs and symptoms of m and ibular dysfunction Forty-five individuals with long-st and ing facial pain or headache of muscular origin were r and omly allocated into three groups . The first group was treated with acupuncture , the second group received an occlusal splint , and the third group served as controls . Both acupuncture and occlusal splint therapy significantly reduced subjective symptoms and clinical signs from the stomatognathic system . No differences between these two groups were found with regard to treatment effects . It is concluded that acupuncture is an alternative method to conventional stomatognathic treatment for individuals with craniom and ibular disorders of muscular origin Twenty-four patients were selected to participate in this study . Twelve patients were r and omly selected to receive occlusal splint therapy and the other 12 to receive a simplified relaxation therapy technique .  Observable pain scores , maximum comfortable interincisal distance , and maximum interincisal distances were recorded for each group before and after treatment . The occlusal splint group showed a significant decrease in total mean observable pain scores ( decrease score of 10.5 , t = 3.124 ; P less than 0.1 ) . The relaxation group showed no significant decrease in total mean observable pain scores ( decrease score of 1.8 , t = 0.888 ; P = ns ) . The occlusal splint group showed a significant increase in the mean maximum comfortable opening ( an increase of 12.4 mm , t = 5.085 ; P less than .01 ) . The relaxation group showed no significant increase in the mean maximum comfortable opening ( an increase of 2.3 mm , t = 0.734 ; P = ns ) . The occlusal splint group showed a significant increase in the mean maximum opening ( an increase of 6.0 mm , t = 2.471 ; P less than .05 ) . The relaxation group showed no increase in the mean maximum opening ( decrease of 0.7 mm , t = 0.343 ; P = ns ) . This study suggests that occlusal splint therapy is a more effective treatment for the pain , tenderness , and limited m and ibular opening associated with temporom and ibular disorders than relaxation therapy . In this study , the relaxation technique used had no significant effect on the patients ' pain , tenderness , or limited opening To assess the differential efficacy of two commonly used treatments for temporom and ibular disorders ( TMD ) , intraoral appliances ( IAs ) and biofeedback ( BF ) , separately and in combination , two studies were conducted . The first study directly compared IA treatment , a combination of biofeedback and stress management ( BF/SM ) , and a waiting list control group in a sample of 80 TMD patients . Both treatments were determined to be equally credible to patients , ruling out this potential threat to the validity of the results obtained . The results demonstrated that the IA treatment was more effective than the BF/SM treatment in reducing pain after treatment , but at a 6-month follow-up the IA group significantly relapsed , especially in depression , whereas the BF/SM maintained improvements on both pain and depression and continued to improve . The second study examined the combination of IA and BF/SM in a sample of 30 TMD patients . The results of this study demonstrated that the combined treatment approach was more effective than either of the single treatments alone , particularly in pain reduction , at the 6-month follow-up . These results support the importance of using both dental and psychologic treatments to successfully treat TMD patients if treatment gains are to be maintained The aim of this study was to investigate if the difference in treatment outcome between patients provided with a stabilisation appliance and a control appliance  was due to the treatment and /or other factors in patients with temporom and ibular disorders ( TMD ) of arthrogeneous origin . Sixty patients were assigned to two equally sized groups : a treatment group , treated with a stabilisation appliance , and a control group given a control appliance . Thirteen possible background variables for the treatment outcome were correlated to changes in severity of temporom and ibular joint ( TMJ ) pain on a verbal scale in the two patient groups . The logistic regression analyses revealed that , after correcting for the background variables , stabilisation appliance treatment was a strong explanatory factor for a positive treatment outcome , with a significance of P = 0.0013 compared to patients belonging to the control group . Background variables of significant importance for the treatment outcome were male sex ( positive ) ( P = 0.0268 ) , and severe or very severe TMJ pain ( negative ) ( P = 0.0034 ) . These findings indicate that not only the treatment with a stabilisation appliance but also sex and the intensity of the TMJ pain before treatment might influence the treatment outcome in patients with TMD of arthrogeneous origin One hundred and ten patients , 23 males and 87 females , participated in a comparative study of the effect of acupuncture and occlusal splint therapy .  All the patients exhibited signs and symptoms of craniom and ibular disorders ( CMD ) and had had pain for more than six months . The participants were r and omly assigned to three groups ; acupuncture treatment , occlusal splint therapy or control . The patients were evaluated before and immediately after treatment/control time . Ten different subjective and /or clinical assessment variables were used in the evaluation of the treatment effects . Both acupuncture and occlusal splint therapy  reduced the symptoms as compared with the control group in which the symptoms remained essentially unchanged . In this short-term study , acupuncture gave better subjective results ( p < 0.001 ) than the occlusal splint therapy In a r and omized trial the effects of occlusal appliance and relaxation therapy , each combined with brief information , were compared with brief information only , in adolescents with temporom and ibular disorder ( TMD ) pain . One-hundred- and -twenty-two adolescents ( 93 F and 29 M aged 12 - 18 years ) were r and omly assigned to one of the following 3 groups : brief information + occlusal appliance ( BI + OA ) , brief information + relaxation therapy ( BI + RT ) , or brief information ( BI ) . Included were subjects reporting pain once a week or more often , in addition to receiving a diagnosis of TMD according to the Research Diagnostic Criteria ( RDC/TMD ) . They were evaluated before and after treatment and at a 6-month follow-up by means of self-reports and clinical assessment . The result revealed a significantly higher reduction in frequency of pain , in pain intensity ( visual analog scale [ VAS ] ) , and in a composite pain index ( intensity x frequency ) for patients treated with BI + OA compared with 
    Output:
    
Based on the currently best available evidence it appears that most patients with masticatory muscle pain are helped by the incorporation of a stabilization splint .
Nevertheless , evidence is equivocal if improvement of pain symptoms after incorporation of the intraoral appliance is caused by a specific effect of the appliance .
A stabilization splint does not appear to yield a better clinical outcome than a soft splint , a non-occluding palatal splint , physical therapy , or body acupuncture .