***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: ABSTRACT Forty-five patients with a primary diagnosis of muscular MD were evaluated and treated in a university based facial pain center . The patients were equally and r and omly assigned to one of three treatment groups . Group 1 patients were treated with traditional therapies appropriate for the particular patient . Group two patients used similar therapies that were appropriate for the patient but also had an oral vertical exercise device integrated into their therapy . Patients in the third group were instructed in home care , educated about TMD , and instructed in the use of the oral exercise device . Results indicated that all three groups demonstrated significant overall patient clinical and subjective improvement . The three groups did not differ significantly from each other in degree of patient improvement A study of the effectiveness of physical therapy for patients with myofacial pain dysfunction syndrome was performed . Clinical evaluation of 120 patients revealed marked male preponderance , distribution according to age showed a great prevalence of the third decade , and most common chief complaints were pain and muscle tenderness . Patients were classified r and omly into three equal groups treated by muscle relaxant drugs , shortwave diathermy , and ultrasonic therapy , respectively . Regular follow-up was carried out for 6 to 12 months to assess patients ' responses to different forms of treatment . Evaluation revealed marked relief of symptoms by the use of physical therapy , and the best results were obtained by the use of ultrasonic therapy Objective The aim of the present study was to evaluate the effects of upper thoracic manipulation on pain in subjects with temporom and ibular disorder . Design Thirty-two women with a diagnosis of temporom and ibular disorder were r and omly allocated to an experimental group ( n = 16 ) , su bmi tted to upper thoracic manipulation , and a placebo group ( n = 16 ) , su bmi tted to a procedure in the thoracic region with no therapeutic effect . All volunteers underwent an evaluation of pain in the masticatory muscles and the temporom and ibular joint using an algometer and the visual analog scale before and immediately after the procedure as well as after 48–72 hrs . Two-way repeated- measures analysis of variance was used for the intragroup and intergroup analyses , with the level of significance set to 5 % ( P < 0.05 ) . Cohen d was calculated for the determination of the effect size . Results No significant group-by-time interaction was found ( P > 0.05 ) for algometry in any analysis , and Cohen d revealed no significant effect of the treatment . Moreover , no significant group-by-time interaction was found for facial pain intensity determined using the visual analog scale ( P > 0.05 ) , and Cohen d also revealed no significant effect of the treatment regarding this variable . Conclusions On the basis of the present findings , upper thoracic spinal manipulation does not lead to a reduction in pain in women with temporom and ibular disorder BACKGROUND Temporom and ibular pain has multiple etiologies and a range of therapeutic options . In this pilot study , the authors assessed the feasibility of conducting a larger trial to evaluate chiropractic treatment of temporom and ibular disorders ( TMDs ) . METHODS The authors assigned 80 participants r and omly into one of the following four groups , all of which included a comprehensive self-care program : reversible interocclusal splint therapy ( RIST ) , Activator Method Chiropractic Technique ( AMCT ) ( Activator Methods International , Phoenix ) , sham AMCT and self-care only . They made assessment s at baseline and at month 2 and month 6 , including use of the Research Diagnostic Criteria for Temporom and ibular Disorders . RESULTS The authors screened 721 potential participants and enrolled 80 people ; 52 participants completed the six-month assessment . The adjusted mean change in current pain over six months , as assessed on the 11-point numerical rating scale , was 2.0 ( 95 percent confidence interval , 1.1 - 3.0 ) for RIST , 1.7 ( 0.9 - 2.5 ) for self-care only , 1.5 ( 0.7 - 2.4 ) for AMCT and 1.6 ( 0.7 - 2.5 ) for sham AMCT . The authors also assessed bothersomeness and functionality . CONCLUSIONS The authors found the study design and methodology to be manageable . They gained substantial knowledge to aid in conducting a larger study . AMCT , RIST and self-care should be evaluated in a future comparative effectiveness study . PRACTICAL IMPLICATION S This pilot study was a necessary step to prepare for a larger study that will provide clinicians with information that should be helpful when discussing treatment options for patients with TMD Background Myogenous temporom and ibular disorders ( TMD ) are considered to be a common musculoskeletal condition . No studies exist comparing intra-oral myofascial therapies to education , self-care and exercise ( ESC ) for TMD . This study evaluated short-term differences in pain and mouth opening range between intra-oral myofascial therapy ( IMT ) and an ESC program . Methods Forty-six participants with chronic myogenous TMD ( as assessed according to the Research Diagnostic Criteria Axis 1 procedure ) were consecutively block r and omised into either an IMT group or an ESC group . Each group received two sessions per week ( for five weeks ) of either IMT or short talks on the anatomy , physiology and biomechanics of the jaw plus instruction and supervision of self-care exercises . The sessions were conducted at the first author ’s jaw pain and chiropractic clinic in Sydney , Australia . Primary outcome measures included pain at rest , upon opening and clenching , using an eleven point ordinal self reported pain scale . A secondary outcome measure consisted of maximum voluntary opening range in millimetres . Data were analysed using linear models for means and logistic regression for responder analysis . Results After adjusting for baseline , the IMT group had significantly lower average pain for all primary outcomes at 6 weeks compared to the ESC group ( p < 0.001 ) . These differences were not clinical ly significant but the IMT group had significantly higher odds of a clinical ly significant change ( p < 0.045 ) . There was no significant difference in opening range between the IMT and ESC groups . Both groups achieved statistically significant decreases in all three pain measures at six weeks ( p ≤ 0.05 ) , but only the IMT group achieved clinical ly significant changes of 2 or more points . Conclusion This study showed evidence of superiority of IMT compared to ESC over the short-term but not at clinical ly significant levels . Positive changes over time for both IMT and ESC protocol s were noted . A longer term , multi-centre study is warranted . Trial registration Australian and New Zeal and Clinical Trials Registry ACTRN12610000508077 A r and om sample of U.S. dentists was surveyed with a mailed question naire to determine the number  of splints that they fabricated over the preceding year for bruxers , patients with myofascial pain-dysfunction syndrome and patients with TM joint pain . The results indicate that a significant number of dentists treat these disorders with dental splints . Estimates are provided for the dental profession 's yearly splint output for each disorder Abstract The aim of this research was to study if changes in condyle position in temporom and ibular disorders ( TMD ) patients could be a factor that is affected by resilient appliance therapy and if it influences the treatment outcome . The study investigated 48 patients r and omly assigned to a treatment group ( T group = 21 patients , using resilient appliance ) or a control group ( C group = 27 patients , using nonoccluding appliance ) . Changes in the condyle-fossa relationship ( with and without the appliance ) were determined in an MRI examination . Ten weeks after treatment , the treatment outcome was measured . The results showed that with the appliance , change in condyle position occurred in 76 % of the T group and 22 % of the C group ( p<0.001 ) . Sixty-seven percent ( 67 % ) of the T group and 44 % of the C group experienced a successful treatment outcome . Treatment outcome was not related to changes in condyle position in patients with TMD pain OBJECTIVE Studies investigating the efficacy of intraoral myofascial therapies ( IMTs ) for chronic temporom and ibular disorder ( TMD ) are rare . The present study was an expansion of a previously published pilot study that investigated whether chiropractic IMT and the addition of education and self-care were superior to no-treatment or IMT alone for 5 outcome measures -interincisal opening range , jaw pain at rest , jaw pain upon opening , jaw pain upon clenching , and global reporting of change-over the course of 1 year . METHODS Ninety-three participants with myogenous TMD between the ages of 18 and 50 years experiencing chronic jaw pain of longer than 3 months in duration were recruited for the study . Successful applicants were r and omized into 1 of 3 groups : ( 1 ) IMT consisting of 2 treatment interventions per week for 5 weeks , ( 2 ) IMT plus education and " self-care " exercises ( IMTESC ) , and ( 3 ) wait-list control . The main outcome measures were used . Range of motion findings were measured by vernier callipers in millimeters , and pain scores were quantified using an 11-point self-reported grade d chronic pain scale . Global reporting of change was a 7-point self-reported scale , balanced positively and negatively around a zero midpoint . RESULTS There were statistically significant differences in resting , opening and clenching pain , opening scores , and global reporting of change ( P < .05 ) in both treatment groups compared with the controls at 6 months and 1 year . There were also significant differences between the 2 treatment groups at 1 year . CONCLUSIONS The study suggests that both chiropractic IMT and IMTESC were superior to no-treatment of chronic myogenous TMD over the course of 1 year , with IMTESC also being superior to IMT at 1 year AIMS 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 r and omly 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 . CONCLUSION 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 Abstract Objective . The aim of this study was to analyze and compare prevalence of signs and frequently occurring symptoms indicative of temporom and ibular disorder ( TMD ) and headaches in 35- , 50- , 65- and 75-year-old men and women in Västerbotten County , Sweden . Material s and methods . From a total target population of 11 324 subjects living in Västerbotten County in the year 2002 , 300 individuals in each age group were r and omly selected . Of these , 998 ( 82 % response rate ) answered and returned a postal question naire and 779 ( 65 % response rate ) individuals accepted a clinical examination . Results . The prevalence of frequent TMD symptoms peaked among 50-year-old women and then declined . Women at this age reported significantly higher prevalence compared to men for all TMD symptoms except temporom and ibular joint locking . In the 65- and 75-year-olds , the prevalence was practically equal between men and women as well as between these ages . Frequent headaches showed the highest prevalence among 35- and 50-year-old women , with a statistically significant difference between men and women of 50 years of age ( p < 0.05 ) . Fifty-year-old women had statistically significantly higher prevalence of muscle pain to palpation ( p < 0.001 ) , temporom and ibular joint sounds ( p < 0.01 ) and impaired maximal jaw opening capacity ( p < 0.01 ) , compared to 50-year-old men . Conclusions . The different symptoms indicative of TMD and headaches showed a similar pattern , with higher prevalence among the 35- and 50-year-old , as compared to the 65- and 75-year-old , participants . The pattern may be related to biological , psychosocial or generation-related factors Summary Dental hygienist‐delivered pain self‐management training was superior to continuous oral contraceptive therapy for women with TMD pain ; focusing on menstrually‐related changes in symptoms did not increase its efficacy . ABSTRACT Mounting evidence supports the importance of hormonal fluctuations in temporom and ibular disorder ( TMD ) pain among women . Stabilizing influential hormones or having a plan and skills for coping with hormonally related increases in TMD pain , therefore , may be beneficial for women with TMD pain . This r and omized clinical trial evaluated the short‐ and long‐term efficacy of 3 interventions for women with TMD pain : ( 1 )  dental hygienist‐delivered pain self‐management training ( SMT ; n = 59 ) ; ( 2 ) the same dental hygienist‐delivered pain self‐management training , but with a focus on menstrual cycle‐related changes in pain and 
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The general heterogeneity was not found among included trials .
But predictive intervals ( PrIs ) were conspicuously wider than confidential intervals ( CIs ) of all pairwise comparisons , indicating that heterogeneity may exist between studies .
Complementary therapy showed the greatest probability ( 42.7 % ) to be the best intervention .
Based on the limited evidence of available trials , complementary therapy seemed to be slightly more effective than remaining treatment modalities for pain reduction in TMD patients with masticatory muscle pain .