Comparison of Morphine and Diclofenac Intra-articular Injection in Temporomandibular Joint Disorders: A Randomized Controlled Clinical Trial

Shahrokh Raeesian, Hamid Reza Fallahi, Mahdis Masoudrad



Introduction: Intra-articular injection has been used in patients with chronic temporomandibular joint (TMJ) pain for several years; however, there are still doubts regarding its effectiveness and duration of action. The aim of this study was to compare the analgesic effects of intra-articular injection of morphine, diclofenac, and isotonic saline on the patients with chronic TMJ pain. Materials and Methods: Sixty-six patients with TMJ pain were enrolled in a prospective randomized double-blind and placebo-controlled clinical study. Patients were randomly allocated into three groups in which 12 patients consisted in each group. The analgesic effect of intermittent morphine injection (10 mg/ml), diclofenac sodium (25mg/ml), and normal saline was evaluated. In each group, pain reduction was evaluated by using visual analog scale (VAS) by following time points: 10, 60 min, and a week after injection. Results: All patients in the three groups experienced pain reduction during the experiment. Among them, patients who received morphine showed significantly more reduction in pain than the other the two groups at 60 minutes (P<0.05) and a week after the second injection (P<0.001). Conclusion: Regardless of the type of treatment, TMJ pain was initially reduced presumably due to the arthrocenthesis effect of the drug or because of the placebo effect. According to the analytical results, 10 mg of morphine had a longer effect on pain reduction followed by diclofenac.


Morphine; Diclofenac sodium; Temporomandibular joint

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Gray R, Davies S, Quayle A. A clinical approach to temporomandibular disorders. 1. Classification and functional anatomy. British dental journal. 1994;176(11):429.

Gray R, Davies S, Quayle A. A clinical approach to temporomandibular disorders. III: Examination of the articulatory system: The muscles. British dental journal. 1994;177(1):25-8.

Zwijnenburg A, Lobbezoo F, Kroon G, Naeije M. Mandibular movements in response to electrical stimulation of superficial and deep parts of the human masseter muscle at different jaw positions. Archives of oral biology. 1999;44(5):395-401.

Bessa-Nogueira RV, Vasconcelos BC, Niederman R. The methodological quality of systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment. BMC Oral Health. 2008;8(1):1.

Werneke M, Hart DL. Centralization phenomenon as a prognostic factor for chronic low back pain and disability. Spine. 2001;26(7):758-64.

Khoury G, Garland D, Stein C. Intraarticular opioid-local anesthetic combinations for chronic joint pain. Middle East journal of anaesthesiology. 1994;12(6):579-85.

Kunjur J, Anand R, Brennan P, Ilankovan V. An audit of 405 temporomandibular joint arthrocentesis with intra-articular morphine infusion. British Journal of Oral and Maxillofacial Surgery. 2003;41(1):29-31.

Aktas I, Yalcin S, Sencer S. Intra-articular injection of tenoxicam following temporomandibular joint arthrocentesis: a pilot study. International journal of oral and maxillofacial surgery. 2010;39(5):440-5.

Stein C, Comisel K, Haimerl E, Yassouridis A, Lehrberger K, Herz A, et al. Analgesic effect of intraarticular morphine after arthroscopic knee surgery. New England Journal of Medicine. 1991;325(16):1123-6.

Joshi G, McCarroll S, Cooney C, Blunnie W, O'Brien T, Lawrence A. Intra-articular morphine for pain relief after knee arthroscopy. Journal of Bone & Joint Surgery, British Volume. 1992;74(5):749-51.

Gupta A, Bodin L, Holmström B, Berggren L. A systematic review of the peripheral analgesic effects of intraarticular morphine. Anesthesia & Analgesia. 2001;93(3):761-70.

Bryant C, Harrison S, Hopper C, Harris M. Use of intra-articular morphine for postoperative analgesia following TMJ arthroscopy. British Journal of Oral and Maxillofacial Surgery. 1999;37(5):391-6.

Zuniga JR, Ibanez C, Kozacko M. The analgesic efficacy and safety of intra-articular morphine and mepivicaine following temporomandibular joint arthroplasty. Journal of oral and maxillofacial surgery. 2007;65(8):1477-85.

Ziegler C, Steveling H, Umstadt H, Mühling J. Arthroskopische lysis und lavage des Kiefergelenks zur Therapie von Diskusverlagerungen. Arthroskopie. 1999;12(6):318-22.

Ziegler CM, Wiechnik J, Mühling J. Analgesic effects of intra-articular morphine in patients with temporomandibular joint disorders: a prospective, double-blind, placebo-controlled clinical trial. Journal of oral and maxillofacial surgery. 2010;68(3):622-7.



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