Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması

USTA, Ahmet; YENGİN, Esengün; cifter, ebru demet; ÖZEL YILDIZ, Sevda

doi:10.5336/jtracom.2018-63021

Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması

Ebru Demet ÇİFTER, (İstanbul Üniversitesi)

Esengün YENGİN, (İstanbul Üniversitesi)

Sevda ÖZEL YILDIZ, (İstanbul Üniversitesi)

Ahmet USTA (Üsküdar Üniversitesi)

Geleneksel ve Tamamlayıcı Tıp Dergisi

4 0

Yıl: 2018 Cilt: 1 Sayı: 3 Sayfa Aralığı: 115 - 126 Metin Dili: Türkçe DOI: 10.5336/jtracom.2018-63021 İndeks Tarihi: 06-03-2020

Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması

Öz:

Amaç: Oklüzal splintlerin gece kullanımının, akupunkturun ve parasetamolün miyofasiyalağrı üzerine etkisinin araştırılmasıdır. Gereç ve Yöntemler: Temporomandibular rahatsızlıklar içinaraştırma tanı kriterlerine göre miyofasiyal ağrı teşhisi konulmuş 45 hasta randomize olarak üç grubaayrılmıştır. Birinci gruba 3 mm kalınlığında sert oklüzal splintler 3 ay boyunca gece kullandırılmıştır.İkinci gruba ST6, ST7, ST8, GB3, SI18, LI4 noktalarına 5 seans akupunktur uygulanmıştır. Üçüncügruba 1.000 mg/gün parasetamol içeren tablet iki eşit doz hâlinde 1 hafta süre ile verilmiştir. Tedavilerintamamlanmasının ardından yedinci günde maksimum yardımsız ağız açma miktarı kaydedilmiş;hastaların son bir hafta içerisinde hissettiği en şiddetli ağrı vizüel analog skala (VAS)’sı iletemporal, masseter, sternokleidomastoid kaslar ve temporomandibuler eklem lateral kutbu üzerinden,basınç ağrı eşiği ölçümleri ise algometre yardımı ile değerlendirilmiştir. Bulgular: Maksimumyardımsız ağız açma miktarındaki artış oklüzal splint ve akupunktur grupları için anlamlı bulunuriken, parasetamol grubundaki artış anlamlı saptanmamıştır. VAS değerlerindeki azalma her üç grupiçin de anlamlı bulunmuştur. Basınç ağrı eşiği değerlendirilen 10 noktanın tamamında oklüzal splintve akupunkturun etkinlikleri arasında anlamlı fark belirlenememiştir. Değerlendirilen 10 noktanınbeşinde splintin etkisi parasetamolden üstün bulunur iken, birinde akupunkturun etkisi parasetamoleüstün saptanmıştır. Sonuç: Maksimum yardımsız ağız açma miktarı oklüzal splint ve akupunkturtedavileri sonrasında anlamlı oranda artar iken, parasetamolün bu konudaki etkisi anlamlıbulunmamıştır. Her üç grupta VAS değerlerinin düşüşü anlamlı görülmüştür. Akupunkturun basınçağrı eşiği üzerine etkisi oklüzal splintlerden az olmakla beraber, aradaki farklar istatistiksel olarak anlamlıbulunmamıştır. Oklüzal splintlerin parasetamole göre daha fazla kas bölgesinde basınç ağrı eşiğiniazalttığı gözlenmiştir.

Anahtar Kelime:

Konular: Tıbbi Araştırmalar Deneysel Genel ve Dahili Tıp

Investigation of the Effectiveness of Occlusal Splint, Acupuncture and Pharmacological Treatment in Myofascial Pain

Öz:

Objective: The aim of the study was to investigate the effects of night-time use of occlusal splints, acupuncture and paracetamol on myofascial pain syndrome. Material and Methods: 45 patients diagnosed to have myofascial pain syndrome according to the research diagnostic criteria for temporomandibular disorders were randomly assigned to 3 groups. Patients in the first group were treated with 3 mm thick hard occlusal appliances for three months. Second group received 5 sessions of acupuncture therapy on ST6, ST7, ST8, GB3, SI18, LI4 points. The third group was administered 1.000 mg/day paracetamol tablets in two equal doses for 1 week. Seven days after the completion of the treatments, the maximum amount of unassisted opening; the most severe pain experienced by the patients in the last week, assessed by the visual analog scale (VAS) and pressure pain thresholds (ppt) for temporal, masseter, sternocleidomastoid muscles and temporomandibular joint was evaluated. Results: The increase in maximum unassisted opening was significant for both the occlusal splint and acupuncture groups; the increase in the paracetamol group was not significant. Decrease in VAS values was significant for all three groups. No significant difference was found between the efficacy of the occlusal splint and acupuncture treatments in all 10 regions evaluated for ppt. In five regions ppt decrease was significantly higher for the splint group compared to the paracetamol group and acupuncture was more effective to reduce ppt than paracetamol in one region. Conclusion: The maximum amount of unassisted opening increased significantly after occlusal splint and acupuncture treatments, whereas the effect of paracetamol was not significant. The decrease of VAS values in all three groups was significant. The effect of acupuncture on ppt was less than occlusal splints, but the differences were not statistically significant. It has been observed that occlusal splints reduce ppt in more muscle regions than paracetamol.

Anahtar Kelime:

Konular: Tıbbi Araştırmalar Deneysel Genel ve Dahili Tıp

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Simons DG, Travell JG, Simons LS. General Overview, Apropos of all Muscles. Travel & Simons' Myofascial Pain and Dysfunction, The Trigger Point Manual, Vol 1. Upper Half of Body. 2nd ed. Baltimore, Philadelphia: Williams & Wilkins; 1999.p 11-148.
2. Okeson JP. Management of Temporomandibular Disorders and Occlusion. 4th ed. St. Louis: Mosby Company; 1998. p.640.
3. Ferrando M, Andreu Y, Galdón MJ, Durá E, Poveda R, Bagán JV. Psychological variables and temporomandibular disorders: distress, coping, and personality. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98(2): 153-60.
4. Gerwin RD, Shannon S, Hong CZ, Hubbard D, Gervirtz R. Interrater reliability in myofascial trigger point examination. Pain 1997;69(1- 2):65-73.
5. Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol 2004;14(1):95-107.
6. Simons DG. Myofascial pain syndromes: where are we? Where are we going? Arch Phys Med Rehabil 1988;69(3 Pt 1):207-12.
7. Simons DG. Uderstanding effective treatments of myofascial trigger points. J Bodywork & Movement Therapies 2002;6(2):81-8.
8. Simons DG. Clinical and ethiological update of myofascial pain from trigger points. J Musculoskel Pain 1996;4(1-2):93-121.
9. Sandberg M, Larsson B, Lindberg LG, Gerdle B. Different patterns of blood flow response in the trapezius muscle following needle stimulation (acupuncture) between healthy subjects and patients with fibromyalgia and workrelated trapezius myalgia. Eur J Pain 2005;9(5):497-510.
10. Dürer TS. [The treatment of tinnitus originating from temporomandibular joint dysfunction with neuraltherapy and dental restoration]. Journal of Complementary Medicine, Regulation and Neural Therapy 2015;9(3):33-5.
11. Baldry P. Management of myofascial trigger point pain. Acupunct Med 2002;20(1):2-10.
12. Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician 2002;65(4):653-60.
13. De Las Penas CF, Campo MS, Carnero JF, Page JCM. Manual therapies in myofascial trigger point treatment: a systematic rewiew. J Bodywork and Movement Therapies 2005;9:27-34.
14. Hou CR, Tsai LC, Cheng KF, Chung KC, Hong CZ. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil 2007;83(10):1406-14.
15. Raj PP, Paradise LA. Myofascial pain syndrome and its treatment in low back pain. Seminars in Pain Medicine 2004;2(3):167-74.
16. McMakin CR. Microcurrent therapy: a novel treatment method for chronic low back myofascial pain. J Bodywork and Movement Therapies 2004;8(2):143-53.
17. Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am 2014;25(2):357-74.
18. Hiyama S, Ono T, Ishiwata Y, Kato Y, Kuroda T. First night effect of an interocclusal appliance on nocturnal macticatory muscle activity. J Oral Rehabil 2003;30(2):139-45.
19. Sheikholeslam A, Holmgren K, Riise C. Therapeutic effects of the plane occlusal splint on signs and symptoms of craniomandibular disorders in patients with nocturnal bruxism. J Oral Rehabil 1993;20(5):473-82.
20. Chung SC, Kim YK, Kim HS. Prevalence and patterns of nocturnal bruxofacets on stabilization splints in temporomandibular disorder patients. Cranio 2000;18(2):92-7.
21. Gu T, Lin L, Jiang Y, Chen J, D’Arcy RC, Chen M, et al. Acupuncture therapy in treating migraine: results of a magnetic resonance spectroscopy imaging study. J Pain Res 2018;11:889-900.
22. Eftekharsadat B, Porjafar E, Eslamian F, Shakouri SK, Fadavi HR, Raeissadat SA, et al. Combination of exercise and acupuncture vs acupuncture alone for treatment of myofascial pain syndrome: a randomized clinical trial. J Acupunct Meridian Stud 2018;11(5): 315-22.
23. Lu W, Rosenthal DS. Oncology acupuncture for chronic pain in cancer survivors: a reflection on the American Society of Clinical Oncology Chronic Pain Guideline. Hematol Oncol Clin North Am 2018;32(3):519-33.
24. Gaubeca-Gilarranz A, Fernández-de-LasPeñas C, Medina-Torres JR, Seoane-Ruiz JM, Company-Palonés A, Cleland JA, et al. Effectiveness of dry needling of rectus abdominis trigger points for the treatment of primary dysmenorrhoea: a randomised parallel-group trial. Acupunct Med 2018;36(5):302-10.
25. Chu H, Seo J, Kim C, Moon Y, Kang DG, Lee HS, et al. Electroacupuncture for migraine protocol for a systematic review of controlled trials. Medicine (Baltimore) 2018;97(17):e9999.
26. Kawakita K, Shinbara H, Imai K, Fukuda F, Yano T, Kuriyama K. How do acupuncture and moxibustion act? J Pharmacol Sci 2006; 100(5):443-59.
27. Andersson S, Lundeberg T. Acupuncture-- from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypotheses 1995;45(3):271-81.
28. Nikles CJ, Yelland M, Del Mar C, Wilkinson D. The role of paracetamol in chronic pain: an evidence-based approach. Am J Ther 2005;12(1):80-91.
29. Peterson GM. Selecting nonprescription analgesics. Am J Ther 2005;12(1):67-79.
30. Boutaud O, Aronoff DM, Richardson JH, Marnett LJ, Oates JA. Determinants of the cellular specificity of acetaminophen as an inhibitor of prostaglandin H(2) synthases. Proc Natl Acad Sci U S A 2002;99(10):7130-5.
31. Botting R. COX-1 and COX-3 inhibitors. Thromb Res 2003;110(5-6):269-72.
32. Botting R, Ayoub SS. COX-3 and the mechanism of action of paracetamol/acetaminophen. Prostaglandins Leukot Essent Fatty Acids 2005;72(2):85-7.
33. Bueno CH, Pereira DD, Pattussi MP, Grossi PK, Grossi ML. Gender differences in temporomandibular disorders in adult populational studies: a systematic review and meta-analysis. J Oral Rehabil 2018;45(9):720-9.
34. Kállai I, Barke A, Voss U. The effects of experimenter characteristics on pain reports in women and men. Pain 2004;112(1-2):142-7.
35. King JC, Goddard MJ. Pain rehabilitation. 2. chronic pain syndrome and miyofascial pain. Arch Phys Med Rehabil 1994;75(5 Spec No):9-14.
36. Fleckenstein J, Zaps D, Rüger LJ, Lehmeyer L, Freiberg F, Lang PM, et al. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord 2010;11: 32.
37. Gonzalez-Perez LM, Infante-Cossio P, Granados-Nunez M, Urresti-Lopez FJ, Lopez-Martos R, Ruiz-Canela-Mendez P. Deep dry needling of trigger points located in the lateral pterygoid muscle: efficacy and safety of treatment for management of myofascial pain and temporomandibular dysfunction. Med Oral Patol Oral Cir Bucal 2015;20(3):e326-33.
38. Park G, Kim CW, Park SB, Kim MJ, Jang SH. Reliability and usefulness of the pressure pain threshold measurement in patients with myofascial pain. Ann Rehabil Med 2011;35(3): 412-7.
39. Cheatham SW, Kolber MJ, Mokha GM, Hanney WJ. Concurrent validation of a pressure pain threshold scale for individuals with myofascial pain syndrome and fibromyalgia. J Man Manip Ther 2018;26(1):25-35.
40. Kelly-Martin R, Doughty L, Garkavi M, Wasserman JB. Reliability of modified adheremeter and digital pressure algometer in measuring normal abdominal tissue and C-section scars. J Bodyw Mov Ther 2018;22(4):972-9.
41. Jakorinne P, Haanpää M, Arokoski J. Scand reliability of pressure pain, vibration detection, and tactile detection threshold measurements in lower extremities in subjects with knee osteoarthritis and healthy controls. Scand J Rheumatol 2018;1-10.
42. Lacourt TE, Houtveen JH, van Doornen LJP. Experimental pressure-pain assessments: test-retest reliability, convergence and dimensionality. Scand J Pain 2012;3(1):31-7.
43. Arendt-Nielsen L. Reliability of pressure pain threshold testing (PPT) in healthy pain free young adults. Scand J Pain 2015;9(1): 28-9.
44. Waller R, Straker L, O’Sullivan P, Sterling M, Smith A. Reliability of pressure pain threshold testing in healthy pain free young adults. Scand J Pain 2015;9(1):38-41.
45. Raeissadat SA, Rayegani SM, Sadeghi F, Rahimi-Dehgolan S. Comparison of ozone and lidocaine injection efficacy vs dry needling in myofascial pain syndrome patients. J Pain Res 2018;11:1273-9.
46. Aktürk S, Kaya A, Çetintaş D, Akgöl G, Gülkesen A, Kal GA, et al. Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome: randomized, sham-controlled study. J Phys Ther Sci 2018;30(3):448-53.
47. Melero-Suárez R, Sánchez-Santos JA, Domínguez-Maldonado G. Evaluation of the analgesic effect of combination therapy on chronic plantar pain through the myofascial trigger points approach. J Am Podiatr Med Assoc 2018;108(1):27-32.
48. Calvo-Lobo C, Diez-Vega I, Martínez-Pascual B, Fernández-Martínez S, de la CuevaReguera M, Garrosa-Martín G, et al. Tensiomyography, sonoelastography, and mechanosensitivity differences between active, latent, and control low back myofascial trigger points: a cross-sectional study. Medicine (Baltimore) 2017;96(10):e6287.
49. Ozden AV, Alptekin HK, Esmaeilzadeh S, Cihan C, Aki S, Aksoy C, et al. Evaluation of the sympathetic skin response to the dry needling treatment in female myofascial pain syndrome patients. J Clin Med Res 2016;8(7): 513-8.
50. Kavadar G, Çağlar N, Özen Ş, Tütün Ş, Demircioğlu D. Efficacy of conventional ultrasound therapy on myofascial pain syndrome: a placebo controlled study. Agri 2015;27(4): 190-6.
51. Somprasong S, Mekhora K, Vachalathiti R, Pichaiyongwongdee S. Correlation between pressure pain threshold and soft tissue displacement in muscle pain conditions. J Med Assoc Thai 2015;98 Suppl 5:S68-73.
52. Castelnuovo E, Cross P, Mt-Isa S, Spencer A, Underwood M. Cost-effectiveness of advising the use of topical or oral ibuprofen for knee pain; the TOIB study [ISRCTN: 79353052]. Rheumatology (Oxford) 2008;47(7):1077- 81.
53. Hsieh LF, Hong CZ, Chern SH, Chen CC. Efficacy and side effects of diclofenac patch in treatment of patients with myofascial pain syndrome of the upper trapezius. J Pain Symptom Manage 2010;39(1):116-25.
54. Goldenberg DL, Felson DT, Dinerman H. A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. Arthritis Rheum 1986;29(11): 1371-7.
55. Fossaluzza V, De Vita S. Combined therapy with cyclobenzaprine and ibuprofen in primary fibromyalgia syndrome. Int J Clin Pharmacol Res 1992;12(2):99-102.
56. Russell IJ, Fletcher EM, Michalek JE, McBroom PC, Hester GG. Treatment of primary fibrositis/fibromyalgia syndrome with ibuprofen and alprazolam. A double-blind, placebo-controlled study. Arthritis Rheum 1991;34(5):552- 60.
57. Singer E, Dionne R. A controlled evaluation of ibuprofen and diazepam for chronic orofacial muscle pain. J Orofac Pain 1997;11(2):139- 46.
58. Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am 2014;25(2):357-74.
59. Leite FM, Atallah AN, El Dib R, Grossmann E, Januzzi E, Andriolo RB, et al. Cyclobenzaprine for the treatment of myofascial pain in adults. Cochrane Database Syst Rev 2009;8;(3): CD006830.
60. Yap AU. Effects of stabilization appliances on nocturnal parafunctional activities in patients with and without signs of temporomandibular disorders. J Oral Rehabil 1998;25(1):64-8.
61. Holmgren K, Sheikoleslam A, Riise C. Effect of a full-arch maxillary occlusal splint on parafunctional activity during sleep in patients with nocturnal bruxism and signs and symptoms of craniomandibular disorders. J Prosthet Dent 1993;69(3):293-7.
62. Gerwin RD. Neurobiology of the myofascial trigger point. Baillieres Clin Rheumatol 1994;8(4):747-62.
63. Butts R, Dunning J, Pavkovich R, Mettille J, Mourad F. Conservative management of temporomandibular dysfunction: a literature review with implications for clinical practice guidelines (Narrative review part 2). J Bodyw Mov Ther 2017;21(3):541-8.
64. Johansson A, Wenneberg B, Wagersten C, Haraldson T. Acupuncture in the treatment of facial muscular pain. Acta Odontol Scand 1991;49(3):153-8.
65. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28(1):6-27.
66. Goulet J, Palla S. The path to diagnosis. In: Sessle BJ, Lavigne GJ, Lund JP, Dubner R, eds. Orofacial Pain: From Basic Science to Clinical Management: the Transfer of Knowledge in Pain Research to Education. 2nd ed. Chicago: Quintessence; 2008. p135-44.
67. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6(4):301-55.

APA	cifter e, YENGİN E, ÖZEL YILDIZ S, USTA A (2018). Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması. , 115 - 126. 10.5336/jtracom.2018-63021
Chicago	cifter ebru demet,YENGİN Esengün,ÖZEL YILDIZ Sevda,USTA Ahmet Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması. (2018): 115 - 126. 10.5336/jtracom.2018-63021
MLA	cifter ebru demet,YENGİN Esengün,ÖZEL YILDIZ Sevda,USTA Ahmet Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması. , 2018, ss.115 - 126. 10.5336/jtracom.2018-63021
AMA	cifter e,YENGİN E,ÖZEL YILDIZ S,USTA A Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması. . 2018; 115 - 126. 10.5336/jtracom.2018-63021
Vancouver	cifter e,YENGİN E,ÖZEL YILDIZ S,USTA A Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması. . 2018; 115 - 126. 10.5336/jtracom.2018-63021
IEEE	cifter e,YENGİN E,ÖZEL YILDIZ S,USTA A "Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması." , ss.115 - 126, 2018. 10.5336/jtracom.2018-63021
ISNAD	cifter, ebru demet vd. "Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması". (2018), 115-126. https://doi.org/10.5336/jtracom.2018-63021

APA	cifter e, YENGİN E, ÖZEL YILDIZ S, USTA A (2018). Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması. Geleneksel ve Tamamlayıcı Tıp Dergisi, 1(3), 115 - 126. 10.5336/jtracom.2018-63021
Chicago	cifter ebru demet,YENGİN Esengün,ÖZEL YILDIZ Sevda,USTA Ahmet Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması. Geleneksel ve Tamamlayıcı Tıp Dergisi 1, no.3 (2018): 115 - 126. 10.5336/jtracom.2018-63021
MLA	cifter ebru demet,YENGİN Esengün,ÖZEL YILDIZ Sevda,USTA Ahmet Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması. Geleneksel ve Tamamlayıcı Tıp Dergisi, vol.1, no.3, 2018, ss.115 - 126. 10.5336/jtracom.2018-63021
AMA	cifter e,YENGİN E,ÖZEL YILDIZ S,USTA A Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması. Geleneksel ve Tamamlayıcı Tıp Dergisi. 2018; 1(3): 115 - 126. 10.5336/jtracom.2018-63021
Vancouver	cifter e,YENGİN E,ÖZEL YILDIZ S,USTA A Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması. Geleneksel ve Tamamlayıcı Tıp Dergisi. 2018; 1(3): 115 - 126. 10.5336/jtracom.2018-63021
IEEE	cifter e,YENGİN E,ÖZEL YILDIZ S,USTA A "Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması." Geleneksel ve Tamamlayıcı Tıp Dergisi, 1, ss.115 - 126, 2018. 10.5336/jtracom.2018-63021
ISNAD	cifter, ebru demet vd. "Miyofasiyal Ağrıda Oklüzal Splint, Akupunktur ve Farmakolojik Tedavinin Etkinliklerinin Araştırılması". Geleneksel ve Tamamlayıcı Tıp Dergisi 1/3 (2018), 115-126. https://doi.org/10.5336/jtracom.2018-63021