Virtual Reality and Pain of Temporomandibular Joint After Cervicofacial Burn: A Randomized Controlled Trial

Abstract

Objectives: This single-blind, randomized controlled trial aims to investigate the effect of virtual reality on pain associated with temporomandibular joint (TMJ), maximal mouth opening (MMO), and quality of life in patients with cervicofacial burns.

Background: Chronic pain and limitation of TMJ movements may occur following cervicofacial burn, in which chronic TMJ pain is the most common and with virtual reality (VR) which is a new form of cognitive distraction for pain, helps in reducing pain, improving TMJ range of motion (ROM) and patients’ quality of life.

Methods: Forty-Eight patients aged from 18 to 40 years who were suffering from chronic pain of the TMJ after cervicofacial burn were randomly selected from a specialized burn hospital (Hospital Legitimacy Assembly for Tumors and Burns) in Obour City, Cairo, Egypt. Patients randomly allocated into two groups: VR group (n=24) and Control group (n=24). The VR group was treated by wearing a fully immersive Head-Mounted Display virtual reality, watching a landscape view with application of Maitland mobilization for 15 to 30 seconds for 10 repetitions, 5 times per week for 4 consecutive weeks in addition to regular medical care and ROM home exercises. The Control Group received Maitland mobilization in addition to regular medical care and ROM home exercises. Treatment started 6 months post-burn. MMO was used to assess TMJ ROM, pressure algometry was used to assess TMJ pain, both were evaluated respectively on Day 1, 14, and 28 post-treatments. Quality of life was assessed using The University of Washington Quality of Life Questionnaire (UW-QOL) on Day 1 and 28 post-treatments.

Results: Virtual Reality significantly reduced chronic TMJ pain compared to Maitland mobilization (p<0.05). Virtual Reality demonstrated superior pain reduction with MMO improvement on day 14 and 28 post-treatments while UW-QOL showed improvement on day 28 post-treatments (p<0.05) compared with Maitland mobilization.

Conclusions: Virtual Reality can significantly improve chronic TMJ pain, MMO, and UW-QOL with cervicofacial burn patients compared to standard Maitland Mobilization.