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Published on: June 2, 2014
Effect of comorbid migraine on propranolol efficacy for painful TMD in a randomized controlled trial
Inna E Tchivileva1,2, Richard Ohrbach3, Roger B Fillingim4
1Center for Pain Research and Innovation, Adams School of Dentistry, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Introduction:
The migraine-preventive drug propranolol is efficacious in reducing pain from temporomandibular disorder, suggesting potential modifying or mediating effects of comorbid migraine.
Methods:
In this randomized controlled trial, myofascial temporomandibular disorder patients were treated with propranolol or placebo for 9 weeks. The primary endpoint was change in a facial pain index derived from daily symptom diaries. Linear and logistic regression models tested for a migraine × treatment-group interaction in reducing facial pain index. Counterfactual models explored changes in headache impact and heart rate as mediators of propranolol's efficacy.
Results:
Propranolol's efficacy in reducing facial pain index was greater among the 104 migraineurs than the 95 non-migraineurs: For example, for the binary ≥ 30% reduction in facial pain index, odds ratios were 3.3 (95% confidence limits: 1.4, 8.1) versus 1.3 (0.5, 3.2), respectively, although the interaction was statistically non-significant (p = 0.139). Cumulative response curves confirmed greater efficacy for migraineurs than non-migraineurs (differences in area under the curve 26% and 6%, respectively; p = 0.081). While 9% of the treatment effect was mediated by reduced headache impact, 46% was mediated by reduced heart rate.
Conclusions:
Propranolol was more efficacious in reducing temporomandibular disorder pain among migraineurs than non-migraineurs, with more of the effect mediated by reduced heart rate than by reduced headache impact.
Study Identification And Registration:
SOPPRANO; NCT02437383; https://clinicaltrials.gov/ct2/show/NCT02437383.
Insights
Propranolol effectively reduced temporomandibular disorder pain, especially in patients with comorbid migraine. Reduced heart rate significantly mediated this pain relief more than headache impact.
Area of Science:
- Neurology
- Pain Management
- Clinical Trials
Background:
- Temporomandibular disorder (TMD) is a common condition causing facial pain.
- Comorbid migraine may influence TMD treatment outcomes.
- Propranolol, a migraine-preventive drug, is investigated for TMD efficacy.
Purpose of the Study:
- To evaluate the efficacy of propranolol in reducing TMD pain.
- To explore the role of comorbid migraine in propranolol's effectiveness.
- To identify mediators of propranolol's therapeutic effects in TMD.
Main Methods:
- A 9-week randomized controlled trial (RCT) involving patients with myofascial TMD.
- Treatment arms included propranolol or placebo.
- Facial pain index, headache impact, and heart rate were primary and secondary outcome measures.
Main Results:
- Propranolol demonstrated greater efficacy in reducing TMD pain among migraineurs compared to non-migraineurs.
- The treatment effect was significantly mediated by reduced heart rate (46%) and, to a lesser extent, by reduced headache impact (9%).
Conclusions:
- Propranolol is a potentially effective treatment for TMD pain, particularly in individuals with co-occurring migraines.
- Heart rate reduction is a key mediator of propranolol's efficacy in managing TMD pain.
