Thanks to advances in neuroscience, biopsychosocial models for diagnostics and treatment (including physical, psychological, and pharmacological therapies) currently have more clinical support and scientific growth. At present, a conservative treatment approach prevails over surgery, given it is less aggressive and usually results in satisfactory clinical outcomes in mild–moderate temporomandibular disorder (TMD). The aim of this review is to evaluate the recent evidence, identify challenges, and propose solutions from a clinical point of view for patients with craniofacial pain and TMD. The treatment we propose is structured in a multimodal approach based on a biobehavioral approach that includes medical, physiotherapeutic, psychological, and dental treatments. We also propose a new biobehavioral model regarding pain perception and motor behavior for the diagnosis and treatment of patients with painful TMD.

Objective: Telerehabilitation is an option that should be adapted as soon as possible to face the crisis caused by coronavirus disease 2019. An umbrella and mapping review with meta–meta-analysis (MMA) of the available scientific evidence was performed to determine whether telerehabilitation could be an effective alternative to conventional rehabilitation in physical therapist practice. Methods: A systematic review of reviews and a synthesis of the findings of all systematic evidence published to date with a visual map and a meta–meta-analysis (MMA) were performed. A systematic search was realized in Cochrane Database of Systematic Reviews, MEDLINE (PubMed), and Google Scholar. Two independent reviewers performed a data analysis and assessed the quality of the included reviews, assessing the risk of bias using ROBIS. Results: Twenty-nine articles that met the inclusion criteria were selected and divided according to the type of patient targeted for rehabilitation (patients with cardiorespiratory, musculoskeletal, and neurological conditions). The MMA regarding physical function between telerehabilitation and usual care rehabilitation did not reveal a statistically significant difference for patients with cardiorespiratory and musculoskeletal conditions. For patients with neurological conditions, the MMA revealed a statistically significant but negligible effect size in 6 reviews in favor of telerehabilitation (standardized mean difference = 0.18; 95% CI = 0.03–0.34). Conclusion: The results of the present review showed that telerehabilitation offers positive clinical results, even comparable to conventional face-to-face rehabilitation approaches. Impact: The advantages of lower cost and less interference by the rehabilitation processes in patients’ daily life could justify implementing telerehabilitation in clinical settings in the coronavirus disease 2019 era.

The aims were to investigate the effects of anterior-posterior upper cervical mobilization (APUCM) on pain modulation in craniofacial and cervical regions and its influence on the sympathetic nervous system. Thirty-two patients with cervico-craniofacial pain of myofascial origin were randomly allocated into experimental or placebo groups. Each patient received 3 treatments. Outcome measures included bilateral pressure pain thresholds assessed at craniofacial and cervical points preintervention, after the second intervention and after the final treatment. Pain intensity and sympathetic nervous system variables (skin conductance, breathing rate, heart rate, and skin temperature) were assessed before and immediately after each intervention. The pressure pain thresholds in the craniofacial and cervical regions significantly increased (P<0.001) and pain intensity significantly decreased (P<0.001) in the treatment group compared with placebo. APUCM also produced a sympathoexcitatory response demonstrated by a significant increase in skin conductance, breathing rate, and heart rate (P<0.001), but not in skin temperature (P=0.071), after application of the technique compared with placebo. This study provided preliminary evidence of a short-term hypoalgesic effect of APUCM on craniofacial and cervical regions of patients with cervico-craniofacial pain of myofascial origin, suggesting that APUCM may cause an immediate nociceptive modulation in the trigeminocervical complex. We also observed a sympathoexcitatory response, which could be related to the hypoalgesic effect induced by the technique, but this aspect should be confirmed in future studies.

The aim of this study was to determine the effectiveness of a multimodal treatment in the short and medium term for disability in nonspecific chronic neck pain. The design of this study is a single-blinded randomized controlled trial carried out in a university research laboratory. Forty-five patients between 18 and 65 yrs with nonspecific chronic neck pain were included in this study. Each patient was treated eight times over a 4-wk period. The sample was divided into three groups: control group, subjected to a protocol of manual therapy; experimental group 1, subjected to a protocol of manual therapy and therapeutic patient education; and experimental group 2, subjected to manual therapy, therapeutic patient education, and a therapeutic exercise protocol. Assessments were performed at baseline and at 4, 8, and 16 wks using the following measurements: the Neck Disability Index, the 11-item Tampa Scale of Kinesiophobia, the Fear Avoidance Beliefs Questionnaire, the Neck Flexor Muscle Endurance Test, and the Visual Analog Fatigue Scale. The nonparametric Kruskal-Wallis test for the Neck Disability Index showed statistically significant differences between baseline outcomes and all follow-up periods (P < 0.01). In the Kruskal-Wallis test, differences were found for the Visual Analog Fatigue Scale and the Neck Flexor Muscle Endurance Test in the follow-ups at 8 and 16 wks (P < 0.05). Analysis of variance for group × time interaction showed statistically significant changes (Tampa Scale of Kinesiophobia, F = 3.613, P = 0.005; Fear Avoidance Beliefs Questionnaire, F = 2.803, P = 0.022). Minimal detectable changes were obtained in both experimental groups for the 11-item Tampa Scale of Kinesiophobia but not in the control group. Differences between experimental groups and the control group were found in the short and medium term. A multimodal treatment is a good method for reducing disability in patients with nonspecific chronic neck pain in the short and medium term.