Neurofeedback bzw. Biofeedback versus Aufbiss-Schienentherapie bei CMD-Patienten mit chronifizierter myogener Leitkomponente

The aim of this pilot study was to clarify whether the neurofeedback or biofeedback method (NeXus-10 with Biotrace+ software, Mind Media BV-NL) could be used on selected patients to achieve a more effective reduction in the discomfort suffered by patients with chronified CMD due to bruxism than by means of conventional occlusal splint therapy. In addition, it was to be determined on the basis of the RDC TMD to what extent the pre-existing chronic pain symptoms and depression suffered by the patients could be reduced overall, or to what extent the individual treatments could achieve some improvement in this regard. Methods: A total of 36 patients with chronic bruxism were randomized into the three treatment arms (neurofeedback and splint therapy, biofeedback and splint therapy and splint therapy only as a control group) within the framework of a prospective, randomised, three-arm parallel-group study. All patients received individually adjusted bite splint therapy before and during the study in order to filter out arthrogenic and occlusal factors in the symptoms evenly. The main results of the pilot study were the identification of significant differences in the neurofeedback (p=0.003) and biofeedback (p=0.015) method with regard to the "total myogenic score" (the primary target criterion), in comparison with splint therapy. While a significant relative reduction in the "total myogenic score" could only be confirmed for the biofeedback method (p=0.005), the absolute reductions in the biofeedback (p=0.019) and neurofeedback groups (p=0.024) were significant. Clinical diagnosis regarding the functional range and muscle pains ("secondary target criteria" of the RDC TMD, with clinical findings on Axis I) did not show any significant overall differences between the various treatment arms before and after treatment. It was only when comparing the vertical range of movement and the associated pain that the differences between neurofeedback and splint (p=0.016) as well as between biofeedback and splint (p=0.011) were significant. Contrary to expectations, the maximum active opening of the mouth, with the associated pain, showed a significant reduction in the maximum interincisal distance in the neurofeedback (p=0.003) and biofeedback (p=0.015) treatment groups. The evaluation of the RDC TMD Axis II (biopsychosocial components) did not result in any significant associations between the changes in the degree of "graded chronic pain severity" before and after treatment and the respective treatment arm. However, practically all the patients in the study presented as suffering from moderate to severe depression (8% "moderate" and 92% "severe" before treatment and 25% "moderate" and 75% "severe" after treatment). In the splint group, there were significant intra-individual differences between the scores for the modified "SCL-90-R" symptom checklist according to DEROGATIS before and after treatment (p=0.004). In the neurofeedback treatment arm, there were significant differences (p=0.015) for the unspecific physical symptoms. Unlike the splint therapy and neurofeedback treatment arms, the biofeedback treatment group did not show any significant associations between the results before and after treatment. As all three parallel groups had already received adjusted intra-oral bite splint therapy before and during the pilot study to filter out as many of the occlusal, somatoform or arthrogenic components of the symptoms, the evaluation of the present results may be based on the principal assumption that the changes in the target criterion achieved by neurofeedback or biofeedback (total myogenic score and RDC TMD, with Axis I and II findings) can indeed be attributed to the respective feedback method. In summary, both the biofeedback and the neurofeedback method may be used to achieve a more effective reduction in muscular hypertonicity in comparison to the occlusally oriented splint therapy. The neurofeedback method does not, however, enable a further improvement in the efficiency of the method in comparison to conventional biofeedback. Both feedback methods may, however, be regarded as suitable options for the treatment of CMD and may be incorporated into interdisciplinary and multi-modal treatment strategies at an early stage, or be taken into account within the framework of an interdisciplinary total treatment plan.