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Nocipoint Therapy Versus Standard Physical Therapy Using Electrical Stimulation in Treating Pain From TMJ Disorder

The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.
Verified August 2012 by National Taiwan University Hospital.
Recruitment status was:  Recruiting
Pain Cure Center, California
Information provided by (Responsible Party):
National Taiwan University Hospital Identifier:
First received: August 28, 2012
Last updated: NA
Last verified: August 2012
History: No changes posted
The purpose of this study is to measure the effect of nocipoint therapy on patients with temporomandibular joint disorders (TMD) and compare it with the effect of standard electrical stimulation therapy.

Condition Intervention
Temporomandibular Joint Disorders
Procedure: Nocipoint Therapy
Procedure: Physical Therapy

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Comparing the Effect of Typical Electrical Stimulation Therapy With Nocipoint Stimulation Therapy on TMD-Related Myofascial Pain

Resource links provided by NLM:

Further study details as provided by National Taiwan University Hospital:

Primary Outcome Measures:
  • Visual Analog Scale (VAS) for pain [ Time Frame: Measurements will be taken before and after each session, and at the follow-up, which is about 4 to 6 weeks after the last session ]

    VAS is measured before each treatment session and at the follow-up:

    1. VAS - overall
    2. VAS - most painful
    3. VAS - when biting hard food
    4. VAS - at maximal mouth opening range (MMO)
    5. VAS of pressure pain- measured at the three most painful pressure points.

    1,2, and 5 are also measured after each treatment session.

Secondary Outcome Measures:
  • Maximal mouth opening range (MMO) [ Time Frame: Measurements will be taken before and after each session, and at the follow-up, which is about 4 to 6 weeks after the last session ]
  • Quality of Life (QoL) [ Time Frame: Measurements will be taken before the first session and at the follow-up. ]

Estimated Enrollment: 90
Study Start Date: July 2012
Estimated Study Completion Date: March 2013
Estimated Primary Completion Date: December 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Nocipoint Therapy

Nocipoint therapy (NT) follows rules of TENS stimulation in each session, all within the general FDA guidelines of TENS uses. The key points of Nocipoint Therapy include the following:

  • The stimulation pads are located at the skin surface location of the nociceptors of the muscle/tissue in pain (i.e., "Nocipoint")
  • The intensity is set to induce C-fiber response during the stimulation
  • The duration of stimulation (about 1.5-4 minutes for each tissue stimulation)
  • Stimulations for different tissues (muscles, ligaments) are sequenced such that later stimulations will not cause re-injury of previously treated tissues.
  • Patient are instructed not to use the newly recovered muscle/tissue too much for an estimated "rest period" depending on his/her age.
Procedure: Nocipoint Therapy
Other Name: Charles Koo's Pain Cure Therapy
Active Comparator: Physical Therapy

Patients in this group will be treated with comprehensive physical therapy program including typical electrical stimulation using a standard transcutaneous electrical nerve stimulation (TENS) device, manual myofascial release and postural correction exercise.

The application of TENS will follow general physical therapy guidelines, especially for TMD. Manual myofacial release will be applied on orofacial muscles and neck muscles.

TENS will serve both as a part of the standard of care and as placebo, as the same TENS device is used in both arms.

Procedure: Physical Therapy

Detailed Description:

The prevalence of temporomandibular disorders (TMD) is about 20% to 60% of dental patients. Most patients suffer from myofascial pain (MFP) subtype of TMD. Analgesics, local muscle injection or oral appliance are often used to treat TMD-related MFP. Patients are also referred to physical therapists frequently. Many physical therapy (PT) modalities and techniques are applied to these patients, including non-invasive transcutaneous electrical nerve stimulation (TENS) using TENS devices. However, the exact application of TENS devices, including the location of the stimulation, duration and intensity of stimulation, is largely decided by physical therapists. Nocipoint Therapy, a unique combination of precise location, duration and intensity of TENS has been found to substantially relieve general myofascial pain and recover the muscle function with lasting effect.

In preliminary observations of clinical applications, Nocipoint Therapy has been found to rapidly and substantially relieve TMD-related MFP within 2-3 sessions of the treatment.

This clinical study compares the effect of Nocipoint Therapy on TMD with that of standard Physical therapy (PT). TENS will be used in the control group both as a part of the standard of care (i.e., PT) and as placebo.


Ages Eligible for Study:   20 Years to 65 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • 20-65 years old female or male
  • Diagnosed as MFP subtype of TMD according to RDC/TMD
  • Pain duration over 3 month
  • Tender point in masseter
  • Asymmetrical pain intensity
  • Subsided symptoms of joint inflammation

Exclusion Criteria:

  • Traumatic TMD from external impact force
  • History of traumatic cervical injury
  • Presence of systemic disease
  • Fibromyalgia
  • Co-interventions for cervical problems or TMD during study period
  • Signs of psychosomatic illness
  • Unwilling to be randomized
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01676129

Contact: Wan-Ling Kuo, BS +886-0919-306-856
Contact: Charlie Koo, PhD +1-6504248818

National Taiwan University Hospital Recruiting
Taipei, Taiwan
Contact: Wan-Ling Kuo, BS    +886-0919-306-856   
Contact: Charles C. Koo, PhD    +1-650-996-8168   
Principal Investigator: Alex YJ Chen, DDS, PhD         
Principal Investigator: Charles C Koo, PhD         
Principal Investigator: Jau-Yih Tsauo, PhD         
Sponsors and Collaborators
National Taiwan University Hospital
Pain Cure Center, California
Principal Investigator: Alex YJ Chen, DDS, PHD National Taiwan University
Principal Investigator: Charles C Koo, PhD National Taiwan University and Pain Cure Center California
Principal Investigator: Jau-Yih Tsauo, PhD National Taiwan University
  More Information

Additional Information:
Responsible Party: National Taiwan University Hospital Identifier: NCT01676129     History of Changes
Other Study ID Numbers: 101R104054-TMJ
Study First Received: August 28, 2012
Last Updated: August 28, 2012

Keywords provided by National Taiwan University Hospital:
temporomandibular joint disorders
physical therapy

Additional relevant MeSH terms:
Joint Diseases
Temporomandibular Joint Disorders
Temporomandibular Joint Dysfunction Syndrome
Musculoskeletal Diseases
Craniomandibular Disorders
Mandibular Diseases
Jaw Diseases
Muscular Diseases
Stomatognathic Diseases
Myofascial Pain Syndromes processed this record on April 25, 2017