Myorelaxant Effect of Transdermal Cannabidiol Application in Patients with TMD : A Randomized, Double-Blind Trial, Aleksandra Nitecka-Buchta et al., 2019

Myorelaxant E ffect of Transdermal Cannabidiol Application in Patients with TMD : A Randomized, Double-Blind Trial

Aleksandra Nitecka-Buchta, Anna Nowak-Wachol, KacperWachol, KarolinaWalczynska-Dragon, Paweł Olczyk, Olgierd Batoryna, Wojciech Kempa and Stefan Baron

Journal of Clinical Medicine, 2019, 8, 188, 1-17.

doi : 10.3390/jcm8111886


Background : The healing properties of cannabidiol (CBD) have been known for centuries. In this study, we aimed to evaluate the efficiency of the myorelaxant e ffect of CBD after the transdermal application in patients with myofascial pain.

Methods : The Polish version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD Ia and Ib) was used. A total of 60 patients were enrolled in the study and were randomly divided into two groups: Group1 and Group2. The average age in Group1 was 23.2 years (SD) = 1.6 years) and in Group2, it was 22.6 years (SD = 1.86). This was a parallel and double-blind trial. Group1 received CBD formulation, whereas Group2 received placebo formulation for topical use. The masseter muscle activity was measured on days 0 and 14, with surface electromyography (sEMG) (Neurobit Optima 4, Neurobit System, Gdynia, Poland). Pain intensity in VAS (Visual Analogue Scale) was measured on days 0 and 14.

Results : in Group1, the sEMG masseter activity significantly decreased (11% in the right and 12.6% in the left masseter muscles). In Group2, the sEMG masseter activity was recorded as 0.23% in the right and 3.3% in the left masseter muscles. Pain intensity in VAS scale was significantly decreased in Group1: 70.2% compared to Group2: 9.81% reduction. Patients were asked to apply formulation twice a day for a period of 14 days.

Conclusion : The application of CBD formulation over masseter muscle reduced the activity of masseter muscles and improved the condition of masticatory muscles in patients with myofascial pain.

Keywords : cannabidiol; CBD; myofascial Pain; TMD; bruxism; EMG; masseter muscle


1. Introduction

Nowadays, dental practitioners are more obliged to treat patients suff ering from myofascial pain (MFP). The main syndrome, which forces patients to search for medical help, is face and neck pain, headache and pain in the ear. Bruxism, the common sleep disorder and parafunctional activity of the masticatory system, may be considered one of the major causes of tooth wear and masticatory muscles MFP. Bruxis —determined by an increased activity of the limbic system, together with the modification of excitability of the neuromuscular spindles, leading to an increase in muscle contraction strength, which persists despite the end of motor function—constitutes a risk factor for the development of temporomadibular disorders (TMD). Bruxism is a common phenomenon that can a ffect from 8 to even 31% of the population without significant di erences in relation to sex. Depending on the time of occurrence, we can distinguish awake bruxism (AB) and sleep bruxism (SB) [1]. AB is a masticatory muscle activity during wakefulness that is characterized by repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible and is not a movement disorder in otherwise healthy individuals [2]. SB is a masticatory muscle activity during sleep that is characterized as rhythmic (phasic) or non-rhythmic (tonic) and is not a movement disorder or a sleep disorder in otherwise healthy individuals [2]. In addition, bruxism in the waking state is referred to as “centric”, characterized by vertical loading of teeth, while bruxism during sleep is referred to as “eccentric” characterized by horizontal displacement of teeth and grinding during sleep. SB can occur in about 13% of the adult population. In childhood, this adverse phenomenon has the highest frequency, 14–20%, and this decreases with age, reaching 3% among older people [3]. Myofascial pain (MFP) within masseter muscles is a common disorder. Excessive muscle e ffort in bruxers may develop muscle pain. The main syndrome of myofascial pain is a trigger point: a hard, painful on compression, palpable, localized nodule. Myofascial pain is a symptom of muscle damage. Energy crisis is the reason for the initial sarcomere contracture, that leads to increased metabolism and local hypoxia, muscle damage and inflammatory mediators release. Contraction knots are formed, as an eff ect of local injury, ischemia and fiber lock. The blood flow around and within the trigger point is reduced. Current approaches for trigger point management are needling, injections and deep massage. Recently, there has been a heated debate regarding the controversial issue on the legalization of marijuana for medical purposes. The leaves of marijuana along with the blossoms and the fruiting tips of hemp are rich in tetrahydrocannabinol (THC). Cannabis sativa L. is known to contain more than 565 chemical compounds that belong to di erent groups, such as flavonoids, dihydrostilbens, phenanthrenes and the most characteristic for this plant—cannabinoids, mainly psychoactive THC, cannabidiol (CBD), and cannabinol (CBN) [4,5]. The above-mentioned constituents—occurring in the number of 120 active, mainly represented by psychoactive D9-tetrahydrocannabinol (THC), cannabidiol (CBD) and cannabinol (CBN)—belong to the C21 or C22 terpenophenolic group of compounds synthesized by the alkylation of resorcinol with a monoterpene unit [6]. The content of individual phytocanabinoids in the plant raw material depends on the growing conditions, geographical location, plant processing methods and the plant variety or chemotype which automatically a ects the pharmacological e ect of the cannabis extract [7]. Psychoactive e ect of THC limits its use in clinical practice.