Pathophysiology and rehabilitation treatment strategies for chronic myalgia: Exercise therapy as the first-line treatment for chronic pain

Abstract

Masticatory muscle pain is a chronic myalgia, and the main pathological condition is myofascial pain involving a nociceptive mechanism in the peripheral muscles, a pain perception mechanism in the central nervous system, and pain emotion/cognition. Since masticatory myalgia is presumed to include pathological conditions similar to other chronic myalgias and musculoskeletal pain, it is necessary to deal with not only local peripheral muscles, but also peripheral and central sensitization. Currently, exercise therapy, along with patient education, is positioned as the first-line treatment for chronic pain and is expected to bring about a high analgesic effect through the anti-nociceptive mechanism and central pain inhibitory system by various endogenous analgesic substances. The initial exercises prescribed are painless, short-term, and with low intensity and high frequency. Since exercise therapy has the potential to enhance the patient's own endogenous analgesic ability, it can be one of the fundamental treatments that can be introduced and actively utilized in the dental field.