Effect of Δ9-tetrahydrocannabinol and cannabidiol on myofascial pain modulation in patients with temporomandibular disorder: a prospective crossover study
Francisco Gomes Bonetto Schinko 1, Luiz Renato Paranhos 2, Lucas Gonçalves de Sousa 3, Gabriel Phelipe de Paula Santos 3, Sigmar de Mello Rode 4, Antonio Sergio Guimarães 5, Juliana Cama Ramacciato 6
- 1Postgraduate Program in Pain and Temporomandibular Disorders, Faculdade São Leopoldo Mandic, Campinas, SP, Brazil.
- 2Department of Orthodontics, School of Dentistry, Universidade Federal de Uberlândia (UFU), Uberlândia, MG, Brazil. Electronic address: paranhos.lrp@gmail.com.
- 3Postgraduate Program in Dentistry, Faculty of Dentistry, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.
- 4Department of Dental Materials and Prosthesis, Science and Technology Institute, Universidade Estadual Paulista, São José dos Campos, SP, Brazil.
- 5Experimental Pain Laboratory, Faculdade São Leopoldo Mandic, Campinas, SP, Brazil.
- 6Division of Pharmacology, Anesthesiology, and Therapeutics, Faculdade São Leopoldo Mandic, Campinas, SP, Brazil.
Affiliationer
Background: Temporomandibular Disorder (TMD) often causes chronic orofacial pain and functional limitations, with conventional treatments providing suboptimal results. Phytocannabinoids such as Δ9-Tetrahydrocannabinol (Δ9-THC) and Cannabidiol (CBD) have analgesic and anti-inflammatory properties, but evidence in TMD is scarce.
Objective: To evaluate the efficacy of Δ9-THC/CBD therapy in reducing pain and improving mandibular function in TMD patients.
Methods: Twenty adults with chronic myofascial pain (DC/TMD diagnosis) participated in a blinded, crossover, non-randomized study. Participants underwent two consecutive 90-day phases: placebo followed by Δ9-THC/CBD therapy (1:1 ratio, starting with a dose of 2 mg/day in the first week, gradually adjusting an increase of 2 mg/week until reaching 10 mg/day in the fifth week, sublingually), without washout. Outcomes included pain intensity (VAS), muscle sensitivity (algometry), mandibular function (mouth opening, protrusion, laterality) and pain sensitivity (allodynia/hyperalgesia). Data were analyzed using linear mixed models for repeated measures.
Results: Δ9-THC/CBD improved all outcomes versus baseline and post-placebo (p < 0.001; Cohen’s d > 0.8). Mouth opening increased from 45.9 mm to 49.9 mm; VAS pain decreased from 7.35 to 3.50. Functional pain dropped by ∼90%, with near elimination of allodynia and hyperalgesia. Placebo effects were minimal.
Conclusion: Δ9-THC/CBD therapy provided substantial analgesic and functional benefits in TMD patients, supporting its potential as a therapeutic alternative. Larger randomized studies are recommended to validate these findings and explore underlying mechanisms.
