Efficacy of Duloxetine and Amitriptyline along with Arthrocentesis In The Management of Temporomandibular Joint Disorders

Temporomandibular Joint Disorders (TMDs) are musculoskeletal conditions affecting the temporomandibular joint (TMJ), commonly resulting in pain, limited mouth opening, joint sounds, and psychological distress. This study aimed to evaluate and compare the efficacy of Duloxetine and Amitriptyline as adjuncts to arthrocentesis in the management of TMD. A total of 10 patients diagnosed with early-stage internal derangement of the TMJ (Wilkes Stage II and III) were randomly divided into two groups. Group I underwent arthrocentesis followed by Duloxetine 20 mg twice daily for 15 days, while Group II received arthrocentesis followed by Amitriptyline 25 mg twice daily for the same duration. Clinical parameters such as pain (VAS score), maximum mouth opening, TMJ clicking, lateral mandibular movement, and psychological status (Hospital Anxiety and Depression Scale) were evaluated preoperatively, and at the 7th day and 4th week postoperatively. Both groups showed improvement in symptoms, but Group I demonstrated significantly better outcomes in pain reduction (p = 0.021), increased mouth opening (p = 0.016), and decreased anxiety levels (p = 0.021) at the 4th week. No significant difference was noted between the groups in terms of TMJ clicking and lateral movement. The results suggest that arthrocentesis combined with Duloxetine is more effective than when combined with Amitriptyline in managing TMD symptoms. However, larger studies with extended follow up are needed to further substantiate these findings.