Comparative effect of virtual reality and Galvanic Skin Response Biofeedback on Pain and Disfunction Among TMJ

Aim:TocomparetheeffectivenessofVirtualReality(VR)-basedtrainingandGalvanicSkin Response (GSR) biofeedback on pain and dysfunction in temporomandibular joint (TMJ) disorder.Background:Temporomandibular joint (TMJ) disorders are common musculoskeletal conditions characterizedbyjawpain,restrictedmouthopening,andfunctionallimitationsthatcan significantly affect oral activities. Nonpharmacological interventions that target both physiologicalandpsychologicalcontributorstopainhavethereforegainedimportance inTMJmanagement.Galvanicskinresponse(GSR)biofeedbackisaneuromodulator technique that trains patients to recognize and voluntarily regulate autonomic arousal relatedtostress,helpingthemreducemuscletensionandpainintensity.Virtualreality (VR)-based therapy, a newer cognitive behavioral and sensory distraction approach, hasshownbeneficialeffectsinreducingTMJpain,improvingmaximalmouthopening, and enhancing quality of life by increasing engagement and modulating pain-related attention and emotion.Methodology:Apre-testandpost-testexperimentalcomparativestudywasconductedover4months atACSMedicalCollegeandHospitalon30participantsaged18–65yearsdiagnosed withtemporomandibularjoint(TMJ)dysfunction.Participantswererandomlyassigned into two groups: Group A (Virtual Reality Therapy) and Group B (Galvanic Skin Response Biofeedback), with 15 subjects in each group. Both groups underwent intervention for 10 days, 5 sessions per week, with each session lasting 15 minutes undertherapistsupervision.OutcomemeasuresincludedtheDigitalAlgometer [DA]for Pressure Pain Threshold (PPT) and the Mandibular Function Impairment Questionnaire(MFIQ),alongwithassessmentofjawrangeofmotion,includingmouth opening,lateralexcursion,andprotrusion.GroupAreceivedVR-basedrelaxationand jaw movement exercises using immersive audiovisual environments, while Group B received GSR biofeedback therapy. The study aimed to reduce pain and muscle tension associated with temporomandibular joint dysfunction.Results:Both groups, A (Virtual Reality) and B (GSR Biofeedback), experienced statistically highly significant effects in their level of pain and dysfunction after the treatment program(P≤0.001). GroupAhadbettereffectsasDAscoresincreasedfrom2.39to 3.44 and MFIQ scores decreased from 44.93 to 33.86, while group B DA scores increasedfrom2.33to3.43andMFIQscoresdecreasedfrom46.20to34.26.Between groups' analysis indicated that Virtual Reality is a significantly more effective method than GSR Biofeedback when reducing pain andenhancing mandibular dysfunction in TMD patients.