Percorrer por autor "Poluha, Rodrigo Lorenzi"
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- Botulinum toxin type A for the prevention of migraines : an umbrella review of systematic reviewsPublication . Chamani, Goli; Jasim, Hajer; Minston, Ava; Dias, Marlon Ferreira; Poluha, Rodrigo Lorenzi; Gonçalves, Daniela A. Godoi; Christidis, Maria; Al-Moraissi, Essam Ahmed; Christidis, Nikolaos; Canales, Giancarlo De la Torre; Ernberg, MalinBotulinum toxin type A (BoNT-A) is an established preventive therapy for chronic migraines; however, uncertainty remains regarding its comparative efficacy and safety. Thus, we aimed to summarize current evidence from high-quality systematic reviews of the therapeutic effects of BoNT-A in migraine management. An umbrella review was conducted following PRISMA guidelines and registered in PROSPERO. High-quality systematic reviews with meta-analysis evaluating BoNT-A efficacy were identified through five databases up to August 2024. Primary outcomes included monthly headache frequency and severity. Methodological quality and risk of bias were assessed using the umbrella review checklist. Fourteen articles were included. Overall, quantitative evidence indicated favorable effects of BoNT-A compared with placebo for chronic migraines, across headache frequency, headache severity, and acute medication use, but less efficacy than topiramate and the CGRP monoclonal antibodies (CGRPmAbs) galcanezumab and fremanezumab. Though the adverse events were frequent, BoNT-A was generally well-tolerated. Comparative data suggested superior tolerability versus topiramate and a safety profile like CGRPmAbs. Although botulinum toxin type A is widely used as a preventive treatment for chronic migraines, the available evidence supports its efficacy at a moderate level. Further head-to-head and long-term analyses are needed to clarify its comparative role alongside newer biologic treatments.
- Botulinum toxin type A for trigeminal and postherpetic neuralgia : an umbrella review of systematic reviewsPublication . Canales, Giancarlo De la Torre; Dureisseix, Marie-Amélie; Santos, Thiago Germano dos; Cebola, Pedro Miguel Teixeira Carvas; Nascimento, Glauce Crivelaro do; Foscaldo, Tatiana; Poluha, Rodrigo Lorenzi; Durham, Justin; Christidis, NikolaosBackground and Objective: Trigeminal neuralgia (TN) and postherpetic neuralgia (PHN) are severe peripheral neuropathic pain conditions associated with substantial functional impairment. Although pharmacological treatments are available, many patients experience insufficient efficacy or poor tolerability. Botulinum toxin type A (BoNT-A) has emerged as a potential treatment, but uncertainties remain regarding its efficacy, safety, and clinical positioning. This umbrella review aimed to synthesise evidence from systematic reviews evaluating BoNT-A in TN and PHN. Methods: A systematic search was conducted in MEDLINE, Embase, Cochrane Library, Web of Science, and CINAHL from inception to November 2025. Systematic reviews with or without meta-analysis evaluating BoNT-A in adults with TN or PHN were included. Methodological quality was assessed using AMSTAR-2, and only moderate- or high-quality reviews were included. Primary outcomes were pain intensity reduction and responder rates (≥ 50% pain reduction). Secondary outcomes included quality of life and adverse events. Results: Ten systematic reviews (2015–2024) met the inclusion criteria. Botulinum toxin type A was consistently associated with reductions in pain intensity and higher responder rates than placebo, particularly in TN. In PHN, evidence was more limited but supported short-term (1–3 months) improvements in pain intensity. Evidence on quality of life was scarce and inconclusive. Botulinum toxin type A was well tolerated, with mostly mild and transient adverse events. Conclusions: Botulinum toxin type A appears to provide short-term pain relief in selected patients with TN and PHN and is generally well tolerated. Current evidence supports its role as an adjunctive third-line option for focal peripheral neuropathic pain, although heterogeneity and limited long-term data warrant cautious interpretation.
- Botulinum toxin-A effects on pain, somatosensory and psychosocial features of patients with refractory masticatory myofascial pain : a randomized double-blind clinical trialPublication . Canales, Giancarlo De la Torre; Poluha, Rodrigo Lorenzi; Bonjardim, Leonardo Rigoldi; Ernberg, Malin; Conti, Paulo César RodriguesThe antinociceptive effect of BoNT-A have been well documented in animal studies; however, results of few but well-designed randomized placebo-controlled clinical trials about BoNT-A efficacy in masticatory myofascial pain (MFP) are inconsistent. Therefore, the present randomized, double-blind, placebo-controlled clinical trial evaluated the efficacy of BoNT-A in patients with refractory MFP. Twenty-eight patients with pain reduction of less than 30% despite conservative treatment and with an average pain intensity of > 50 mm on the visual analogue scale (VAS) participated. Patients were randomly assigned to receive a total of 80 U of BoNT-A or saline solution (SS) injected into the masseter and anterior temporalis muscles. Pain intensity (VAS), quantitative sensory testing (QST), conditioned pain modulation (CPM), and psychosocial status were examined. Follow-up was performed at 1 and 6 months. For repeated-measure comparisons between evaluation times, Friedman test with Bonferroni correction was used for pain and somatosensory variables and the Wilcoxon test for the psychosocial variables. The Mann–Whitney test was used for all comparisons between groups. The BoNT-A group had a significant decrease in pain intensity at follow-ups compared with the SS group (p < 0.001). QST assessment revealed higher pressure pain threshold values in the masseter muscle for BoNT-A group compared to SS (p < 0.03) at all follow-ups. No differences were found for mechanical pain threshold and wind-up ratio values (p > 0.05) in the entire study. The BoNT-A group presented the most efficient CPM effect (p < 0.03) only at the 1 month follow-up in the masseter muscle. There was a significant time effect for BoNT-A in all psychosocial variables (p < 0.05) and a drug effect in the Central Sensitization Inventory (p < 0.01), Pittsburgh Sleep Quality Index (p < 0.004), and Healthy Survey 36 (p < 0.05) at 6 months follow-up. The study demonstrates that a single injection-session of BoNT-A has positive effects on the hall pain spectrum of patients with refractory masticatory myofascial pain.
- Botulinum toxin-A for the treatment of myogenous temporomandibular disorders : an umbrella review of systematic reviewsPublication . Canales, Giancarlo De la Torre; Câmara-Souza, Mariana Barbosa; Ernberg, Malin; Al-Moraissi, Essam Ahmed; Grigoriadis, Anastasios; Poluha, Rodrigo Lorenzi; Christidis, Maria; Jasim, Hajer; Lövgren, Anna; Christidis, NikolaosObjective: Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs. Method: An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisal checklist developed by the umbrella review methodology working group. Only high-quality SRs were included. Results: In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments. Conclusion: The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.
- Can poor nutrition and diet influence temporomandibular disorder? A systematic reviewPublication . Lima, Flávio Fidêncio de; Razavian, Artin; Hosokawa, Mai; Foscaldo, Tatiana Ferreira; Koldzo, Melisa; Poluha, Rodrigo Lorenzi; Christidis, Maria; Christidis, Nikolaos; Canales, Giancarlo De la TorreBackground: The relationship between diet, nutrition, and painful temporomandibular disorders (TMD) is not well established, despite increasing interest in lifestyle factors in chronic pain. This systematic review aimed to synthesize available evidence on how dietary patterns and nutritional status may be associated with painful TMD. Methods: An electronic search was conducted in the databases MEDLINE, CINAHL, EMBASE, the Cochrane Central Registry of Controlled Trials (CENTRAL) and Web of Science for clinical and observational trials from the beginning of each database to November 2025. Risk of bias was performed using the Study Quality Assessment Tools from the National Heart, Lung, and Blood Institute (NHLBI). Results: Out of 7,760 records and after the risk of bias assessment, only seven studies judged as having a low risk of bias were included. Overall, the included studies indicate that the association between dietary factors and TMD remains unclear. Prospective cohort studies did not demonstrate that prenatal or adolescent diet quality independently predicted TMD. Cross-sectional studies suggested that specific dietary patterns may be related to TMD-related symptoms. Women with myogenous TMD showed lower intake of several nutrients compared with controls. Experimental evidence indicated that monosodium glutamate ingestion increased pain intensity in myofascial TMD, while the only randomized trial found no significant pain differences between vitamin D supplementation and diclofenac. Conclusions: Current evidence suggests that some dietary components and nutritional factors may be associated with TMD-related symptoms or pain responses; however, the findings are limited, heterogeneous, and insufficient to support firm causal or therapeutic conclusions.
- Cognitive and orofacial intersections : prevalence of temporomandibular disorders and bruxism in individuals with symptoms of attention deficit hyperactivity disorderPublication . Caron, Arthur Alexis Valentin; Poluha, Rodrigo Lorenzi; Dias, Marlon Ferreira; Flores, Dyanne Medina; Sanchéz-Ayala, Alfonso; Durham, Justin; Canales, Giancarlo De la TorreObjective: Despite emerging evidence pointing to a comorbidity between temporomandibular disorders (TMD), bruxism, and neuropsychiatric conditions such as Attention-Deficit/Hyperactivity Disorder (ADHD), limited studies have explored this relationship in adult populations. This study aimed to investigate the prevalence of painful TMD and self-reported bruxism in adults with highly consistent ADHD symptoms. Methodology: In total, 90 adult participants were divided into two groups based on the Adult ADHD Self-Report Scale Screener, G1: individuals with highly consistent ADHD symptomatology (n=60), and G2: controls (n=30). All participants completed validated instruments assessing TMD (TMD Pain Screener), self-reported bruxism (OBC), anxiety (GAD-7), somatization (PHQ-15), perceived stress (PSS), sleep quality (PSQI), pain hypervigilance (PVAQ), and jaw function (JFLS-8). The chi-square test, adjusted using Bonferroni criteria for multiple comparisons, and the Mann-Whitney U-test were used. Results: A higher prevalence of women (p=0.006), South Americans (p=0.008), and individuals with low/lower middle income (p=0.0001) was found in G1. G1 showed a significantly higher prevalence of painful TMD (p=0.001) and awake bruxism (p=0.013) compared to G2. Participants in G1 also exhibited significantly higher levels of anxiety, somatization, stress, poor sleep quality, pain hypervigilance, and jaw limitation (p<0.05). No significant differences in sleep bruxism were found between groups (p>0.05). Conclusion: These findings suggest a potential behavioral and emotional vulnerability to orofacial disorders in adults with highly consistent ADHD symptoms.
- Comparing ready-to-use and powder abobotulinumtoxinA for glabellar lines : a randomized, controlled, triple-blinded clinical trialPublication . Silva Junior, Silvio Ventura da; Neves, Maria Luiza Boechat Borges; Sanchez-Ayala, Alfonso; Cebola, Pedro Miguel Teixeira Carvas; Carbone, Ana Claudia; Câmara-Souza, Mariana Barbosa; Poluha, Rodrigo Lorenzi; Canales, Giancarlo De la TorreBackground: Botulinum toxin A (BoNT-A) is the most used procedure to treat glabellar lines; however, limited data exist about the effectiveness of ready-to-use BoNT-A (RTUaboBoNT-A) for this indication. Aims: This study compared the efficacy, durability, and safety of RTUaboBoNT-A for moderate and severe glabellar wrinkles. Methods: This randomized triple-blinded trial included 38 male volunteers aged between 25 and 50 years. Participants were randomly divided into two groups: abobotulinumtoxinA (aboBoNT-A, n = 18) and RTUaboBoNT-A (n = 20). Groups received 10 U for procerus muscle and 20 U for the corrugator muscle. Assessed variables included, electromyography activity (EMG), Merz 5-point glabellar lines scale, FACE-Q appraisal for lines between the eyebrows and Visual Analogue Scale for pain intensity. Assessments were performed before and 1, 2, 3, and 4 months after injections. For differences in EMG and satisfaction scores, the two-way repeated-measures ANOVA and Bonferroni's post hoc analyses were conducted. Wrinkle severity scores were analyzed with the chi-squared test. Results: Inter-group comparisons revealed no significant differences in EMG scores in all assessed periods for the corrugator supercili (p = 0.11) and the procerus muscles (p = 0.93); for severity of glabellar lines, no significant differences were also found in all follow-ups for rest (p = 0.737) and contracted position (p = 0.390), as well as for satisfaction with the treatments. However, the RTUaboBoNT-A group presented higher levels of pain intensity during the injection procedure (p = 0.01). Conclusion: The RTUaboBoNT-A and aboBoNT-A are comparable in efficacy, durability, and safety.
- Efficacy and safety of poly-l-lactic acid in facial aesthetics : a systematic reviewPublication . Signori, Roberta; Barbosa, Antony de Paula; Cezar-dos-Santos, Fernando; Carbone, Ana Claudia; Ventura, Silvio; Nobre, Bryanne Brissian de Souza; Neves, Maria Luiza Boechat Borges; Câmara-Souza, Mariana Barbosa; Poluha, Rodrigo Lorenzi; Canales, Giancarlo De la TorreThe primary objective of this systematic review study was to investigate the effectiveness, durability, and adverse events of PLLA treatment for aesthetic indications. The search strategy was performed in MEDLINE (Ovid). The electronic literature search of five databases was performed, from the inception of the databases until the 12th of February 2024. This was to identify randomized clinical trials that assessed PLLA treatment in adult individuals exhibiting facial aging and/or facial lipoatrophy. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). Eleven RCTs out of 1467 identified citations were included. Four studies showed increased dermal thickness, significant improvement in facial lipoatrophy severity and aesthetic clinical scores, after PLLA treatment with its effects sustained for at least 25 months. Two studies demonstrated the superiority of PLLA over injectable human collagen. Also, three studies showed positive results favoring PLLA when compared with PH gel in lipoatrophy severity, transepidermal water loss, skin quality, elasticity, and patient satisfaction. All adverse events were mild-to-moderate in intensity, and the main ones worth noting were bruising, hematoma, tenderness, nodules, and edema. Five out of eleven studies were considered having high risk of bias. The evidence on the effectiveness and safety of PLLA for facial rejuvenation is of low quality; thus, the reported high effectiveness, safety, and long-lasting effects for this purpose should be further investigated.
- Efficacy of botulinum toxin type-A I in the improvement of mandibular motion and muscle sensibility in myofascial pain TMD subjects : a randomized controlled trialPublication . Canales, Giancarlo De la Torre; Poluha, Rodrigo Lorenzi; Pinzón, Natalia Alvarez; Silva, Bruno Rodrigues Da; Almeida, André Mariz; Ernberg, Malin; Manso, Ana Cristina; Bonjardim, Leonardo Rigoldi; Rizzatti-Barbosa, Célia MarisaThis study assessed the effects of botulinum toxin type A (BoNT-A) in mandibular range of motion and muscle tenderness to palpation in persistent myofascial pain (MFP) patients (ReBEC RBR-2d4vvv). Eighty consecutive female subjects with persistent MFP, were randomly divided into four groups (n = 20): three BoNT-A groups with different doses and a saline solution group (placebo control group). Treatments were injected bilaterally in the masseter and anterior temporalis muscle in a single session. Clinical measurements of mandibular movements included: pain-free opening, maximum unassisted and assisted opening, and right and left lateral excursions. Palpation tests were performed bilaterally in the masseter and temporalis muscle. Follow-up occurred 28 and 180 days after treatment. For the statistical analysis the Mann–Whitney U-test with Bonferroni correction was used for groups comparisons. Regardless of dose, all parameters of mandibular range of motion significantly improved after 180 days in all BoNT-A groups, compared with the control group. Palpation pain over the masseter and temporalis muscles were significantly reduced in all BoNT-A groups regardless of dose, compared with the control group, after 28 and 180 days of treatment. Independent of doses, BoNT-A improved mandibular range of motion and muscle tenderness to palpation in persistent MFP patients.
- Game over : unraveling the prevalence and associations between bruxism, TMD and psychosocial factors in the Esports arenaPublication . Cardoso, Flávia Paula Da Silva; Barjandi, Golnaz; Flores, Dyanne Medina; Poluha, Rodrigo Lorenzi; Christidis, Nikolaos; Canales, Giancarlo De la TorreBackground: The professionalization of electronic sports (Esports) and streaming has introduced new challenges to players' physical and mental health, including chronic stress, sleep disruption and pain-related dysfunction. These factors are linked to bruxism and temporomandibular disorders (TMD), yet their prevalence and psychosomatic correlations within this community remain unknown. This study aimed to investigate the occurrence of bruxism and TMD among Esports players and streamers as well as their associations with psychosomatic and gaming-related variables. Methods: This cross-sectional study included 97 Esports players and streamers that completed validated self-report instruments screening for TMD (TMD pain-screener), bruxism, sociodemographic data, oral behaviors, sleep quality, perceived stress, anxiety, somatic symptoms, pain vigilance, and gaming/streaming habits. In addition to standard statistical tests, orthogonal partial least squares-discriminant analysis (OPLS-DA) were applied to identify group differences and multivariate associations. Results: Nearly half of the participants screened positive for TMD (49.5 %) and 78.4 % reported self-reported bruxism. Increased daily gaming hours correlated significantly with higher perceived stress and oral parafunctions. Multivariate analyses further showed that anxiety, somatic symptoms, poor sleep and perceived stress were key factors distinguishing participants with TMD from those without, and those with combined sleep and awake bruxism from those with only awake bruxism. Conclusion: TMD and bruxism are highly prevalent among Esports players and streamers, with greater daily gaming exposure linked to psychosomatic stress and oral parafunctions. Digital athletes with combined sleep and awake bruxism and/or TMD, experience greater psychosocial distress, indicating a subgroup that needs closer attention through early screening and targeted preventive strategies.