Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials
Review (153 RCTs; n=8713 included in network meta-analyses) found CBT augmented with biofeedback or relaxation therapy, therapist-assisted jaw mobilisation and manual trigger point therapy were probably most effective for pain relief in this population.
Source:
British Medical Journal
SPS commentary:
Article notes that temporomandibular disorders (TMD) are the second most common musculoskeletal chronic pain disorder, and that chronic TMD pain affects 6% to 9% of adults globally.
Other findings included moderate to high certainty evidence that five interventions were less effective, yet more effective than placebo/sham procedures for pain relief: CBT, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care (such as home exercises, stretching, reassurance, self-massage, and education). The evidence for pain relief was low or very low certainty.
This systematic review informed a parallel guideline published in The BMJ and MAGICapp. In terms of drug therapy, there is a conditional recommendation in favour of CBT plus NSAIDs, and conditional recommendations against the use of paracetamol, benzodiazepines, beta-blockers, botulinum toxin injection, capsaicin cream, gabapentin, hyaluronic acid injection, NSAIDs, steroid injection and trigger point injection. There is a strong recommendation against the use of NSAIDs + opioid.