The treatment modalities of masticatory muscle pain a network meta-analysis

Abstract

Background: Numerous treatment modalities have been attempted for masticatory muscle pain in patients with temporomandibular disorders (TMD). To compare the treatment efficacy of more than 2 competing treatments, a network meta-analysis (NMA) was conducted. Methods: This study was reported with reference to the extended Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting of systematic reviews incorporating network meta-analyses. Medline via Pubmed, Embase via OVID, and Cochrane Library Central were searched (up to February 11, 2019). Axis I protocol of Diagnostic Criteria or Research Diagnostic Criteria for Temporomandibular Disorders (DC/TMD, RDC/TMD) were chosen as diagnostic standards. The PICOS (Problem/patient, Intervention, Comparison, Outcome, Study design) method was used to screen trials under eligibility criteria. And the NMA was performed with mvmeta commands in Stata (StataCorp, Tex). Results: Of 766 studies searched, 12 randomized clinical trials (RCTs) were finally included. Nineteen different therapies were found and further categorized into 9 treatment modalities. The general heterogeneity was not found among included trials. But predictive intervals (PrIs) were conspicuously wider than confidential intervals (CIs) of all pairwise comparisons, indicating that heterogeneity may exist between studies. Complementary therapy showed the greatest probability (42.7%) to be the best intervention. It also had the highest mean rank (2.3) in the rankogram and the biggest value of surface under the cumulative ranking (SUCRA, 84.1%). Conclusions: Based on the limited evidence of available trials, complementary therapy seemed to be slightly more effective than remaining treatment modalities for pain reduction in TMD patients with masticatory muscle pain. High-quality randomized controlled trials are expected to validate the findings.

Effectiveness of TENS and home exercises as an adjunct to drug therapy in the management of myogenous masticatory pain: a comparative study

“…Pharmacological agents such as muscle relaxants, analgesics, and physical therapies are the first line of treatment in these patients. Non-invasive physical therapies such as TENS and home exercises program as adjuncts to pharmacological agents may modify the muscular activity and help reduce the pain further [2].…”

“…The major characteristics of Myogenous TMDs include pain, muscle tenderness, and limited range of motion [1]. Myogenous pain can restrain the daily activities and concomitantly be associated with headache, jaw pain, ear-related symptoms, sleep disturbances, and changes in the cervical and head posture [2]. The true prevalence of Myogenous TMDs in the general population is high, although the symptoms may resolve over time.…”

“…However, in many patients, symptoms may persist for a year or more [3]. It has been reported that only about 3.6-7.0% of the population with TMDs seek medical assistance for pain [2].…”

Development of Core Outcome Sets for Clinical Trials in Temporomandibular Disorders

“…There is a wide range of therapeutic modalities used in the management of TMD. They range from conservative therapies such as behavior therapies to surgical treatments [11,12]. Despite the many therapies applied to intra-articular TMD and masticatory muscle disorder, most of these treatment's effectiveness has not yet been established through robust scienti c evidence.…”

Comparative effectiveness of low‐level laser therapy with different wavelengths and transcutaneous electric nerve stimulation in the treatment of pain caused by temporomandibular disorders: A systematic review and network meta‐analysis

“…2 Furthermore, the life quality of a patient would decline if suffering from frequent pain. 3 However, the aetiology of TMD is multidimensional, which is due to related biomechanical, neuromuscular, biopsychosocial and neurobiological factors. 4 Therefore, conservative therapies, including supportive patient education, occlusal splint, medication and physical therapy, have been adopted as the predominant methods to cure TMD.…”