Clinical question What is the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD)?
Current practice TMD are the second most common musculoskeletal chronic pain disorder after low back pain, affecting 6-9% of adults globally. TMD are associated with pain affecting the jaw and associated structures and may present with headaches, earache, clicking, popping, or crackling sounds in the temporomandibular joint, and impaired mandibular function. Current clinical practice guidelines are largely consensus-based and provide inconsistent recommendations.
Recommendations For patients living with chronic pain (≥3 months) associated with TMD, and compared with placebo or sham procedures, the guideline panel issued: (1) strong recommendations in favour of cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise,
Objective We explored the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD).
Design Systematic review and network meta-analysis of randomised clinical trials (RCTs).
Data sources MEDLINE, EMBASE, CINAHL, CENTRAL, and SCOPUS were searched to May 2021, and again in January 2023.
Study selection Interventional RCTs that enrolled patients presenting with chronic pain associated with TMD.
Data extraction and synthesis Pairs of reviewers independently identified eligible studies, extracted data, and assessed risk of bias. We captured all reported patient-important outcomes, including pain relief, physical functioning, emotional functioning, role functioning, social functioning, sleep quality, and adverse events. We conducted frequentist network meta-analyses to summarise the evidence and used the GRADE approach to rate the certainty of evidence and categorise interventions from most to least beneficial.
Results 233 trials
With the smell of smoke in the air, 10 military veterans living with chronic pain from across Canada completed the second annual Military Veterans Alpine Challenge on Saturday, in Whistler, B.C.