Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials.

Temporomandibular disorders, which cause chronic jaw pain, are treated with a wide range of approaches, from exercises and manual therapy to psychological techniques, but it has been unclear which actually help. This review pooled 153 randomised trials involving 8713 participants across 59 different interventions or combinations, comparing them mainly against placebo or sham treatment. The therapies with the strongest evidence for pain relief were cognitive behavioural therapy combined with biofeedback or relaxation, therapist-assisted jaw mobilisation, and manual trigger point therapy, all showing moderate to high certainty benefit over placebo.

Several other approaches, including plain cognitive behavioural therapy, supervised exercises, and usual care, showed somewhat smaller but still real benefits. For physical functioning, jaw exercises, manipulation, and acupuncture stood out. However, most other interventions and all evidence on side effects were rated low or very low certainty, meaning many commonly used treatments still lack solid support.

If you live with ongoing jaw pain from a temporomandibular disorder, you have probably encountered many treatment options, from exercises and jaw mobilisation to talk-based therapies and acupuncture. This large analysis pooled results from 153 clinical trials involving over 8,700 people to see which treatments actually helped with pain and daily functioning, compared with doing nothing meaningful, such as a placebo or sham treatment. The treatments with the most reliable evidence for easing pain were psychological therapy that builds coping skills, sometimes combined with relaxation or biofeedback, hands-on jaw mobilisation done by a therapist, and manual trigger point therapy targeting sore muscle spots.

Regular jaw exercises, general activity-based programmes, and simple home-care advice also showed real, though somewhat smaller, benefits. For improving how well the jaw functions day to day, supervised exercises, manipulation, and acupuncture showed promising results. Importantly, most other treatments people commonly try do not yet have strong evidence behind them, and the review could not draw firm conclusions about side effects because that evidence was weak across the board.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This network meta-analysis synthesised 153 randomised trials (8,713 participants, 59 interventions or combinations) addressing chronic pain from temporomandibular disorders, using GRADE to rate certainty and comparing all interventions against placebo or sham. Only eight interventions had moderate to high certainty evidence for pain outcomes.

The most effective for pain relief were cognitive behavioural therapy augmented with biofeedback or relaxation (risk difference for reaching the minimally important difference of 1 cm on a 10 cm visual analogue scale: 36%, 95% CI 33 to 39), therapist-assisted jaw mobilisation (RD 36%, 31 to 40), and manual trigger point therapy (RD 32%, 29 to 34). Five further interventions, including standalone cognitive behavioural therapy, supervised postural or jaw exercise programmes, and usual care, showed smaller but still meaningful risk differences of 23 to 30%. For physical functioning, moderate certainty evidence favoured supervised jaw exercise and stretching, manipulation, acupuncture, and supervised jaw exercise with mobilisation, with risk differences ranging from 36% to 43%.

Beyond this select group, certainty for both pain and functioning outcomes was low or very low, and evidence on adverse events was uniformly low or very low certainty, precluding any safety conclusions. The authors note that interventions promoting coping strategies and encouraging movement were the most consistently supported, but the breadth of low certainty evidence across the remaining 50-plus interventions limits confidence in ranking treatments overall.