Effectiveness of manual therapy, exercise, low-level laser therapy, ultrasound, and transcutaneous electrical nerve stimulation in reducing pain and improving mouth opening in temporomandibular joint disorders: A network meta-analysis of randomized controlled trials
Lin LH, Hsieh GJ, Lin TY, Chang KV, Wu WT, Özçakar L
Medicine · 0 citas
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Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Marcadores de salud y funcionamiento
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2026-06-19 · Medicine (Baltimore) · vol. 105 · número 25 · pág. e49263
- Editorial
- Wolters Kluwer
- Citado
- 1 cita · más que el 87% de estudios similares · 2.3× el promedio de su campo
- Referencias
- 51 trabajos
- Acceso
- Acceso abierto (revista) · CC-BY-NC
- Áreas de investigación
- Temporomandibular Joint Disorders · Musculoskeletal pain and rehabilitation · Myofascial pain diagnosis and treatment
- Palabras clave
- temporomandibular disorders, manual therapy, low-level laser therapy, ultrasound therapy, transcutaneous electrical nerve stimulation, analgesia, maximum mouth opening, physical agents, treatment ranking
- MeSH
- humans, temporomandibular joint disorders, treatment outcome, musculoskeletal manipulations, exercise therapy, transcutaneous electric nerve stimulation, ultrasonic therapy, randomized controlled trials as topic, pain management, low-level light therapy
6 autores
- L Lin🇹🇼Chang Gung University
- Guo-Jia Hsieh🇹🇼Chang Gung University
- Ting‐Yu Lin🇹🇼Luodong Poh-Ai Hospital
- Kevin C. Chang🇹🇼 · autor de correspondenciaNational Taiwan University; National Taiwan University Hospital; Wan Fang Hospital; Taipei Medical University
- Wei‐Ting Wu🇹🇼National Taiwan University; National Taiwan University Hospital
- Levent Özçakar🇹🇷Hacettepe University
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
Temporomandibular joint (TMJ) disorders are prevalent musculoskeletal conditions. Common therapies include TMJ manual therapy, TMJ exercise, and modalities such as low-level laser, therapeutic ultrasound, and transcutaneous electrical nerve stimulation (TENS). This study ranked TMJ manual therapy, TMJ exercise, low-level laser therapy, therapeutic ultrasound, and TENS for pain relief and improved maximal mouth opening (MMO) to strengthen evidence for clinical practice.
Methods
PubMed, Scopus and Ovid MEDLINE were systematically searched from inception to March 2026 for randomized controlled trials evaluating TMJ manual therapy, TMJ exercise, low-level laser therapy, therapeutic ultrasound, and TENS for TMJ disorder. A frequentist network meta-analysis with a random-effects model was performed to compare treatment effects across interventions, with standardized mean differences calculated as the effect size. Treatment rankings were estimated using the surface under the cumulative ranking curve. Publication bias was assessed using funnel plots and Egger test.
Results
This network meta-analysis demonstrated significant pain reduction with therapeutic ultrasound, TMJ manual therapy, TMJ exercise, and low-level laser therapy, and TENS. Therapeutic ultrasound showed the highest probability of providing pain relief, followed by TMJ manual therapy, low-level laser therapy, TMJ exercise, and TENS. For MMO, TMJ manual therapy, low-level laser therapy, therapeutic ultrasound, and TENS showed significant improvements, while TMJ exercise demonstrated a borderline effect. Based on the surface under the cumulative ranking curve rankings, TMJ manual therapy had the highest probability ranking, followed by therapeutic ultrasound.
Conclusion
This network meta-analysis suggests that TMJ manual therapy had a higher probability ranking than TMJ exercise for reducing pain and improving MMO. Among physical modalities, therapeutic ultrasound and low-level laser therapy tended to rank higher than TENS. These findings may help inform clinical decision-making in the management of TMJ disorder. Future studies should further investigate the influence of treatment duration and TMJ disorder diagnostic subtypes.
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial (CC BY-NC).
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