Background & Aims
An increasing number of studies advocate a biopsychosocial, evidence-based and patient-centered approach for the treatment of chronic pain (1,2). Chronic pain in the orofacial region is common, affecting 10-15% of the general population (3). It is most often related to musculoskeletal pain, Temporomandibular Disorders (TMD), involving the masticatory muscles and/or the temporomandibular joints (4). One of the commonly used treatment approaches for the management of TMD are different types of self-management therapies. These include education, behavioral therapy, relaxation techniques, self-massage, and home physiotherapy (5). The aim of the present umbrella review was to summarize the existing evidence in systematic reviews (SRs) on self-management therapies for the treatment of TMD. The study is part of a larger project on the evidence for different therapies in the management of patients with TMD.
Methods
The review was carried out in accordance with the PRISMA guidelines and a study protocol was registered in PROSPERO (CRD42021276856). Four electronic databases were searched in September 2021 and updated December 2023; PubMed (NLM), Scopus (Elsiever), Lilacs (VHL), Cochrane (Wiley). SRs were included if they evaluated management of TMD in adults and/or adolescents. Two independent reviewers screened titles and abstracts, performed full-text assessment, data extraction and risk of bias assessment with AMSTAR 2. From each SR, the following data were extracted: authors, year, country, study funding, search period, databases and additional searches, diagnostic system (DC/TMD, RDC/TMD, other), diagnoses, intervention, control, risk of bias of primary studies, risk of bias assessment tool, design of primary studies, follow-ups, results and conclusion.
Results
In total, 1,741 references were screened after removal of duplicates. After title and abstract screening, 407 studies were included for full-text assessment and 256 were finally included. The primary reason for exclusion was not meeting the criteria for a SR. Nine of the included SRs had as primary focus to evaluate the effects of self-management therapies for TMD. Among these, one SR included only children, one SR included both children and adults, and the remaining included primary studies with adult populations. Four SRs reported favorable results for education, jaw posture regulation, and cognitive behavioral therapy in the management of TMD. Three SRs concluded that there was insufficient evidence either for or against the use of self-management therapies over other interventions for TMD. Several SRs reported weak levels of evidence, stressing the need for well-designed randomized controlled trials investigating the effect of self-management therapies in the treatment of TMD.
Conclusions
Based on the included SRs, both the number of systematic reviews and the level of evidence for the efficacy of self-management therapies in TMD treatment is still low. Even so, beneficial effects from patient education and self-management strategies such as cognitive behavioral therapy and jaw posture regulation have been reported in eligible SRs.
References
(1)Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129-136. doi:10.1126/science.847460
(2)Hampf G. A biopsychosocial approach to TMJ pain–or looking for keys in the dark. Proc Finn Dent Soc. 1990;86(3-4):171-181.
(3)Lövgren A, Häggman-Henrikson B, Visscher CM, Lobbezoo F, Marklund S, Wänman A. Temporomandibular pain and jaw dysfunction at different ages covering the lifespan–A population based study. Eur J Pain. 2016 Apr;20(4):532-40. doi: 10.1002/ejp.755. Epub 2015 Aug 27. PMID: 26311138.
(4)Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache. 2014;28(1):6-27.
(5)Story WP, Durham J, Al-Baghdadi M, Steele J, Araujo-Soares V. Self-management in temporomandibular disorders: a systematic review of behavioural components. J Oral Rehabil. 2016;43(10):759-770.
Presenting Author
Tessa Bijelic
Poster Authors
Tessa Bijelic
DDS
Dept. of Orofacial Pain and Jaw Function, Malmö University
Lead Author
Ambrosina Michelotti
DDS
Department of Neuroscience, Reproductive Science and Oral Science
Lead Author
Rosaria Bucci
DDS
Department of Neuroscience, Reproductive Science and Oral Science
Lead Author
Daniela Del Sorbo
DDS
Department of Neuroscience, Reproductive Science and Oral Science
Lead Author
EwaCarin Ekberg
DDS
Department of Orofacial Pain and Jaw Function, Faculty of Odontology
Lead Author
Birgitta Häggman-Henrikson
Malmö University
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Orofacial Pain