Cochrane · intervention · CD013515
Psychological therapies for temporomandibular disorders (TMDs)
Penlington, C, Bowes, C, Taylor, G, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Oral HealthOral and maxillofacial surgeryTemporomandibular disorders and sleep2 versionsAMSTAR 2: not assessed
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
28
current version
GRADE rated
14
No studies
4
Included studies
22
as reported
No studies 4 · 14.3%Ungraded 10 · 35.7%Very low 2 · 7.1%Low 12 · 42.9%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults and adolescents aged 12 years or older with pain lasting 3 months or longer since initial onset of TMD diagnosed by any method | 22 RCTs, 2001 participants (24 to 191 per trial); 20 studies in adults (aged 18+), 2 studies in adolescents aged 12 to 19 years (Wahlund 2003; Wahlund 2015) |
| Intervention | Any psychological intervention (e.g. CBT, behaviour therapy, ACT, mindfulness) based on a widely accepted psychological theory, delivered by psychologists or staff with appropriate behavioural healthcare training (at least 50% psychological content for mixed packages) | CBT (n=13); Relaxation (n=4); Hypnosis (n=2); Mindfulness (n=1); Mixed CBT and hypnosis (n=1); Habit reversal treatment (n=1); Education and counselling (n=1); Hope-based intervention (n=1) |
| Comparison | Alternative treatment (e.g. medication or oral splints); control condition (usual care, attention control, waiting-list control, or no treatment); or another psychological treatment | Pharmacological interventions (n=4); Occlusal appliances (n=4); Self-care management (n=1); Disease management (n=1); Pain education (n=1); Non-directive counselling (n=1); Usual care (n=7); Waiting-list control/no treatment/placebo (n=5) |
| Outcomes | Pain intensity; Disability caused by pain; Adverse events; Psychological distress; Additional physical symptoms; Quality of life | Pain intensity (n=22); Disability caused by pain (n=8); Adverse events (n=6); Psychological distress (n=8); Additional physical symptoms (n=4); Quality of life (n=1) |
| Study designs | Randomised controlled trials (including cross-over trials where each arm can be evaluated independently) | 22 RCTs (21 parallel-arm; 1 cross-over used as parallel with first-period data); 8 multi-arm trials; 12 studies combined in meta-analyses |
| Timing | Pain lasting 3 months or longer; outcomes at treatment completion and longest follow-up | Outcomes at treatment completion (shortest 4 weeks) and longest follow-up (3 to 12 months) |
Search date: 2021-10. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; PsycINFO Ovid; Trip database; Web of Science Conference Proceedings; Proquest Dissertations and Theses Global; OpenGrey; US National Institutes of Health Ongoing Trials…
Questions and results
Show all 2 versionsCognitive behavioural therapy (CBT) vs Alternative (active) treatment (e.g. oral splint, medication, self-care or disease management)
Population: People aged 12 years and over with painful TMD lasting 3 months or longer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quality of life | This outcome was not measured (not synthesised for this comparison; review-wide only one study reported quality of life). | NR | No studies |
Pain intensity at treatment completion Treatment completion | SMD 0.03 [-0.21, 0.28] | 5 studies · 509 participants | Low Downgraded: risk of bias, imprecision |
Disability caused by pain at treatment completion Treatment completion | SMD -0.15 [-0.40, 0.10] | 3 studies · 245 participants | Low Downgraded: risk of bias, imprecision |
Disability caused by pain at follow-up Follow-up | SMD -0.15 [-0.42, 0.12] | 3 studies · 245 participants | Low Downgraded: risk of bias, imprecision |
Additional physical symptoms | This outcome was not measured (not synthesised for this comparison; review-wide only one study reported additional physical symptoms). | NR | No studies |
Psychological distress at follow-up Follow-up | SMD -0.32 [-0.51, -0.13] | 6 studies · 516 participants | Low Downgraded: risk of bias, imprecision |
Pain intensity at follow-up (6-12 months) Follow-up (6-12 months) | SMD -0.29 [-0.50, -0.08] | 5 studies · 475 participants | Low Downgraded: risk of bias, imprecision |
Adverse events | SoF: 3 studies reported minor adverse events in the control group; 1 study reported minor adverse events in psychological therapy group; 1 study reported that there were no adverse events. Results: NCT00066937 minor… | 5 studies | Very low Downgraded: risk of bias, imprecision, inconsistency |
Psychological distress at treatment completion Treatment completion | SMD -0.32 [-0.50, -0.15] | 6 studies · 553 participants | Low Downgraded: risk of bias, imprecision |
Cognitive behavioural therapy (CBT) vs Usual care, waiting list or no treatment (control)
Population: People aged 12 years and over with painful TMD lasting 3 months or longer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quality of life | This outcome was not measured for this comparison. | NR | No studies |
Pain disability at treatment completion Treatment completion | SMD 0.02 [-0.21, 0.24] | 3 studies · 315 participants | Low Downgraded: risk of bias, imprecision |
Adverse events | Only 1 study reported adverse events as an outcome (Litt 2010): it found worsening symptoms in 13 people treated with an oral splint (as part of standard treatment) and 4 people treated with CBT. | 1 study · 101 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Pain intensity at follow-up (12 months) Follow-up (12 months) | SMD -0.30 [-0.51, -0.09] | 6 studies · 639 participants | Low Downgraded: risk of bias, imprecision |
Psychological distress at follow-up Follow-up | MD -1.02 [-4.02, 1.98] | 1 study · 101 participants | Low Downgraded: risk of bias, imprecision |
Psychological distress at treatment completion Treatment completion | MD 2.36 [-1.17, 5.89] | 1 study · 101 participants | Low Downgraded: risk of bias, imprecision |
Pain intensity at treatment completion Treatment completion | SMD -0.09 [-0.30, 0.12] | 6 studies · 577 participants | Low Downgraded: risk of bias, imprecision |
Pain disability at follow-up Follow-up | SMD 0.01 [-0.61, 0.64] | 2 studies · 240 participants | Low Downgraded: risk of bias, imprecision |
Additional physical symptoms | This outcome was not measured for this comparison. | NR | No studies |
Hypnosis vs Relaxation
Population: People aged 12 years and over with painful TMD lasting 3 months or longer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events | Abrahamsen 2011: one participant who received hypnosis was admitted to a psychiatric hospital during the intervention; per study authors this was unrelated to the study treatment. | 1 study | Ungraded |
Pain intensity Treatment completion | Not pooled (clinical heterogeneity). Abrahamsen 2011: MD -1.00 (95% CI -2.27 to 0.27), n=38 (hypnosis 19, relaxation 19); Stam 1984: MD not reported, n=27 (hypnosis 12, relaxation 15). | 2 studies · 65 participants | Ungraded |
Hope-based intervention vs Pain education
Population: People aged 12 years and over with painful TMD lasting 3 months or longer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain intensity Treatment completion | MD 0.10 [-13.52, 13.72] | 1 study · 29 participants | Ungraded |
CBT plus hypnosis (combined package) vs Usual care
Population: People aged 12 years and over with painful TMD lasting 3 months or longer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain intensity Treatment completion | MD -2.32 [-3.52, -1.12] | 1 study · 59 participants | Ungraded |
Habit reversal treatment vs Waiting-list control
Population: People aged 12 years and over with painful TMD lasting 3 months or longer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain intensity Treatment completion | MD -1.31 [-1.97, -0.65] | 1 study · 20 participants | Ungraded |
Relaxation vs Occlusal (oral) appliance
Population: People aged 12 years and over with painful TMD lasting 3 months or longer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain intensity Treatment completion · Adolescents (12-19 years) | Not pooled. Wahlund 2015: MD 3.70 (95% CI -1.21 to 8.61), n=57 (relaxation 28, appliance 29); Wahlund 2003: MD not reported, n=83 (relaxation 41, appliance 42). Both studies were in adolescents; the occlusal appliance… | 2 studies · 140 participants | Ungraded |
Adverse events Adolescents (12-19 years) | Wahlund 2015: reported no adverse treatment effects from treatment with an occlusal appliance or with relaxation therapy. | 1 study | Ungraded |
Mindfulness plus medication vs Medication alone
Population: People aged 12 years and over with painful TMD lasting 3 months or longer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain intensity | Shevtsova 2020: data could not be combined; both groups achieved at least a 30% reduction in pain from baseline at treatment completion and follow-up (Table 1). No between-group MD reported. | 1 study | Ungraded |
Education vs Usual care
Population: People aged 12 years and over with painful TMD lasting 3 months or longer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain intensity | Lupton 1968: multi-arm study; education arm versus usual care. No usable pain-reduction data reported and could not be combined in meta-analysis (Table 1). | 1 study | Ungraded |
Counselling (non-directive) vs Usual care
Population: People aged 12 years and over with painful TMD lasting 3 months or longer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain intensity | Lupton 1968: multi-arm study; counselling arm versus usual care. No usable pain-reduction data reported and could not be combined in meta-analysis (Table 1). | 1 study | Ungraded |