Effect of acupuncture for pain management in patients with Temporomandibular disorders: A Systematic Review and Meta Analysis

 Temporomandibular disorders (TMD) are common, with a systematic review suggesting a prevalence as high as 31 percent in adults and 11 percent in children. TMD is associated with substantial morbidity, affecting quality of life and work productivity. As an example, it is estimated that for every 100 million working adults in the United States, TMD contributes to 17.8 million lost workdays annually. TMD patients have also been shown to use health care services at a higher rate, with a mean health care expenditure that is 1.6 times higher when compared with non-TMD individuals.
 The most common symptoms of TMD include pain in the ear, head, and facial area, as well as limitations in jaw movement and clicking sounds. Diagnosis of TMD is typically conducted through a thorough evaluation of medical history and a clinical examination. One of the representative diagnostic tools is the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).

Purpose/Objectives: In the clinical field of Korean medicine, acupuncture, Chuna manipulation, pharmacopuncture, oral balance device, and herbal medicine treatment are the most commonly used treatments for TMD. In this study, we would like to confirm whether acupuncture treatment for patients with TMD is effective in pain, opening volume, quality of life, and improvement rate, and derive meta-analysis results.

(1) Upon completion, Participants will be able to explain the epidemiology and types of treatment for TMD.
(2) Upon completion, Participants will be able to know the results of meta-analysis of acupuncture effects to improve pain and function in patients with TMD.
(3) Upon completion, Participants will be able to explain that acupuncture is effective in pain, amount of mouth opening, and improvement rate in patients with TMD.

Method: Patients diagnosed with a TMD or with symptoms related to TMD were selected as Patients, and adult patients aged 19 to 70 years with theTMD were targeted. Acupuncture was selected as intervention, including warm-needle acupuncture, fire-needle acupuncture, electroacupuncture and dry needling. For Comparison, an inactive control group such as sham acupuncture or no treatment was set according to the key question, or usual conservative treatment such as analgesic, hyperthermia, and electrophysiotherapy was selected. The Outcome attempted to utilize all outcome variables related to the TMD, such as pain, function, quality of life, and improvement rate.
 Search and selection of reference, Assessing the risk of bias in the reference, and synthesis & analysis of evidence are included in the poster material.

Results:

 According to the results of studies comparing the acupuncture treatment group with the inactive control group, there were statistically significant changes in VAS for pain, maximum mouth opening, and improvement rate in acupuncture treatment group.
Compared to the general conservative treatment group, the acupuncture group and combination of acupuncture and general conservative treatment group showed more significant improvement rate and pain reduction.
In addition, studies comparing proximal and distal acupoints showed similar pain reduction and functional recovery, so both acupoints can be considered according to the judgment of Korean medicine doctors by referring to the clinical aspects of TMD.

Conclusions: According to the results of meta analysis(The detail results and the heterogeneity of the meta analysis are included in the actual poster material), acupuncture treatment can be recommended for improving function and reducing pain in patients with TMD. Additionally, concurrent acupuncture treatment can be recommended for TMD patients undergoing usual conservative treatment, and both proximal and distal acupoints can be selected and utilized during acupuncture treatment.
To summarize, acupuncture for TMD showed effectiveness on relieving pain and improving mouth opening in both single and combination treatments. Therefore, it is considered as one of the recommended treatment methods for TMD patients.

References: 1. Johansson A, Unell L, Carlsson GE, Söderfeldt B, Halling A. Gender difference in symptoms related to temporomandibular disorders in a population of 50-year-old subjects. Journal of orofacial pain. 2003;17(1).
2. Macfarlane TV, Blinkhorn AS, Davies RM, Kincey J, Worthington HV. Oro‐facial pain in the community: prevalence and associated impact. Community dentistry and oral epidemiology. 2002;30(1):52-60.
3. Pow EHN, Leung KCM, McMillan AS. Prevalence of symptoms associated with temporomandibular disorders in Hong Kong Chinese. Journal of orofacial pain. 2001;15(3):228-34.
4. Mujakperuo HR, Watson M, Morrison R, Macfarlane TV. Pharmacological interventions for pain in patients with temporomandibular disorders. Cochrane Database of Systematic Reviews. 2010(10).
5. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J-P, 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. Journal of oral & facial pain and headache. 2014;28(1):6.4. Durham J, Newton-John TRO, Zakrzewska JM. Temporomandibular disorders. bmj. 2015;350.
6. Gauer R, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. American family physician. 2015;91(6):378-86.
7. Kim C-E, Do H-J, Song H-S, Shin J-K, Lee W-J, Kim J-H, et al. A web-based survey for assessment of Korean medical treatment clinical practice patterns for temporomandibular disorders. Journal of Korean Medicine Rehabilitation. 2018;28(1):73-84.
8. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj. 2011;343.
9. Andrews J, Guyatt G, Oxman AD, Alderson P, Dahm P, Falck-Ytter Y, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. Journal of clinical epidemiology. 2013;66(7):719-25.
10. Goddard G, Karibe H, McNeill C, Villafuerte E. Acupuncture and sham acupuncture reduce muscle pain in myofascial pain patients. Journal of orofacial pain. 2002;16(1).
11. List T, Helkimo M, Karlsson R. Pressure pain thresholds in patients with craniomandibular disorders before and after treatment with acupuncture and occlusal splint therapy: a controlled clinical study. Journal of orofacial pain. 1993;7(3).
12. McMillan AS, Nolan A, Kelly PJ. The efficacy of dry needling and procaine in the treatment of myofascial pain in the jaw muscles. Journal of orofacial pain. 1997;11(4).
13. Schmid-Schwap M, Simma-Kletschka I, Stockner A, Sengstbratl M, Gleditsch J, Kundi M, et al. Oral acupuncture in the therapy of craniomandibular dysfunction syndrome–a randomized controlled trial. Wiener Klinische Wochenschrift. 2006;118(1):36-42.
14. Shen YF, Goddard G. The short‐term effects of acupuncture on myofascial pain patients after clenching. Pain Practice. 2007;7(3):256-64.
15. Shen YF, Younger J, Goddard G, Mackey S. Randomized clinical trial of acupuncture for myofascial pain of the jaw muscles. Journal of orofacial pain. 2009;23(4):353.
16. Smith P, Mosscrop D, Davies S, Sloan P, Al-Ani Z. The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: a randomised controlled trial. Journal of dentistry. 2007;35(3):259-67.
17. Zotelli VL, Grillo CM, Gil ML, Wada RS, Sato JE, de Sousa MdLR. Acupuncture effect on pain, mouth opening limitation and on the energy meridians in patients with temporomandibular dysfunction: a randomized controlled trial. Journal of acupuncture and meridian studies. 2017;10(5):351-9.
18. Johansson A, Wenneberg B, Wagersten C, Haraldson T. Acupuncture in treatment of facial muscular pain. Acta Odontologica Scandinavica. 1991;49(3):153-8.
19. Fernández-Carnero J, La Touche R, Ortega-Santiago R, Galan-del-Rio F, Pesquera J, Ge H-Y, et al. Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders. Journal of orofacial pain. 2010;24(1):106.
20. Kang K-W, Kim W-Y, Kim T-H, Shin B-C, Jung S-Y, Kim A-R, et al. Adjacent, distal, or combination of point-selective effects of acupuncture on temporomandibular joint disorders: A randomized, single-blind, assessor-blind controlled trial. Integrative medicine research. 2012;1(1):36-40.

***Due to the word count limitation, I was unable to include additional references.