Drugs for temporomandibular disorders help — most of all in arthralgia

A moderate effect on pain and greater mouth opening

The team led by first author Cristiana Palmela Pereira published in Acta Stomatologica Croatica a systematic review with meta-analysis on how much drugs really help in pain associated with temporomandibular disorders. The analysis was carried out according to the Cochrane handbook and reported following the PRISMA 2020 statement, and it covered 17 randomised controlled trials published between 2018 and 2024.

The analysis included 1128 participants allocated to 25 treatment groups. Non-steroidal anti-inflammatory drugs, corticosteroids, muscle relaxants, antidepressants and intra-articular injectables were compared, against placebo or against another active treatment. Two outcomes were primary: pain intensity on a visual analogue scale and maximum unassisted interincisal opening.

Pharmacotherapy brought a significant reduction in pain (SMD = -0.68; 95% CI: -1.09 to -0.26; p < 0.001) and an improvement in mouth opening (SMD = 0.51; 95% CI: 0.20 to 0.82; p < 0.001). The more interesting finding comes from the subgroups: in patients with arthralgia the effect was more uniform and more predictable, with less heterogeneity, while populations with isolated myalgia showed a smaller and less stable benefit. Conservative therapies retained a consistent advantage, in line with international recommendations that place them first.

Limitations

This is a synthesis of already published trials, not a new clinical study; heterogeneity among the studies with isolated myalgia was high, so the authors themselves call for new trials with standardised protocols.

For your practice

• Pharmacotherapy remains second line: conservative measures first, the drug as a supplement and not as the start of treatment.
• In predominantly joint pain, expect a relatively predictable response to the drug; in isolated muscle pain, be more cautious with promises to the patient.
• Track the outcome with the two numbers the studies use as well — VAS and maximum opening in millimetres — and change the treatment according to the measured change, not according to an impression.