Efficacy of duloxetine in treating temporomandibular joint disorder: a systematic review with bayesian meta-analysis.

Abstract

<h4>Objectives</h4>This study aims to evaluate the efficacy of duloxetine in managing temporomandibular joint disorder (TMD), focusing on pain reduction and functional improvement. The research addresses the need for novel therapeutic agents due to the suboptimal efficacy and tolerability of existing treatments.<h4>Materials and methods</h4>A systematic review and Bayesian meta-analysis were conducted following PRISMA guidelines. A comprehensive search of MEDLINE (via PubMed), Web of Science, Scopus, Embase, and Google Scholar was performed up to February 2025. Eligibility criteria were defined using the PICOS framework: Population (TMD patients), Intervention (duloxetine), Comparator (placebo or other treatments), Outcomes (pain reduction, maximum mouth opening), and Study design (randomized controlled trials). Data synthesis employed Bayesian meta-analysis, and evidence quality was assessed using the GRADE framework.<h4>Results</h4>Five studies involving 203 participants met the inclusion criteria. Four evaluated duloxetine combined with TMJ arthrocentesis, while one compared duloxetine to a placebo. Combination therapy yielded significant pain reduction (pooled effect size = 1.42) and a consistent, though not statistically significant, improvement in maximum mouth opening. Bayesian analysis strongly supported pain reduction (BF₁₀ = 44.197) but was inconclusive for functional improvement (BF₁₀ = 0.783). The risk of bias ranged from moderate to high, with high-certainty evidence supporting the efficacy of combination therapy.<h4>Conclusion</h4>Duloxetine, when combined with TMJ arthrocentesis, provides significant pain relief and potential functional benefits in TMD management. However, further large-scale, high-quality randomized trials are necessary to confirm these findings.