Pharmacological Interventions in the Management of Temporomandibular Disorders: A Systematic Review and Meta-analysis.

Abstract

<h4>Introduction</h4>Temporomandibular Disorders (TMDs) encompass a set of conditions affecting the masticatory muscles and the temporomandibular joint (TMJ), with an impact on both functionality and individuals' quality of life. Myalgia is a diagnosis of TMD with multifactorial etiology, and treatment strategies aim primarily to relieve pain and restore function. Pharmacological therapy is commonly considered a second-line option, thus complementing conservative measures.<h4>Objectives</h4>Assess the efficacy of pharmacological interventions in the management of myalgia associated with temporomandibular disorders, in adolescents and adults, while exploring differential effects across TMD subtypes through subgroup analyses, using a systematic review and meta-analysis of randomized controlled trials (RCTs).<h4>Materials and methods</h4>A systematic review with meta-analysis was conducted in accordance with the <i>Cochrane Handbook for Systematic Reviews of Interventions</i> and reported following the PRISMA 2020 statement. Seventeen randomized controlled trials (RCTs) published between 2018 and 2024 were included. Pharmacological interventions such as nonsteroidal anti-inflammatory drugs, corticosteroids, muscle relaxants, antidepressants, and intra-articular injectables-were compared with placebo or other active treatments. The primary outcomes were pain intensity (Visual Analog Scale, VAS) and maximum interincisal opening (MIO) unassisted.<h4>Results and discussion</h4>A total of 1,128 participants were analyzed across 25 treatment arms. Pharmacological interventions were associated with a significant reduction in pain (SMD = -0.68; 95% CI: -1.09 to -0.26; p < 0.001) and an improvement in MIO (SMD = 0.51; 95% CI: 0.20 to 0.82; p < 0.001). Subgroup analyses indicated that interventions were more consistent and effective in arthralgia-only populations, showing lower heterogeneity and a more predictable therapeutic response, whereas myalgia-only populations exhibited smaller and less consistent benefits. Conservative therapies demonstrated a consistent advantage, thus aligning with international recommendations that prioritize such approaches. Subgroup analyses demonstrated more consistent and homogeneous effects in arthralgia-dominant populations, whereas myalgia-only studies showed greater heterogeneity and less predictable responses.<h4>Conclusion</h4>Pharmacological therapy provides a moderate overall beneficial effect in reducing pain and improving mandibular function in TMD, with stronger and more consistent evidence in arthralgia-dominant populations, while myalgia-related outcomes remain more variable, thus indicating the need for tailored treatment strategies. Further high-quality RCTs with standardized protocols are needed.