Available online 16 October 2020
Abstract
Statement of problem
Occlusal
devices, particularly the stabilization appliances, have been commonly
used as treatment for painful temporomandibular disorders (TMDs).
However, the mechanisms of action of these devices are still unclear,
including the role of the placebo effect in the pain management.
Purpose
The
purpose of this network meta-analysis was to identify to what extent
the degree of efficacy of stabilization appliances in the management of
painful TMDs arises from the placebo effect only or whether it arises
chiefly from an actual effect.
Material and methods
An
electronic search was undertaken to identify randomized clinical trials
(RCTs) published up to April 2020, comparing the efficacy of the
stabilization appliances in patients with painful temporomandibular
disorders, with nonoccluding appliances (active placebo), and untreated
controls (passive placebo). Outcome variables were pain intensity at
follow-ups, the proportion of participants reporting pain improvement,
and the number needed to treat. The quality of evidence was rated as per
the Cochrane tool for assessing risk of bias. Mean difference was used
to analyze via frequentist network meta-analysis by using the STATA
software program.
Results
Treatment
with stabilization appliances showed a significant reduction in pain
intensity when compared with the other groups; but, the lower pain
intensity at follow-ups in favor of stabilization appliances when
compared with nonoccluding appliances was not statistically significant.
However, a significantly higher number of participants reported pain
improvement after treatment with stabilization appliances when compared
with those treated with nonoccluding appliances or untreated
participants.
Conclusions
This
network meta-analysis showed no significant difference in reported pain
intensity at follow-ups between the treatment of painful TMDs with
stabilization appliances or nonoccluding appliances (active placebo).
However, a significant difference in participants reporting treatment
satisfaction with reduced pain, and a significantly lower number needed
to treat in favor of stabilization appliances were found.
Patient-reported treatment satisfaction probably included more domains
than just pain intensity, such as improvements in physical functioning
and psychosocial factors, and deserves further investigation. The
authors concluded that stabilization appliances treatment efficacy is
beyond the placebo effect.
Clinical Implications
Stabilization
appliances seem to have a treatment efficacy beyond the placebo effect
and can be suggested as one of the initial treatment approaches for
patients with painful temporomandibular disorders. However, the
evaluation of the effect of the treatment must include more domains than
just change the pain intensity. Based on the outcome of this systematic
review as well as that of other studies, pain intensity is not an
appropriate treatment outcome measure by itself but should be used in
combination with other domains such as physical functioning.
Comments