Acupuncture in Temporomandibular Disorder Myofascial Pain Treatment: A Systematic Review

Aims: To carry out a systematic review of clinical trials published up to 2015 to determine the effectiveness of acupuncture in treating myofascial pain in temporomandibular disorder (TMD) patients. Methods: The databases used were the Cochrane Library, PubMed, Scopus, and Web of Science; the dates of the articles surveyed ranged from 1990 to May 2015. The inclusion criteria were: (1) publications in English, Portuguese, or Spanish; (2) controlled clinical trials; (3) patients with TMD of muscular origin; and (4) studies that used acupuncture or laser acupuncture only for treatment. Reference lists of the included articles were hand searched. Results: A total of four randomized clinical trials using acupuncture (traditional, trigger point, and laser) for TMD treatment met the eligibility criteria and were included. Although the studies featured small sample sizes and short-term follow-up periods, acupuncture yielded results similar to those observed in groups treated with occlusal splints and were significantly superior than those obtained from placebo acupuncture–treated groups. Conclusion: Despite the weak scientific evidence supporting its efficacy, acupuncture treatment appears to relieve the signs and symptoms of pain in myofascial TMD. More controlled and randomized clinical trials with larger sample sizes are needed in this field of research to verify these initial findings.

acupuncture therapy; controlled clinical trial; myofascial pain; temporomandibular joint dysfunction disorders

1. de Leeuw R, American Academy of Orofacial Pain. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management, ed 4. Chicago: Quintessence, 2008:129–175.

2. La Touche R, Goddard G, De­la­Hoz JL, et al. Acupuncture in the treatment of pain in temporomandibular disorders: A sys­tematic review and meta­analysis of randomized controlled tri­als. Clin J Pain 2010;26:541–550.

3. Herb K, Cho S, Stiles MA. Temporomandibular joint pain and dysfunction. Curr Pain Headache Rep 2006;10:408–414.

4. da Cunha SC, Nogueira RV, Duarte AP, Vasconcelos BC, Almeida Rde A. Analysis of helkimo and craniomandibular indexes for temporomandibular disorder diagnosis on rheu­matoid arthritis patients. Braz J Otorhinolaryngol 2007;73: 19–26.

5. de Oliveira SB, de Siqueira SR, Sanvovski AR, do Amaral LM, de Siqueira JT. Temporomandibular disorder in Brazilian patients: A preliminary study. J Clin Psychol Med Settings 2008;15: 338–343.

6. Gonçalves DA, Dal Fabbro AL, Campos JA, Bigal ME, Speciali JG. Symptoms of temporomandibular disorders in the population: An epidemiological study. J Orofac Pain 2010;24: 270–278.

7. Stohler CS. Clinical perspectives on masticatory and related muscle disorders. In: Sessle BJ, Bryant PS, Dionne RA (eds). Temporomandibular Disorders and Related Pain Conditions: Progress in Pain Research and Management, vol 4. Seattle: IASP, 1995:3–29.

8. Dimitroulis G, Gremillion HA, Dolwick MF, Walter JH. Temporomandibular disorders. 2. Non­surgical treatment. Aust Dent J 1995;40:372–376.

9. Syrop SB. Initial management of temporomandibular disorders. Dent Today 2002;21:52–57.

10. Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disor­ders. N Engl J Med 2008;359:2693–2705.

11. Goudot P, Jaquinet AR, Hugonnet S, Haefliger W, Richter M. Improvement of pain and function after arthroscopy and arthro­centesis of the temporomandibular joint: A comparative study. J Craniomaxillofac Surg 2000;28:39–43.

12. Yuasa H, Kurita K, Treatment Group on Temporomandibular Disorders. Randomized clinical trial of primary treatment for temporomandibular joint disk displacement without reduction and without osseous changes: A combination of NSAIDs and mouth­opening exercise versus no treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:671–675.

13. Crider AB, Glaros AG. A meta­analysis of EMG biofeedback treatment of temporomandibular disorders. J Orofac Pain 1999;13:29–37.

14. Komiyama O, Kawara M, Arai M, Asano T, Kobayashi K. Posture correction as part of behavioural therapy in treatment of myofascial pain with limited opening. J Oral Rehabil 1999; 26:428–435.

15. La Touche R, Angulo­Díaz­Parreño S, de­la­Hoz JL, et al. Effectiveness of acupuncture in the treatment of temporomandibular disorders of muscular origin: A systematic review of the last decade. J Altern Complement Med 2010;16:107–112.

16. List T, Helkimo M. Acupuncture and occlusal splint therapy in the treatment of craniomandibular disorders. II. A 1­year fol­low­up study. Acta Odontol Scand 1992;50:375–385.

17. Rosted P, Bundgaard M, Pedersen AM. The use of acupunc­ture in the treatment of temporomandibular dysfunction—An audit. Acupunct Med 2006;24:16–22.

18. Ernst E. Homeopathic prophylaxis of headaches and migraine? A systematic review. J Pain Symptom Manage 1999;18:353–357.

19. Cho SH, Whang WW. Acupuncture for temporomandibular dis­orders: A systematic review. J Orofac Pain 2010;24:152–162.

20. Ernst E, Pittler MH. The effectiveness of acupuncture in treating acute dental pain: A systematic review. Br Dent J 1998; 184:443–447.

21. Melchart D, Linde K, Fischer P, et al. Acupuncture for idiopathic headache. Cochrane Database Syst Rev 2001;(1):CD001218.

22. Melchart D, Thormaehlen J, Hager S, Liao J, Linde K, Weidenhammer W. Acupuncture versus placebo versus sumatriptan for early treatment of migraine attacks: A randomized controlled trial. J Intern Med 2003;253:181–188.

23. Coeytaux RR, Kaufman JS, Kaptchuk TJ, et al. A randomized, controlled trial of acupuncture for chronic daily headache. Headache 2005;45:1113–1123.

24. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension­type headache. Cochrane Database Syst Rev 2009;(1):CD007587.

25. Melchart D, Streng A, Hoppe A, et al. Acupuncture in patients with tension­type headache: Randomised controlled trial. BMJ 2005;331:376–382.

26. Jung A, Shin BC, Lee MS, Sim H, Ernst E. Acupuncture for treating temporomandibular joint disorders: A systematic review and meta­analysis of randomized, sham­controlled trials. J Dent 2011;39:341–350.

27. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Control Clin Trials 1996;17:1–12.

28. Ferreira LA, de Oliveira RG, Guimarães JP, Carvalho AC, De Paula MV. Laser acupuncture in patients with temporomandibular dysfunction: A randomized controlled trial. Lasers Med Sci 2013;28:1549–1558.

29. Vicente­Barrero M, Yu­Lu SL, Zhang B, et al. The efficacy of acupuncture and decompression splints in the treatment of temporomandibular joint pain­dysfunction syndrome. Med Oral Patol Oral Cir Bucal 2012;17:e1028–e1033.

30. Shen YF, Younger J, Goddard G, Mackey S. Randomized clinical trial of acupuncture for myofascial pain of the jaw muscles.J Orofac Pain 2009;23:353–359.

31. Simma I, Gleditsch JM, Simma L, Piehslinger E. Immediate effects of microsystem acupuncture in patients with oromyofacial pain and craniomandibular disorders (CMD): A double­blind, placebo­controlled trial. Br Dent J 2009;207:e26.

32. Schmid­Schwap M, Simma­Kletschka I, Stockner A, et al. Oral acupuncture in the therapy of craniomandibular dysfunction syndrome—A randomized controlled trial. Wien Klin Wochenschr 2006;118:36–42.

33. Shen YF, Goddard G. The short­term effects of acupuncture on myofascial pain patients after clenching. Pain Pract 2007;7:256–264.

34. Elsharkawy TM, Ali NM. Evaluation of acupuncture and occlusal splint therapy in the treatment of temporomandibular joint disor­ders. Egypt Dent J 1995;41:1227–1232.

35. Raustia AM. Diagnosis and treatment of temporomandibular joint dysfunction. Advantages of computed tomography diag­nosis. Stomatognathic treatment and acupuncture—A random­ized trial. Proc Finn Dent Soc 1986;82(suppl):s1–s41.

36. Simma­Kletschka I, Gleditsch J, Simma L, Piehslinger E. Microsystems acupuncture in craniomandibular pain syn­dromes—A randomised controlled trial [in Spanish]. Rev Int Acupuntura 2010;4:6–11.

37. 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. J Orofac Pain 1993;7:275–282.

38. List T, Helkimo M, Andersson S, Carlsson GE. Acupuncture and occlusal splint therapy in the treatment of craniomandibular disorders. Part I. A comparative study. Swed Dent J 1992;16:125–141.

39. List T. Acupuncture in the treatment of patients with craniomandibular disorders. Comparative, longitudinal and methodologi­cal studies. Swed Dent J Suppl 1992;87:1–159.

40. Johansson A, Wenneberg B, Wagersten C, Haraldson T. Acupuncture in treatment of facial muscular pain. Acta Odontol Scand 1991;49:153–158.

41. Smith P, Mosscrop D, Davies S, Sloan P, Al­Ani Z. The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: A randomised controlled trial. J Dent 2007;35:259–267.

42. Katsoulis J, Ausfeld­Hafter B, Windecker­Gétaz I, Katsoulis K, Blagojevic N, Mericske­Stern R. Laser acupuncture for myofascial pain of the masticatory muscles. A controlled pilot study. Schweiz Monatsschr Zahnmed 2010;120:213–225.

43. Itoh K, Asai S, Ohyabu H, Imai K, Kitakoji H. Effects of trigger point acupuncture treatment on temporomandibular disorders: A preliminary randomized clinical trial. J Acupunct Meridian Stud 2012;5:57–62.

44. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta­analyses of studies that evaluate healthcare interventions: Explanation and elabora­tion. BMJ 2009;339:b2700.

45. Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: A systematic review and meta-­analy­sis of randomised controlled trials. Eur J Pain 2009;13:3–10.