Mena Mariam, Dalbah Lana, Levi Lauren, Padilla Mariela, Enciso Reyes
Master of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA.
Post-graduate Orthodontic Department, European University College, Dubai, United Arab Emirates.
J Dent Anesth Pain Med. 2020 Dec;20(6):337-356. doi: 10.17245/jdapm.2020.20.6.337. Epub 2020 Dec 28.
This systematic review focused on the efficacy of topical products in reducing temporomandibular joint disorder (TMD)-associated pain, in comparison to placebo or control interventions. The EMBASE, Web of Science, Cochrane Library, and MEDLINE via PubMed databases were searched for randomized controlled trials (RCTs) using topical interventions in adults diagnosed with TMD. The pain intensity was the primary outcome, and other clinical findings were the secondary outcomes. The risk of bias was evaluated according to the Cochrane's handbook. The search up to February 7, 2020 identified a total of 496 unduplicated references. Nine RCTs with 355 adult patients diagnosed with TMD were included. The meta-analysis did not show a significant reduction in baseline pain intensity in the nonsteroidal anti-inflammatory drug (NSAIDs) group, when compared to the placebo group (P = 0.288). One study demonstrated a statistically significant pain score decrease for Theraflex-TMJ compared to placebo after 10 d of treatment (P = 0.003) and follow-up, 5 d after the last application (P = 0.027). Ping On reduced pain at 4 weeks of application (P < 0.001) but not after 7 d of application (P = 0.136). In one study, cannabidiol (CBD) significantly improved the pain intensity compared to placebo (P < 0.001). However, no differences were found with capsaicin in the two studies (P = 0.465). Evidence was of low quality because the studies were considered as having an unclear or a high risk of bias and a small number of studies were analyzed. The evidence is not sufficient to support the use of topical NSAIDs and capsaicin, and limited evidence was found for Threraflex-TMJ, bee venom, Ping On, and CBD, with only one study reporting for each. Additional studies are recommended to validate these results.
本系统评价聚焦于局部用产品与安慰剂或对照干预措施相比，在减轻颞下颌关节紊乱病（TMD）相关疼痛方面的疗效。通过EMBASE、科学网、Cochrane图书馆以及经由PubMed数据库检索MEDLINE，查找针对诊断为TMD的成人使用局部干预措施的随机对照试验（RCT）。疼痛强度为主要结局指标，其他临床发现为次要结局指标。依据Cochrane手册评估偏倚风险。截至2020年2月7日的检索共识别出496篇不重复参考文献。纳入了9项RCT，涉及355例诊断为TMD的成年患者。荟萃分析显示，与安慰剂组相比，非甾体抗炎药（NSAIDs）组的基线疼痛强度未显著降低（P = 0.288）。一项研究表明，Theraflex-TMJ治疗10天后与安慰剂相比，疼痛评分有统计学显著降低（P = 0.003），且在最后一次用药后5天的随访中也是如此（P = 0.027）。平痛新在用药4周时减轻了疼痛（P < 0.001），但用药7天后未减轻（P = 0.136）。在一项研究中，大麻二酚（CBD）与安慰剂相比显著改善了疼痛强度（P < 0.001）。然而，两项研究中辣椒素组未发现差异（P = 0.465）。证据质量较低，因为这些研究被认为存在不明确或高偏倚风险，且分析的研究数量较少。证据不足以支持使用局部用NSAIDs和辣椒素，对于Theraflex-TMJ、蜂毒、平痛新和CBD仅发现有限证据，每项仅有一项研究报道。建议进行更多研究以验证这些结果。
