Dei Takara, Galloway Kennedy, Fagundes Nathalia Carolina Fernandes, Kung Janice Y, Beahm Nathan P, Friesen Reid
Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
Department of Physiology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Canada.
J Oral Rehabil. 2025 Jun;52(6):923-936. doi: 10.1111/joor.13971. Epub 2025 Apr 4.
Chronic temporomandibular disorder (TMD) pain significantly impairs quality of life and lacks universally effective treatments. Antidepressants, traditionally used for mood disorders, have shown potential in managing chronic pain conditions. This systematic review evaluates the efficacy and safety of antidepressants for chronic TMD pain management.
Eligibility criteria: Included randomised controlled trials (RCTs) assessing antidepressants for chronic TMD pain in adults, reporting pain reduction or functional improvement as outcomes.
Searches were conducted in MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Cochrane Library through April 2024. Risk of bias: The Cochrane Risk of Bias 2 tool was used to assess study quality.
Narrative synthesis was performed due to heterogeneity in interventions and outcomes.
Included studies: Seven RCTs with sample sizes ranging from 12 to 80 participants. Studies evaluated various antidepressants, including amitriptyline, duloxetine, nortriptyline, and citalopram, alone or combined with non-pharmacological treatments.
Amitriptyline and duloxetine demonstrated significant reductions in pain intensity when used in combination therapies. Functional improvements, such as increased mouth opening, were observed in some studies. Side effects, particularly with duloxetine, were more frequent than with placebo. Variability in study designs, populations, and outcome measures limited comparability. Small sample sizes, short follow-up durations, and heterogeneity in interventions and outcomes reduced the strength of evidence.
Antidepressants, particularly when combined with non-pharmacological treatments, may enhance pain relief and functional outcomes for chronic TMD pain. However, high-quality, long-term studies are needed.
慢性颞下颌关节紊乱症（TMD）疼痛严重影响生活质量，且缺乏普遍有效的治疗方法。传统上用于治疗情绪障碍的抗抑郁药在管理慢性疼痛方面已显示出潜力。本系统评价评估了抗抑郁药治疗慢性TMD疼痛的疗效和安全性。
纳入标准：包括评估抗抑郁药治疗成人慢性TMD疼痛的随机对照试验（RCT），报告疼痛减轻或功能改善作为结局。
截至2024年4月，在MEDLINE、Embase、CINAHL、Scopus、科学网和Cochrane图书馆进行了检索。偏倚风险：使用Cochrane偏倚风险2工具评估研究质量。
由于干预措施和结局存在异质性，进行了叙述性综合分析。
纳入研究：7项RCT，样本量从12至80名参与者不等。研究评估了各种抗抑郁药，包括阿米替林、度洛西汀、去甲替林和西酞普兰，单独使用或与非药物治疗联合使用。
阿米替林和度洛西汀在联合治疗中显示出疼痛强度显著降低。在一些研究中观察到功能改善，如开口度增加。副作用，尤其是度洛西汀的副作用，比安慰剂更常见。研究设计、人群和结局测量的差异限制了可比性。小样本量、短随访时间以及干预措施和结局的异质性降低了证据的强度。
抗抑郁药，特别是与非药物治疗联合使用时，可能会增强慢性TMD疼痛的疼痛缓解和功能结局。然而，需要高质量的长期研究。
