Abstract
Background: Temporomandibular disorders (TMDs) are the most common cause of orofacial pain of non-dental origin, with approximately 42% of diagnoses corresponding to myofascial pain. Manual therapy and dry needling are commonly used interventions for the treatment of myofascial temporomandibular disorders. However, it is unclear whether one of them could be superior to the other.
Objectives: The aim of the present systematic review and network meta-analysis was to compare the effectiveness of manual therapy and dry needling in patients with myofascial TMD.
Methods: This is a systematic review and network meta-analysis. Randomized clinical trials were searched in the databases of Pubmed, PEDro, CINAHL, Web of Science, Scopus, Cochrane, Google Academic and EMBASE. The methodological quality of studies included in this review was judged using the Physiotherapy Evidence Database (PEDro) scale. A frequentist network meta-analysis was carried out, assuming random effects, to estimate the effects of interventions for temporomandibular joint pain measured on a 10-point visual analogue scale.
Results: Out of 3190 records identified, 17 met the inclusion criteria for qualitative analysis and eight were included in the network meta-analysis. Indirect comparisons between dry needling and manual therapy showed no significant differences in their effects on pain reduction (Odds Ratio [95%CI]; - 0.263 [- 1.517, 0.992]). The ranking of treatments shows that manual therapy (SUCRA = 0.932) followed by deep dry needling (SUCRA = 0.775) present the highest values of estimation and can be considered the most likely to reduce pain.
Conclusions: The results of the network meta-analysis should be considered with caution due to the low quality of the evidence available and the high variability of the study protocols in terms of the method of application of dry needling and manual therapy interventions. PROSPERO under identifier: (CRD42020186470).
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Revisión sistemática con metaanálisis en red que compara la efectividad del punción seca profunda (deep dry needling) frente a la terapia manual en el tratamiento de los trastornos temporomandibulares (TTM) de origen miofascial. El estudio incluyó ensayos clínicos aleatorizados publicados en múltiples bases de datos (PubMed, PEDro, CINAHL, Web of Science, Scopus, Cochrane, EMBASE y Google Scholar), evaluando principalmente la reducción del dolor a corto plazo (1–3 meses).
De los 3.190 registros identificados, 17 ensayos cumplieron los criterios de inclusión para análisis cualitativo y ocho fueron incorporados al metaanálisis en red (n=556). Los resultados mostraron que no existen diferencias significativas entre punción seca profunda y terapia manual en la reducción del dolor. Sin embargo, el análisis de jerarquización (SUCRA) indicó que la terapia manual presentó la mayor probabilidad de éxito en la disminución del dolor, seguida por la punción seca. Ambas intervenciones mostraron mejores resultados que placebo, toxina botulínica y terapia cognitiva en determinadas comparaciones indirectas.
Los autores señalan que los hallazgos deben interpretarse con cautela debido a la heterogeneidad metodológica y la limitada calidad de la evidencia disponible, destacando la necesidad de ensayos clínicos directos que comparen ambas intervenciones.
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Menéndez-Torre, Á., Pintado-Zugasti, A.M., Zaldivar, J.N.C. et al. Effectiveness of deep dry needling versus manual therapy in the treatment of myofascial temporomandibular disorders: a systematic review and network meta-analysis. Chiropr Man Therap 31, 46 (2023). https://doi.org/10.1186/s12998-023-00489-x
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