Comparative effectiveness of traditional East Asian medicine treatments for temporomandibular joint disorders: A systematic review and network meta-analysis.

Temporomandibular joint disorders (TMDs) cause pain and functional restrictions in the temporomandibular joint that interfere with daily activities. The aim of this study was to evaluate and compare the effectiveness and safety of various traditional East Asian medicine treatments, including acupuncture, electroacupuncture, moxibustion, and herbal medicine, in the management of TMD. We included searches of MEDLINE, CENTRAL, EMBASE, AMED, CINAHL, OASIS, KISS, RISS, KMbase, KCI, CNKI, and CiNii from inception to November 12, 2023, for randomized controlled trials of traditional East Asian medicine treatments in patients with TMD. A network meta-analysis was performed via frequentist methods, and the confidence in network meta-analysis methodology was employed to assess evidence quality. Forty-five studies with 2,211 participants were ultimately included. Compared with sham treatment, acupotomy (mean difference (MD) of -5.07, 95% confidence interval (CI) of -7.37 to -2.78) and acupuncture (MD of -1.18, 95% CI of -2.28 to -0.09) significantly improved pain intensity. According to the SUCRA rankings, acupotomy was considered the most effective treatment, followed by electroacupuncture, acupuncture, manipulation, laser therapy and occlusal splint. A total of 12 studies reported the incidence of adverse events, and none reported serious adverse events. Acupotomy and acupuncture could be more beneficial than sham treatment for pain relief and might be better options than occlusal splints. However, future rigorous, well-designed trials are needed to draw clear conclusions. PROSPERO (CRD42023467340).