Effectiveness of cognitive behavioral therapy for pain and stress in temporomandibular disorders: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Temporomandibular disorders (TMDs) have been described as multifactorial conditions involving musculoskeletal pain, psychological distress, and impaired jaw function. Although cognitive behavioral therapy (CBT) has been increasingly used to manage the psychological components of chronic pain, its isolated effectiveness for TMDs remains uncertain because of methodological variability in existing studies.

PURPOSE: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the effectiveness of CBT for reducing pain and psychological stress among adults with TMDs compared with conventional therapeutic interventions alone.

MATERIAL AND

METHODS

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search of RCTs published within the past 10 years was conducted across 4 databases: PubMed, Scopus, Web of Science, and Cochrane Library. Study selection, quality appraisal using the Joanna Briggs Institute checklist, data extraction, and meta-analysis were performed independently by 2 reviewers. A random-effects model was used to compute pooled standardized mean differences with 95% confidence intervals, and heterogeneity was assessed using the I² statistic (α=.05).

RESULTS

Five RCTs, with 413 participants, were analyzed. CBT interventions, whether delivered independently or combined with occlusal devices or manual therapy, demonstrated moderate improvements in pain and psychological distress. The pooled standardized mean difference (SMD) was 0.53 (95% CI: -0.06 to 1.12; P=.068), reflecting moderate but statistically nonsignificant effectiveness. Heterogeneity across studies was considerable (I²=77%). Sensitivity analyses indicated variations in intervention duration as a potential source of heterogeneity.

CONCLUSIONS

CBT effectively reduced the pain and psychological distress associated with TMDs, with optimal outcomes when integrated into multidisciplinary treatment approaches. However, evidence remains limited because of the moderate risk of bias, small sample sizes, and short follow-up periods. Future research should prioritize standardized CBT protocols and long-term outcomes to enhance clinical applicability.