Comparison and ranking of interventions for temporomandibular disorders-myofascial pain syndrome: a Bayesian network meta-analysis based on randomized controlled trials.

OBJECTIVE: Various interventions are available for temporomandibular disorders (TMD)-myofascial pain syndrome (MPS) (TMD-MPS). However, a systematic comparison of their relative short-term analgesic effects is lacking. This research, based on evidence from randomized controlled trials (RCTs), aimed to compare and rank these interventions in terms of their short-term analgesic effects, thereby providing evidence for clinical decision-making. METHODS: PubMed, Embase, Cochrane Library, and Web of Science were retrieved from their inception until June 2025 to collect RCTs involving adult patients with TMD-MPS. The primary outcome was the change in pain intensity. A Bayesian random-effects network meta-analysis (NMA) was implemented to calculate standardized mean differences (SMD) with 95% credible intervals (CrI). Treatments were ranked according to the surface under the cumulative ranking curve (SUCRA). The node-splitting method was utilized to evaluate consistency. The basic treatment (BT) node combined multiple sham/placebo controls and minimal conservative treatments. Therefore, the ranking results should be interpreted with caution. RESULTS: Totally 14 RCTs involving 674 patients were included. Compared with BT, lidocaine injection (LI), ischemic compression (IC), platelet-rich plasma (PRP), and laser treatment (LT) demonstrated a statistically significant advantage in short-term pain relief. According to the SUCRA rankings, LI (91.7%) and IC (88.7%) were the top-ranking interventions, followed by PRP (68.6%), transcutaneous electrical stimulation (TES) (67.5%), oral orthodontic appliance + lidocaine injection (OA + LI) (66.6%), and botulinum toxin injection (BTI) (66.5%). However, the effect intervals for TES, OA + LI, and BTI crossed the null value, indicating uncertainty in their rankings. The Confidence In Network Meta-Analysis (CINeMA) grading indicated that the evidence for LI and IC was primarily derived from indirect comparisons and was of very low certainty, while that for LT and PRP was of low certainty. CONCLUSION: Current evidence suggests that LI and IC exhibit substantial short-term analgesic effects. However, this finding is primarily derived from indirect comparisons and the certainty of evidence is very low. Therefore, it should be utilized for generating hypotheses for priority comparisons and guiding the design of head-to-head RCTs, rather than being interpreted as evidence of established clinical superiority. PRP and LT also demonstrated short-term benefits. Nevertheless, the certainty of evidence is low, and thus, further validations are required. The SUCRA rankings are more appropriate for generating hypotheses for priority comparisons and informing clinical decision-making, rather than being directly translated into treatment pathway priorities. Future head-to-head RCTs with more consistent control settings and parameters, larger sample sizes, and long-term follow-up should be conducted to validate efficacy and safety, and to identify the optimal population. CLINICAL TRIAL NUMBER: not applicable.