The effectiveness of conservative interventions on temporomandibular disorder-related kinesiophobia and pain catastrophizing: a systematic review.

BACKGROUND

Temporomandibular disorders (TMD) are prevalent conditions that can significantly impact function and quality of life. Pain catastrophizing and kinesiophobia contribute to temporomandibular disorder-related disability.

AIMS: Evaluate the effectiveness of conservative interventions on kinesiophobia and pain catastrophizing in adults with temporomandibular disorders.

METHODS

PubMed, Embase, CINAHL and Cochrane Central were searched for peer-reviewed interventional studies evaluating the effect of non-pharmacological conservative interventions on kinesiophobia and pain catastrophizing in adults diagnosed with a temporomandibular disorder. Risk of bias was assessed using the Cochrane Risk of Bias (version 2) tool and data were synthesised narratively according to outcomes and interventions. Overall certainty of evidence was evaluated using a modified GRADE approach.

RESULTS

Twelve studies were included, comprising 815 participants (mean age = 42.2 years, 85 % female, most with myofascial/pain-related temporomandibular disorders). Interventions included cognitive behavioural therapy, pain neuroscience education ± exercise, manual therapy, occlusal splinting and hypnosis. There was low to very low confidence that cognitive behavioural therapy, pain neuroscience education plus exercise, and manual therapy may reduce pain catastrophizing in individuals with temporomandibular disorders, and low to very low confidence that pain neuroscience education and manual therapy may improve kinesiophobia. There was very low confidence that hypnosis and occlusal splinting are ineffective at reducing pain catastrophizing levels compared to other conservative interventions.

CONCLUSIONS

Cognitive behavioural therapy, pain neuroscience education and manual therapy may be effective in reducing kinesiophobia and pain catastrophizing in adults with temporomandibular disorders. Further research is needed to improve the quality of this evidence.