The effectiveness of different types of acupuncture to reduce symptoms and disability for patients with orofacial pain. A systematic review and meta-analysis

To determine the effectiveness of different types of acupuncture in reducing pain, improving maximum mouth opening and jaw functions in adults with orofacial pain. Six databases were searched until 15 June 2023. The Cochrane risk of bias tool and GRADE were employed to evaluate bias and overall evidence certainty. Among 52 studies, 86.5% (<i>n</i> = 45) exhibited high risk of bias. Common acupoints, including Hegu LI 4, Jiache ST 6, and Xiaguan ST 7, were used primarily for patients with temporomandibular disorder [TMDs]. Meta-analyses indicated that acupuncture significantly reduced pain intensity in individuals with myogenous TMD (MD = 26.02 mm, I²=89%, <i>p</i> = 0.05), reduced tenderness in the medial pterygoid muscle (standardised mean differences [SMD] = 1.72, I² = 0%, <i>p</i> &lt; 0.00001) and jaw dysfunction (SMD = 1.62, I² = 88%, <i>p</i> = 0.010) in mixed TMD when compared to sham/no treatment. However, the overall certainty of the evidence was very low for all outcomes as evaluated by GRADE. The overall results in this review should be interpreted with caution as there was a high risk of bias across the majority of randomized controlled trial (RCTs), and the overall certainty of the evidence was very low. Therefore, future studies with high-quality RCTs are warranted evaluating the use of acupuncture in patients with orofacial pain. Acupuncture could potentially reduce subjective pain intensity and sensitivity of masticatory muscles, improve mouth opening, and reduce dysfunction in orofacial pain, specifically in patients with temporomandibular disorder (TMD).Acupuncture points such as LI4, ST6, ST7, GB20, SI19, ST36 were the most commonly used acupuncture points to treat patients with orofacial pain, especially TMDs.Clinicians can use the information in this review with caution to develop an effective and appropriate treatment regimen for the acupuncture treatment of patients with TMDs. Acupuncture could potentially reduce subjective pain intensity and sensitivity of masticatory muscles, improve mouth opening, and reduce dysfunction in orofacial pain, specifically in patients with temporomandibular disorder (TMD). Acupuncture points such as LI4, ST6, ST7, GB20, SI19, ST36 were the most commonly used acupuncture points to treat patients with orofacial pain, especially TMDs. Clinicians can use the information in this review with caution to develop an effective and appropriate treatment regimen for the acupuncture treatment of patients with TMDs.

本数据集旨在探究不同针灸方案对伴口面痛成人的疼痛缓解效果、最大张口度提升及颌面部功能改善的作用。本研究检索了截至2023年6月15日的6个数据库，采用Cochrane偏倚风险工具（Cochrane risk of bias tool）与GRADE分级法分别评估研究偏倚风险与整体证据质量。在纳入的52项研究中，86.5%（n=45）存在较高偏倚风险。颞下颌关节紊乱病（Temporomandibular Disorders, TMDs）患者的临床取穴多以合谷LI4、颊车ST6、下关ST7为主。
荟萃分析结果显示，与假针刺/无治疗组相比，针灸可显著降低肌源性颞下颌关节紊乱病患者的疼痛强度（均差MD=26.02mm，I²=89%，p=0.05），减轻混合性颞下颌关节紊乱病患者翼内肌压痛（标准化均差SMD=1.72，I²=0%，p<0.00001）及颌面部功能障碍（SMD=1.62，I²=88%，p=0.010）。但经GRADE分级评估，所有结局指标的整体证据质量均为极低。由于多数随机对照试验（Randomized Controlled Trial, RCT）存在较高偏倚风险，本综述的整体结果需谨慎解读，且整体证据质量极低。因此，未来需开展高质量随机对照试验，进一步评估针灸在口面痛患者中的应用价值。
针灸或可降低咀嚼肌的主观疼痛强度与敏感度，改善张口度，缓解口面痛相关功能障碍，尤其适用于颞下颌关节紊乱病（TMD）患者。LI4、ST6、ST7、GB20、SI19、ST36等穴位是治疗口面痛患者（尤其是颞下颌关节紊乱病患者）的最常用取穴。临床医师可谨慎参考本综述内容，为颞下颌关节紊乱病患者制定安全有效的针灸治疗方案。
针灸或可降低咀嚼肌的主观疼痛强度与敏感度，改善张口度，缓解口面痛相关功能障碍，尤其适用于颞下颌关节紊乱病（TMD）患者。LI4、ST6、ST7、GB20、SI19、ST36等穴位是治疗口面痛患者（尤其是颞下颌关节紊乱病患者）的最常用取穴。临床医师可谨慎参考本综述内容，为颞下颌关节紊乱病患者制定安全有效的针灸治疗方案。