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% (n = 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%, p = 0.05), reduced tenderness in the medial pterygoid muscle (standardised mean differences [SMD] = 1.72, I2 = 0%, p < 0.00001) and jaw dysfunction (SMD = 1.62, I2 = 88%, p = 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.

本研究旨在评估不同针刺疗法对口腔面部疼痛成人患者的镇痛效果、最大张口度及下颌功能的改善作用。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分级系统（GRADE）评估偏倚风险及证据整体确定性。纳入的52项研究中，86.5%（n=45）存在较高偏倚风险。常用腧穴包括合谷LI4、颊车ST6、下关ST7，主要用于颞下颌关节紊乱病（Temporomandibular Disorder, TMD）患者。Meta分析结果显示，与假针刺/未治疗组相比，针刺可显著减轻肌源性TMD患者的疼痛强度（均差MD=26.02mm，I²=89%，p=0.05），并可缓解混合性TMD患者的翼内肌压痛（标准化均差SMD=1.72，I²=0%，p<0.00001）及下颌功能障碍（SMD=1.62，I²=88%，p=0.010）。但采用GRADE分级系统评估显示，所有结局指标的证据整体确定性均极低。由于绝大多数随机对照试验（Randomized Controlled Trial, RCT）存在较高偏倚风险，且证据整体确定性极低，因此对本综述的整体结果应谨慎解读。因此，未来需开展高质量随机对照试验，以评估针刺疗法在口腔面部疼痛患者中的应用价值。针刺或可减轻口腔面部疼痛患者的主观疼痛强度及咀嚼肌敏感性，改善张口度并缓解功能障碍，尤其适用于TMD患者。LI4（合谷）、ST6（颊车）、ST7（下关）、GB20（风池）、SI19（听宫）、ST36（足三里）为治疗口腔面部疼痛，尤其是TMD患者时最常用的腧穴。临床医生可谨慎参考本综述的研究结果，为TMD患者制定安全有效的针刺治疗方案。针刺或可减轻口腔面部疼痛患者的主观疼痛强度及咀嚼肌敏感性，改善张口度并缓解功能障碍，尤其适用于TMD患者。LI4（合谷）、ST6（颊车）、ST7（下关）、GB20（风池）、SI19（听宫）、ST36（足三里）为治疗口腔面部疼痛，尤其是TMD患者时最常用的腧穴。临床医生可谨慎参考本综述的研究结果，为TMD患者制定安全有效的针刺治疗方案。