Comparison of Effectiveness of Pharmacological and Non-pharmacological Management of Temporomandibular Joint Pain - A Systematic Review

Abstract Background: Temporomandibular disorders (TMDs) are a heterogeneous group of conditions affecting the temporomandibular joint (TMJ) and masticatory musculature, commonly presenting with pain and functional limitation. Although both pharmacological and non-pharmacological treatment modalities are widely used, their relative effectiveness remains unclear. Objectives: To systematically compare the clinical effectiveness of pharmacological and non-pharmacological interventions in the management of TMJ-related pain and dysfunction. Data Sources: This systematic review was conducted in accordance with PRISMA-2020 guidelines and registered with PROSPERO (CRD42025641487). Electronic searches of PubMed, Scopus, Web of Science and Cochrane Library were performed for randomised controlled trials (RCTs) published between 2014 and 2024. Adult patients diagnosed with TMDs were included. Primary outcomes were pain reduction and improvement in mandibular function. Risk of bias (RoB) was assessed using the Cochrane RoB-2 tool. Study Eligibility Criteria: Eighteen RCTs comprising 871 participants were included. Pharmacological interventions (NSAIDs, corticosteroids, muscle relaxants, hyaluronic acid and platelet-based injectables) demonstrated effective short-term pain relief, with benefits often diminishing beyond 4–6 weeks. Interventions: Non-pharmacological interventions (physiotherapy, occlusal splints, exercise therapy, low-level laser therapy and behavioural therapy) showed more consistent and sustained improvements in pain, mandibular mobility, and patient-reported outcomes. Study Appraisal: Combined conservative approaches yielded superior and longer-lasting results. Conclusions: Non-pharmacological modalities appear to provide superior long-term outcomes in TMD management and should be considered first-line therapy. Pharmacological agents remain useful as adjuncts, particularly for acute symptom control.