Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Aug 7;25(1):1303.
doi: 10.1186/s12903-025-06043-w.

Efficacy of duloxetine in treating temporomandibular joint disorder: a systematic review with bayesian meta-analysis

Sasidharan Sivakumar  1   2 , Ashok K Sundramoorthy  3 , Sankar Narayanan  4 , Julia Thenmozhi J  5 , Gowardhan Sivakumar  6
Affiliations
Meta-Analysis

Efficacy of duloxetine in treating temporomandibular joint disorder: a systematic review with bayesian meta-analysis

Sasidharan Sivakumar et al. BMC Oral Health. .

Abstract

Objectives: This study aims to evaluate the efficacy of duloxetine in managing temporomandibular joint disorder (TMD), focusing on pain reduction and functional improvement. The research addresses the need for novel therapeutic agents due to the suboptimal efficacy and tolerability of existing treatments.

Materials and methods: A systematic review and Bayesian meta-analysis were conducted following PRISMA guidelines. A comprehensive search of MEDLINE (via PubMed), Web of Science, Scopus, Embase, and Google Scholar was performed up to February 2025. Eligibility criteria were defined using the PICOS framework: Population (TMD patients), Intervention (duloxetine), Comparator (placebo or other treatments), Outcomes (pain reduction, maximum mouth opening), and Study design (randomized controlled trials). Data synthesis employed Bayesian meta-analysis, and evidence quality was assessed using the GRADE framework.

Results: Five studies involving 203 participants met the inclusion criteria. Four evaluated duloxetine combined with TMJ arthrocentesis, while one compared duloxetine to a placebo. Combination therapy yielded significant pain reduction (pooled effect size = 1.42) and a consistent, though not statistically significant, improvement in maximum mouth opening. Bayesian analysis strongly supported pain reduction (BF10 = 44.197) but was inconclusive for functional improvement (BF10 = 0.783). The risk of bias ranged from moderate to high, with high-certainty evidence supporting the efficacy of combination therapy.

Conclusion: Duloxetine, when combined with TMJ arthrocentesis, provides significant pain relief and potential functional benefits in TMD management. However, further large-scale, high-quality randomized trials are necessary to confirm these findings.

Keywords: Arthrocentesis; Bayesian analysis; Duloxetine; Serotonin; Temporomandibular joint disorders.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study did not require ethics approval as it is exclusively based on published literature. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The PRISMA Flow chart
Fig. 2
Fig. 2
Risk of bias for individual studies
Fig. 3
Fig. 3
Summary risk of bias graph
Fig. 4
Fig. 4
Forest plot graph on efficiency of combining duloxetine with TMJ arthrocentesis in improvising the parameter of (a) pain, (b) mouth opening
Fig. 5
Fig. 5
Funnel plot graph on efficiency of combining duloxetine with TMJ arthrocentesis in improvising the parameter of (a) pain, (b) mouth opening
See this image and copyright information in PMC

References

    1. Valesan LF, Da-Cas CD, Réus JC, Denardin ACS, Garanhani RR, Bonotto D, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clin Oral Investig. 2021;25:441–53. 10.1007/s00784-020-03710-w. - PubMed
    1. Ryan J, Hassan N, Hilton G, Wickham J, Akhter R, Ibaragi S. Epidemiology of Temporomandibular Disorder in the General Population: a Systematic Review. Advances in Dentistry & Oral Health 2019;10:1–13. 10.19080/ADOH.2019.10.555787.
    1. Karamat A, Smith JG, Melek LNF, Renton T. Psychologic Impact of Chronic Orofacial Pain: A Critical Review. J Oral Facial Pain Headache 2022;36:103–40. 10.11607/OFPH.3010. - PMC - PubMed
    1. Sivakumar S, Sivakumar G, Sundramoorthy AK. Effects of Glucosamine in the Temporomandibular Joint Osteoarthritis: A Review. Curr Rheumatol Rev. 2024;20:373–8. 10.2174/0115733971283009231225144322. - PubMed
    1. Mathew A, CR V, KA A, Goswami D, Antony T, Bharat R. Effectiveness of Occlusal Splint Therapy in Moderating Temporomandibular Joint Disorders With Joint Displacement: A Retrospective Analysis Using Cone Beam Computed Tomography. Cureus 2024;16. 10.7759/CUREUS.57300. - PMC - PubMed

MeSH terms

Substances

LinkOut - more resources