Objective Temporomandibular disorders (TMD) comprise a cluster of conditions with a wide range of etiological factors that causes pain and discomfort in the masticatory muscles (TMD-M) and temporomandibular joints (TMD-J). More than 50% of the patients with TMD report regular usage of drugs. However, there is still no consensus, nor is there any evidence-based support for clinicians when choosing between different drugs. Therefore, this systematic review, including a network meta-analysis (NMA), aimed to evaluate the scientific evidence and discuss the pharmacological treatment options available to treat painful TMD. Method An electronic search was undertaken to identify randomized controlled trials (RCTs) investigating pharmacological treatments for TMD-M and/or TMD-J, published until 6 April 2023. Since only 11 articles could be used for an NMA regarding TMD-M, a narrative synthesis was also performed for all 40 included RCTs. The quality of evidence was rated according to Cochrane’s tool for assessing risk of bias, while the certainty of evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results When it comes to TMD-M, evidence arises for wet needling therapies with BTX-A, granisetron, and PRP as well as muscle relaxants. For TMD-J, evidence points toward pharmacological treatment approaches including non-steroidal antiinflammatory drugs (NSAIDs) and glucocorticosteriods (for inflammatory conditions) as well as hyaluronic acid and dextrose. Conclusions The evidence clearly indicates that the pharmacological treatment approaches differ between TMD-M and TMD-J. Therefore, it is of great importance to first try to uncover each patient’s individual and multifactorial etiology and then employ a multifaceted treatment strategy, including pharmacological treatment approaches.

The impact of comorbidities in fibromyalgia (FM) and temporomandibular disorders (TMD) have been well documented, but whether TMD sub-diagnoses myalgia (MYA) and myofascial pain with referral (MFP) differ regarding comorbidity is unclear. We aimed to elucidate this by studying the presence and associations of comorbidities in FM, MFP and MYA. An extended version of the Diagnostic Criteria for TMD axis II questionnaire was used to examine demographics, pain and comorbidities in 81 patients with FM, 80 with MYA, and 81 with MFP. Patients with MFP and FM reported a higher percentage of irritable bowel syndrome (IBS), depression, anxiety, somatic symptoms, perceived stress, and insomnia compared to MYA. Patients with FM had more IBS, depression, and somatic symptom disorder versus MFP. After adjusting for confounding variables, participants with anxiety, somatic symptoms disorder, pain catastrophizing, and perceived stress, as well as a greater number of comorbidities, were more likely to have MFP than MYA, whereas FM participants were more associated with IBS, somatic symptoms and insomnia compared to MFP. The number of comorbidities was significantly associated with widespread pain but not pain duration, body mass index or being on sick leave. In conclusion, patients with MFP were more similar to those with FM regarding comorbidity and should be differentiated from MYA in clinical settings and pain management.

Background: Pain frequency is considered an important aspect of pain chronicity, linked to heightened pain and psychosocial distress. In the International Classification of Orofacial Pain (ICOP), temporomandibular disorders (TMD) are classified as frequent (FR, 1–14 days/month) and highly frequent (HF, ≥ 15 days/month), but whether this is clinically relevant is unknown. Objectives: This retrospective study aimed to examine differences in FR and HF TMD patients regarding demographics, diagnostics, characteristic pain intensity (CPI) and disability (GCPS), jaw function (JFLS), psychosocial variables (depression, anxiety, pain catastrophizing (PCS) and somatic symptoms) and oral‐health‐related quality of life (OHIP‐5). Methods: Records of 208 patients with either FR or HF TMD pain (ICOP), were included. All patients had been examined according to the Diagnostic Criteria for TMD (DC/TMD) axis I and axis II. Univariate statistics were used to compare FR and HF TMD, and multivariate statistics to identify variables differentiating HF from FR TMD ( p < 0.05). Results: Arthralgia and degenerative joint disease were more common in HF TMD compared to FR ( p = 0.004 and p = 0.010). HF TMD had higher CPI ( p < 0.001), JFLS ( p < 0.001), PCS ( p < 0.001) and OHIP‐5 ( p < 0.001) scores. Higher CPI, GCPS, PCS, JFLS and OHIP‐5 distinguished HF from FR TMD patients ( p < 0.05). Conclusion: HF TMD patients showed increased pain intensity, disability, catastrophizing jaw functional limitations, and reduced quality of life distinguishing them from FR TMD patients. This study is the first to demonstrate the clinical relevance of the ICOP frequency‐based classification of TMD, highlighting its importance in the risk assessment and management of these patients.