Placebo and nocebo response magnitude on temporomandibular disorder-related pain: A systematic review and meta-analysis.
Study Goal
The researchers aimed to evaluate the placebo effect of avocado soya bean extract compared to other therapies in reducing pain intensity in adult patients with temporomandibular disorder (TMD)-related pain.
Results Summary
The study found that avocado soya bean extract had a significant placebo effect, reducing pain intensity by 36 mm, ranking second highest among the therapies analyzed. The placebo effect for avocado soya bean extract was comparable to other interventions, contributing to pain relief in TMD patients.
Population
Adult patients (over 18 years) diagnosed with painful TMD using Research Diagnostic Criteria (RDC/TMD) or Diagnostic Criteria (DC/TMD).
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
laser acupuncture | decrease | pain intensity | adult patients with temporomandibular disorder (TMD)-related pain | 45.5 mm point reduction | mean variation on pain intensity for placebo therapy was higher | #1 |
avocado soya bean extract | decrease | pain intensity | adult patients with temporomandibular disorder (TMD)-related pain | 36 mm | mean variation on pain intensity for placebo therapy was higher | #2 |
amitriptyline 25 mg | decrease | pain intensity | adult patients with temporomandibular disorder (TMD)-related pain | 25.2 mm | mean variation on pain intensity for placebo therapy was higher | #3 |
Laser | increase | placebo effect | adult patients with temporomandibular disorder (TMD)-related pain | 29% | showed a placebo effect | #4 |
medicine | increase | placebo effect | adult patients with temporomandibular disorder (TMD)-related pain | 19% | showed a placebo effect | #5 |
other therapies | increase | placebo effect | adult patients with temporomandibular disorder (TMD)-related pain | 26% | showed a placebo effect | #6 |
intra-articular injection of Ultracain | increase | pain | adult patients with temporomandibular disorder (TMD)-related pain | 8% | Possible nocebo effect | #7 |
placebo response | increase | pain relief | adult patients with temporomandibular disorder (TMD)-related pain | from 10% to 75% | could play a major effect on TMD pain management and may be responsible | #8 |
Laser acupuncture | increase | placebo effect | adult patients with temporomandibular disorder (TMD)-related pain | - | promoted the higher placebo effect | #9 |
avocado soya bean | increase | placebo effect | adult patients with temporomandibular disorder (TMD)-related pain | - | promoted the higher placebo effect | #10 |
amitriptyline | increase | placebo effect | adult patients with temporomandibular disorder (TMD)-related pain | - | promoted the higher placebo effect | #11 |
Ultracain injection | increase | nocebo effect | adult patients with temporomandibular disorder (TMD)-related pain | 8% | Possible nocebo effect was found | #12 |
OBJECTIVES: The aim of this systematic review (SR) was to answer the following question: "In adult patients with temporomandibular disorder (TMD)-related pain, what is the placebo or nocebo effect of different therapies?" METHODS: A SR was performed with randomised clinical placebo-controlled trials on diagnosed painful TMD studies from five main databases and from three grey literature. Studies included must have sample older than 18 years, with painful TMD, which diagnosis was done by Research Diagnostic Criteria (RDC/TMD) or Diagnostic Criteria (DC/TMD). RESULTS: Out of 770 articles obtained, 42 met the inclusion criteria for qualitative and 26 for quantitative analysis. Meta-analysis indicated mean variation on pain intensity for placebo therapy was higher on laser acupuncture with 45.5 mm point reduction, followed by avocado soya bean extract with 36 mm and amitriptyline 25 mg with 25.2 mm. Laser showed a 29% of placebo effect, as well medicine with 19% and other therapies with 26%. Possible nocebo effect of 8% pain increase was found for intra-articular injection of Ultracain. CONCLUSIONS: Based on the available data, the placebo response could play a major effect on TMD pain management and may be responsible from 10% to 75% of pain relief. Laser acupuncture, avocado soya bean and amitriptyline promoted the higher placebo effect. Possible nocebo effect was found only for Ultracain injection with 8%. CLINICAL RELEVANCE: Clinicians could apply such evidence to optimise pain management and judgement about treatment efficacy, and researches may find it useful when designing their investigations.