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Electrical stimulation therapies for temporomandibular disorders: a systematic review and network meta-analysis of randomized controlled trials
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DOI：10.1186/s40001-026-04991-9.png)
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Abstract
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Electrical stimulation is increasingly used for temporomandibular disorders (TMDs), but the comparative efficacy of different modalities remains unclear. We aimed to rank the comparative efficacy of nine non-pharmacological electrical stimulation therapies for adults with TMD. Seven databases were searched from inception to January 15, 2026, for randomized controlled trials (RCTs) comparing transcutaneous electrical nerve stimulation (TENS), auricular vagus nerve stimulation (aVNS), high-voltage electrical stimulation (HVES), electroacupuncture (EA), electro-massage (ES), microcurrent electrical nerve stimulation (MENS), cranial electrotherapy stimulation (CES), percutaneous needle electrolysis (PNE), or transcranial direct current stimulation (tDCS) versus sham, placebo, or no-treatment controls in adults with Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) or Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) confirmed TMD. Risk of bias was appraised with the Cochrane Risk of Bias 2 (RoB 2) tool. Frequentist random-effects network meta-analyses were conducted, with effect sizes summarized as mean differences (MDs) for visual analog scale (VAS) pain and maximum mouth opening (MMO), and as standardized mean differences (SMDs) for pressure pain threshold (PPT). The treatment hierarchy was estimated by the surface under the cumulative ranking curve (SUCRA). The protocol was registered on PROSPERO (CRD420261370939). Twenty-two RCTs (987 participants; 75.94% female) were included. For VAS pain (19 studies), TENS (MD = − 1.34 cm, 95% CI − 2.04 to − 0.63) and MENS (MD = − 1.73 cm, 95% CI − 2.96 to − 0.50) significantly reduced pain; SUCRA was topped by ES (75.5%), MENS (74.3%), PNE (73.9%), and TENS (61.9%). For MMO (13 studies), five interventions produced significant gains-ES (6.52 mm), EA (5.74 mm), MENS (5.18 mm), PNE (5.00 mm), and TENS (3.35 mm)-with SUCRA led by ES (87.0%) and EA (80.6%). For PPT (4 studies), ES (SMD = 0.93) and TENS (SMD = 0.65) significantly raised PPT. Sensitivity analyses confirmed TENS as the most robust for pain reduction and ES and EA as the most robust for MMO improvement. Among these nine non-pharmacological electrical stimulation modalities, TENS provided the most reliable short-term reduction in TMD pain, whereas ES and EA showed the largest improvements in maximum mouth opening. Given the predominantly star-shaped networks, the high heterogeneity, and the high risk of bias in most trials, these comparative rankings should be interpreted with caution.
Keywords:
Temporomandibular disorders
Electrical stimulation therapy
Network meta-analysis
Transcutaneous electrical nerve stimulation
Pain
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