What This Review Looked At
Temporomandibular disorders (TMD) are a group of conditions affecting the jaw joint and the muscles that move it, producing pain that can radiate to the face, head, neck and ears. They affect a meaningful slice of the adult population and are notoriously difficult to manage, with treatment options ranging from physical therapy and bite splints to medication and, in severe cases, surgery. In 2021 a comparative effectiveness research team published a systematic review and network meta-analysis in the Journal of Oral Rehabilitation asking which non-pharmacological options work best for TMD-related pain — specifically comparing low-level laser therapy (at different wavelengths) with transcutaneous electrical nerve stimulation (TENS).
The authors searched the major medical databases for randomised controlled trials comparing LLLT, TENS or placebo/sham control in adults with TMD. They identified 27 eligible RCTs covering 969 patients and used a network meta-analysis to compare interventions both directly (head-to-head trials) and indirectly through their shared comparators. Primary outcomes centred on pain intensity using validated scales.
What They Found
Low-level laser therapy showed better short-term efficacy than TENS in reducing TMD-related pain. The improvement was consistent across the pooled trials and statistically meaningful at the comparison level. Within the laser arm of the analysis, higher-wavelength treatments tended to produce stronger results than lower-wavelength options — a pattern consistent with the broader photobiomodulation literature, where deeper tissue penetration is associated with better outcomes in joint and muscle pain.
Both active interventions outperformed placebo, but the relative ranking placed LLLT at the top of the comparison set for short-term TMD pain relief.
What This Means in Context
This is a relatively strong piece of evidence in the TMD field. Network meta-analyses allow comparisons between interventions that have rarely been tested head-to-head in single trials — particularly useful in clinical areas like TMD where most individual studies compare a single active treatment to placebo rather than to each other. With 27 trials and nearly a thousand patients pooled, the evidence base is reasonable by the standards of conservative pain medicine.
The review specifically addressed short-term pain outcomes — the question of whether benefits persist over many months is less clearly answered. Trial-to-trial variability in laser wavelengths, treatment duration and protocol design is meaningful, and the practical implication is that the best protocol for an individual patient is a clinical judgement made with the practitioner overseeing care.
What It Means for You
If you live with jaw pain from temporomandibular disorder, this network meta-analysis suggests low-level laser therapy is one of the better-supported non-pharmacological options for short-term pain relief — and outperforms TENS on the pooled evidence. As with any new approach to a chronic pain condition, photobiomodulation is best used alongside the foundations of TMD care (jaw rest, soft-diet periods during flares, stress management, and where appropriate, the bite splint or physiotherapy your dentist or physician has recommended). Discuss it with the clinician helping you manage your TMD before making changes.
Citation: Comparative effectiveness of low-level laser therapy with different wavelengths and transcutaneous electric nerve stimulation in the treatment of pain caused by temporomandibular disorders: A systematic review and network meta-analysis. (2021/2022). Journal of Oral Rehabilitation. PubMed
