Manual therapy and exercise targeted to the neck and orofacial regions for patients with orofacial pain: a systematic review and meta-analysis

PURPOSE: To summarize the evidence on the effectiveness of manual therapy (MT) and exercise targeted to the neck or jaw and neck (combined) in the management of orofacial pain (OFP). MATERIAL AND METHODS: The protocol was registered in PROSPERO (CRD42021227490). Electronic searches were conducted in MEDLINE, EMBASE, Cochrane Library, Web of Science, SCOPUS, and CINAHL. Two independent reviewers screened and extracted data. Studies involving adults with OFP treated with MT or exercise targeted to the neck or both the neck and jaw were eligible. Outcomes of interest were pain intensity, maximum mouth opening (MMO), and tenderness (i.e., pain pressure threshold - PPT). The Cochrane risk of bias (RoB) tool and the GRADE approach were used to determine RoB and certainty of the evidence, respectively. RESULTS: Thirty-seven studies were analyzed, mostly with a high RoB. Therapies (i.e., MT alone or combined therapy-MT plus exercise) targeting both the neck and jaw regions improved pain and tenderness (PPT). MT and combined treatment (i.e., MT plus exercise) targeting only the neck were clinically relevant for pain relief. No significant results were found for MMO. CONCLUSIONS: MT isolated and combined therapies targeting the neck alone or neck and jaw are promising for reducing pain and tenderness for individuals with OFP.