Comparative Effectiveness of Non-Pharmacological Interventions for Management of Post-Orthodontic Pain: A Systematic Review and Network Meta-Analysis

Orthodontic pain is the most common adverse reaction during fixed appliance therapy and significantly impairs patients' quality of life. This study aimed to comprehensively compare and rank the analgesic efficacy of nine non-pharmacological interventions for orthodontic pain at multiple clinically relevant time points following orthodontic activation. PubMed, Embase, Cochrane Library, Web of Science, and CNKI were systematically searched for randomized controlled trials (RCTs) of non-pharmacological interventions for orthodontic pain, and risk of bias was assessed using the Risk of Bias 2.0 (RoB 2.0) tool. A Bayesian random-effects network meta-analysis was performed at each prespecified time point (2 h, 6 h, 12 h, 24 h, 48 h, and 72 h); treatment effects were expressed as mean differences (MDs) with 95% credible intervals (CrIs), and the hierarchy of interventions was described using SUCRA values. Twenty RCTs comprising 1,074 participants were included. The analgesic effects were time-dependent. At 2 h, all interventions significantly reduced pain compared with the control, with acupressure (SUCRA 93.1%) and music therapy (90.1%) ranking highest. At 6 h, acupressure, music therapy, and TENS were significant (SUCRA 92.9%, 92.8%, 65.4%), whereas TEAS and VBM were not. No intervention was significant at 12 h. At 24 h, music therapy and CBT were significant, with CBT ranking first (SUCRA 91.3%). At 48 h, acupressure, music therapy, and CBT were significant. At 72 h, music therapy remained significant (MD = 12.2, 95% CrI [0.57, 25.59]). Acupressure and music therapy were consistently ranked among the top two at most time points, except at 24 h when CBT ranked first. Given inter-study heterogeneity and sparse evidence at certain time points, these findings warrant confirmation in large-scale, rigorous RCTs.