title: Hypnosis/Relaxation therapy for temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To conduct a systematic review and meta-analysis to evaluate the effectiveness of hypnosis/relaxation therapy compared to no/minimal treatment in patients with temporomandibular disorders (TMD).
  
  
  METHODS
  Studies reviewed included randomized controlled trials (RCTs) where investigators randomized patients with TMD or an equivalent condition to an intervention arm receiving hypnosis, relaxation training, or hyporelaxation therapy, and a control group receiving no/minimal treatment. The systematic search was conducted without language restrictions, in Medline, EMBASE, CENTRAL, and PsycINFO, from inception to June 30, 2014. Studies were pooled using weighted mean differences and pooled risk ratios (RRs) for continuous outcomes and dichotomous outcomes, respectively, and their associated 95% confidence intervals (CI).
  
  
  RESULTS
  Of 3,098 identified citations, 3 studies including 159 patients proved eligible, although none of these described their method of randomization. The results suggested limited or no benefit of hypnosis/relaxation therapy on pain (risk difference in important pain -0.06; 95% CI: -0.18 to 0.05; P = .28), or on pressure pain thresholds on the skin surface over the temporomandibular joint (TMJ) and masticatory muscles. Low-quality evidence suggested some benefit of hypnosis/relaxation therapy on maximal pain (mean difference on 100-mm scale = -28.33; 95% CI: -44.67 to -11.99; P =.007) and active maximal mouth opening (mean difference on 100-mm scale = -2.63 mm; 95% CI: -3.30 mm to -1.96 mm; P < .001) compared to no/minimal treatment.
  
  
  CONCLUSIONS
  Three RCTs were eligible for the systematic review, but they were with high risk of bias and provided low-quality evidence, suggesting that hypnosis/relaxation therapy may have a beneficial effect on maximal pain and active maximal mouth opening but not on pain and pressure pain threshold. Larger RCTs with low risk of bias are required to confirm or refute these findings and to inform other important patient outcomes.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Zhang
authors.forename: Luis
authors.initials: L
authors.lastname: Montoya
authors.forename: Shanil
authors.initials: S
authors.lastname: Ebrahim
authors.forename: Jason W
authors.initials: JW
authors.lastname: Busse
authors.forename: Rachel
authors.initials: R
authors.lastname: Couban
authors.forename: Randi E
authors.initials: RE
authors.lastname: McCabe
authors.forename: Peter
authors.initials: P
authors.lastname: Bieling
authors.forename: Alonso
authors.initials: A
authors.lastname: Carrasco-Labra
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
mesh_terms: D006801:Humans; D006992:Hypnosis, Dental / Q000379:methods*; D017288:Pain Threshold / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular / Q000502:physiology; D012064:Relaxation Therapy; D013705:Temporomandibular Joint Disorders / Q000628:therapy*; D016896:Treatment Outcome