Efficacy of Propranolol in Reducing Pain Associated With Temporomandibular Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Publisher



Ahuja TK ; Ravikumar AJ ; Kamdar DJ ; Altuhafy M ; Saghazadeh A ; Khan J
Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Published:2026

Abstract

Objective: Temporomandibular disorders (TMDs) are a common cause of chronic orofacial pain. This systematic review evaluated the effectiveness of propranolol in reducing pain associated with TMDs. Methods: This systematic review was registered in PROSPERO (CRD420251131407) and conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, Web of Science, Scopus, Embase, Ovid, and CINAHL identified randomized controlled trials (RCTs) assessing propranolol in adult TMD populations. Results: Five RCTs with sample sizes ranging from 40 to 200 participants met the inclusion criteria, enrolling predominantly female patients diagnosed using RDC/TMD or DC/TMD criteria. Propranolol was administered in varying doses and formulations, including intravenous and oral regimens, over treatment durations ranging from minutes to six months. Individual studies reported mixed effects on mean pain outcomes; however, responder analyses consistently demonstrated clinically meaningful benefits, with significantly higher proportions of patients achieving ≥ 30 % and ≥ 50 % pain reduction compared with placebo, particularly among those with comorbid migraine. Pooled analysis using a random-effects model demonstrated a slight but statistically significant decrease in pain intensity, favoring propranolol (Hedges’ g = 0.24; 95 % CI, 0.05–0.43; p = 0.01) with low heterogeneity (I² = 19 %). Overall risk of bias was low across most studies, although one crossover trial was judged to have a high risk due to inadequate handling of carryover effects. Conclusions: These findings suggest that propranolol may offer modest analgesic benefit as an adjunctive treatment for select patients with TMD, supporting further investigation in larger, well-designed trials using standardized, clinically meaningful pain outcomes. © 2026 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI