Ultrasound & biofeedback
Therapeutic Ultrasound
Graded on: temporomandibular disorder pain (mixed: pooled analysis favorable, sham-controlled trials null).
Grade C: human trials exist, but they are small, mixed or not yet repeated. This is not a finding that it does not work. How to read a grade →
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How this letter has changedLatest: October 2026 · Corrected.
The record described its only citation (Lin et al., 2026; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 42332459) as showing weak, sham-equivalent evidence; that network meta-analysis finds significant pain reduction with ultrasound and ranks it first for pain, mostly through indirect and active-comparator comparisons. The sham-equivalent wording is supported instead by Hussain et al. (2018; PMID 29767650) and Szajkowski et al. (2024; PMID 37721730), both null on pain against sham A fake version of a procedure or device used as the comparison, so participants cannot tell which one they received., now cited. Ansari et al. (2024; PMID 35315745) added for the mixed modality picture, and the Cochrane review of chronic low back pain (Ebadi et al., 2020; PMID 32623724) added so the page says the letter does not extend to pain elsewhere. C unchanged. Applied the written grade definition under the editor's standing instruction of October 2026 (Arnold Sandlow, D.C.).PMID 29767650 PMID 32623724 PMID 35315745 PMID 37721730 PMID 42332459
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Therapeutic ultrasound uses sound waves to warm deep tissue. This record covers jaw joint pain only. One review ranked it first among five treatments, but most of its comparisons were indirect. The two studies that compared it with a fake treatment found no difference in pain. For low back pain, a careful review found little or no benefit.
A letter describes the human evidence, not the product, the manufacturer, or the intervention's worth.
See the full evidence record →Graded on Temporomandibular disorder pain (mixed: pooled analysis favorable, sham-controlled trials null).
Why this gradeGrade C, small or unreplicated trials. The reasoning, and what the grade does not cover.
Grade C on temporomandibular disorder pain only. The cited network meta-analysis (Lin et al., 2026; PMID 42332459) finds significant pain reduction with ultrasound and ranks it first of five modalities, but most of its comparisons are indirect or against other active treatments drawn from small trials. The two trials that compared ultrasound with a true sham point the other way on pain: Hussain et al. (2018; PMID 29767650) found no difference from sham on self-rated pain in 20 women, and Szajkowski et al. (2024; PMID 37721730) found pain fell equally with sham in 40 patients. Pain is self-reported, which caps the use at B in any case, and the sham-controlled evidence does not support B.
WHAT THIS GRADE DOES NOT COVERpain elsewhere in the body, where a Cochrane review of 10 trials found little to no difference from placebo An inactive substitute made to look like the real treatment, so participants cannot tell which one they received. for chronic low back pain (Ebadi et al., 2020; PMID 32623724); fracture healing or soft-tissue repair, which no cited trial measured; and any specific device, intensity or mode.
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The evidence, in fullFive papers, each linked to its PubMed record.
Lin et al. (Medicine, 2026; PMID 42332459): frequentist network meta-analysis of randomized trials of manual therapy, exercise, low-level laser, therapeutic ultrasound and TENS for temporomandibular joint disorders; ultrasound showed significant pain reduction and the highest probability of pain relief, with manual therapy first for mouth opening. Most comparisons in the network are indirect or against other active treatments, which cannot show a specific effect. Sham-controlled trials: Hussain et al. (J Oral Facial Pain Headache, 2018; PMID 29767650), 20 women with bilateral masseter myalgia, one 5-minute session against sham; no difference on self-rated pain, pressure pain threshold higher. Szajkowski et al. (Minerva Dent Oral Sci, 2024; PMID 37721730), 40 patients, 10 sessions against sham; pain fell in both arms and the authors say a placebo effect cannot be excluded. Ansari et al. (Cranio, 2024; PMID 35315745): meta-analysis of 12 trials in which low-level laser relieved pain more than ultrasound. Outside the jaw: Ebadi et al. (Cochrane Database Syst Rev, 2020; PMID 32623724), 10 trials and 1,025 participants with chronic low back pain; very low certainty evidence of little to no difference from placebo on short-term pain. Grade C: small, mixed randomized evidence, with the sham-controlled trials null on pain.
VAS pain scores and functional range of motion at the treatment site at baseline and after every 4 sessions. All parameters (frequency, intensity, treatment mode, area, duration): ultrasound dose is the product of intensity, frequency, and time, and all three must match the studied protocol. Which mode the device delivers, thermal or mechanical.
Evidence notes: meta-analysis, randomized trial
Endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score. graded: Temporomandibular disorder pain (mixed: pooled analysis favorable, sham-controlled trials null) (self_report)
Last reviewed: July 2026
Educational use only · Not medical advice · EBL grades published human evidence and does not recommend treatment. Stopping a prescription is a decision for your physician.
Primary evidenceFive papers, each linked to its PubMed record.
Lin et al. (Medicine, 2026; PMID 42332459): frequentist network meta-analysis of randomized trials of manual therapy, exercise, low-level laser, therapeutic ultrasound and TENS for temporomandibular joint disorders; ultrasound showed significant pain reduction and the highest probability of pain relief, with manual therapy first for mouth opening. Most comparisons in the network are indirect or against other active treatments, which cannot show a specific effect. Sham-controlled trials: Hussain et al. (J Oral Facial Pain Headache, 2018; PMID 29767650), 20 women with bilateral masseter myalgia, one 5-minute session against sham; no difference on self-rated pain, pressure pain threshold higher. Szajkowski et al. (Minerva Dent Oral Sci, 2024; PMID 37721730), 40 patients, 10 sessions against sham; pain fell in both arms and the authors say a placebo effect cannot be excluded. Ansari et al. (Cranio, 2024; PMID 35315745): meta-analysis of 12 trials in which low-level laser relieved pain more than ultrasound. Outside the jaw: Ebadi et al. (Cochrane Database Syst Rev, 2020; PMID 32623724), 10 trials and 1,025 participants with chronic low back pain; very low certainty evidence of little to no difference from placebo on short-term pain. Grade C: small, mixed randomized evidence, with the sham-controlled trials null on pain.
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How EBL searched for the trials (1 search)
The search that was run, what it returned, and what was left out and why, so the absence of evidence can be checked as well as its presence.
"therapeutic ultrasound"[tiab] AND temporomandibular[tiab] AND (sham[tiab] OR placebo[tiab] OR randomized controlled trial[pt]) AND humans[mesh]Grades move when new trials publish. A free monthly email lists every grade EBL moved, with the reason and the trial behind it: the sign-up is on the Evidence Log →