Therapeutic Ultrasound

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.