Extracorporeal shock wave therapy for pain in temporomandibular disorders and mediation effect analysis

doi:10.19439/j.sjos.2026.05.016

Abstract

Abstract: PURPOSE: To compare the therapeutic efficacy of conventional physical therapy alone versus its combination with extracorporeal shock wave therapy (ESWT) in patients with temporomandibular disorders (TMD), and to analyze the utility of ESWT in the treatment of this condition. METHODS: A prospective cohort study design was adopted. Eighty-five TMD patients were enrolled and divided into a conventional treatment group (n=44) and a combined treatment group (n=41). The conventional treatment group received a standardized physical therapy regimen, while the combined treatment group received additional ESWT once weekly based on a standardized physical therapy regimen. Assessments were conducted before and after treatment, measuring pain intensity, maximum mouth opening, jaw function, and psychobehavioral indicators including somatization, depression, anxiety, sleep quality, and pain catastrophizing. Paired sample t-tests, non-parametric tests, and multivariate analysis of covariance were employed for within-group and between-group comparisons. Mediation analysis was further conducted to explore the underlying mechanisms. RESULTS: Post-treatment, both groups showed significant improvements in pain, mouth opening, jaw function, and most psychobehavioral indicators compared to baseline. The combined treatment group demonstrated superior pain relief compared to the conventional treatment group and exhibited a significant advantage in reducing pain catastrophizing. Multivariate analysis of covariance revealed that ESWT had an independent effect on pain improvement, while its direct effect on pain catastrophizing was not significant. Mediation analysis indicated that pain improvement played a significant mediating role between the treatment modality and the reduction in pain catastrophizing. CONCLUSIONS: The combination of ESWT with conventional physical therapy more effectively alleviates pain in TMD patients and indirectly improves pain catastrophizing cognition through pain relief, providing new clinical evidence for TMD treatment.

Key words: Temporomandibular disorders, Extracorporeal shock wave therapy, Pain intensity, Pain catastrophizing, Mediation analysis

CLC Number:

R782.6

Yang Yang, Dong Yangjun, He Ying, Xu Lili, Fang Zhongyi. Extracorporeal shock wave therapy for pain in temporomandibular disorders and mediation effect analysis[J]. Shanghai Journal of Stomatology, 2026, 35(5): 535-542.

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