Biofeedback‐Based Therapy in Patients With Myofascial Orofacial Pain and Bruxism: An Umbrella Review

Abstract

BACKGROUND: Biofeedback therapy is increasingly used to manage myofascial orofacial pain and bruxism, but the overall strength and consistency of the evidence remain unclear. OBJECTIVES: This umbrella review aimed to synthesize and critically evaluate evidence from systematic reviews on the effectiveness of biofeedback therapy for myofascial orofacial pain and bruxism, focusing on pain reduction and masticatory muscle activity. MATERIALS AND METHODS: CENTRAL, Embase, LILACS, MEDLINE (PubMed), Scopus, Web of Science, WHO ICTRP, and ClinicalTrials.gov were searched from inception to October 2024 for English-language systematic reviews. Study selection was performed independently by two reviewers in two stages. Systematic reviews, with or without meta-analysis, were included. Methodological quality was assessed using AMSTAR-2, and overlap among reviews was evaluated using the corrected covered area (CCA). RESULTS: Out of 1670 records identified, 11 systematic reviews met the inclusion criteria. All reported pain-related outcomes. According to AMSTAR-2, nine reviews were rated critically low confidence, and two were rated low confidence. Only five reviews assessed the certainty of evidence using GRADE. Moderate overlap among reviews was observed (CCA = 8.48%). Biofeedback consistently reduced masticatory muscle activity, whereas its effects on pain outcomes were inconsistent and limited by heterogeneity across studies. CONCLUSIONS: Evidence supporting biofeedback therapy for myofascial orofacial pain and bruxism remains limited due to methodological weaknesses and heterogeneity. Although biofeedback may reduce masticatory muscle hyperactivity, its effect on pain is uncertain. High-quality, standardized clinical trials are needed to clarify its therapeutic value. TRIAL REGISTRATION: Umbrella Review Registration Number: CRD420251005382.