Efficacy of different treatments for burning mouth syndrome: network meta-analysis using minimally contextualized approa

Objective This systematic review of randomized controlled trials (RCTs) aimed to assess the effectiveness of treatments to relieve pain caused by burning mouth syndrome (BMS). Study Design five databases and grey literature were searched, and the reference lists of included studies were manually searched. Independent reviewers selected studies, extracted data, and assessed risk of bias (RoB 2.0). The main outcome was pain relief. For the network meta-analysis (NMA), four comparable interventions were grouped into different geometries to ensure the transitivity assumption: laser, alpha lipoic acid (ALA), phytotherapics, and anxiolytics/antidepressants. The certainty of evidence was assessed using the GRADE approach for NMA with GRADE minimally contextualized framework. Results The anxiolytic medicine (clonazepam) likely reduces pain caused by BMS when compared to placebo (MD: -1.97; 95% CI: -2.31; -1.64; moderate certainty). Although laser, ALA, and phytoterapics proved to be better when compared to placebos, the certainty was low or very low. Conclusion among all tested treatments, only clonazepan is likely to reduce pain caused by BMS when compared to placebos. Most other treatments had low and very low certainty, mainly due to imprecision and indirectness. More RCTs comparing treatments against placebo are encouraged to confirm the evidence. Funding CAPES (Master's research grant) This systematic review of randomized controlled trials (RCTs) aimed to assess the effectiveness of treatments to relieve pain caused by burning mouth syndrome (BMS). five databases and grey literature were searched, and the reference lists of included studies were manually searched. Independent reviewers selected studies, extracted data, and assessed risk of bias (RoB 2.0). The main outcome was pain relief. For the network meta-analysis (NMA), four comparable interventions were grouped into different geometries to ensure the transitivity assumption: laser, alpha lipoic acid (ALA), phytotherapics, and anxiolytics/antidepressants. The certainty of evidence was assessed using the GRADE approach for NMA with GRADE minimally contextualized framework. The anxiolytic medicine (clonazepam) likely reduces pain caused by BMS when compared to placebo (MD: -1.97; 95% CI: -2.31; -1.64; moderate certainty). Although laser, ALA, and phytoterapics proved to be better when compared to placebos, the certainty was low or very low. among all tested treatments, only clonazepan is likely to reduce pain caused by BMS when compared to placebos. Most other treatments had low and very low certainty, mainly due to imprecision and indirectness. More RCTs comparing treatments against placebo are encouraged to confirm the evidence.