Eficácia e segurança das intervenções terapêuticas para síndrome dolorosa miofascial em adultos: revisão de revisões sistemáticas

Abstract

Variation in diagnostic criteria and treatments for myofascial pain syndrome complicates the comparison of evidence and its application to clinical practice. Objective: To synthesize the efficacy and safety of therapeutic interventions for adults with myofascial pain syndrome or symptomatic active trigger points. Methods: An overview of systematic reviews was conducted, with searches in PubMed/MEDLINE, Embase, the Cochrane Database of Systematic Reviews, and Epistemonikos in September 2026. Methodological quality was assessed using AMSTAR 2. The descriptive synthesis considered population, intervention, comparator, outcome, and follow-up, accounting for overlap among primary studies. Selection, data extraction, and appraisal were assisted by generative models, with author review and approval within a “human-in-the-loop” framework. Published certainty ratings were used; no new GRADE assessment or meta-analysis was performed. Results: A total of 231 reviews were included: 150 contributed 317 clinical findings, 61 provided contextual information, and no usable findings were located in the extracted data for 20. Methodological confidence was critically low in 221 and indeterminate in 10. For neck pain, lidocaine provided greater pain relief than dry needling across pooled assessments at two to four weeks (mean difference −2.13 points on a scale from 0 to 10; 95% CI −3.22 to −1.03), with low-certainty evidence and no clear advantage for disability or other outcomes. One trial of low-level laser therapy showed a benefit for pain at treatment completion, without demonstrated persistence at six months. For temporomandibular myofascial pain, one trial favored dry needling over botulinum toxin for pain during chewing at six weeks, without a clear benefit for pain at rest or mouth opening. Adverse events were incompletely reported. Conclusion: The findings suggest pain relief in specific comparisons but do not establish an overall treatment ranking. Methodological limitations, imprecision, and study overlap restrict confidence in the conclusions. Clinical application requires consideration of diagnosis, comparator, functional goals, and duration of benefit, alongside uncertainty about safety.