Pain during orthodontics feels over the top, especially during treatment's early stages. Out of 100, almost 99% patients report unpleasant sensations. So, for patient’s comfort and compliance, pain management is very important. Rather than pharmacological ways which are the first line of providing treatment, various non-pharmacological approaches have been proposed recently as an alternative.

Therefore, to figure out the effects of non-pharmacological interventions to reduce pain during orthodontic treatment, a study was done by Cochrane Oral Health's Information Specialists. For their study, specialists collected information by searching various databases like Cochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and the World Health Organization International Clinical Trials etc. There were no limitations regarding the date of publication or language during database search.

For comparing a non-pharmacological orthodontic pain intervention to a placebo, randomized controlled trials (RCTs) were done. For comparison, every type of orthodontic treatment trails was included except split-mouth trails, cross-over trails and those who involving use of pain relief following orthognathic surgery. These trials were reviewed by two authors independently to evaluate risk of bias and extracted data. For this, random-effects model and expressed results (as mean difference with 95% confidence intervals) were used. The heterogeneity was also evaluated with reference to both methodological and clinical factors.

Out of various RCTs, 14 were included in the study that randomized 931 patients. Out of these 14 studies, 12 were involved self-report assessment of pain on a continuous scale and rest two were involved questionnaires regarding pain nature, location and intensity. These involve five types of non-pharmacological approaches- vibrating devices, low-level laser therapy (LLLT),  chewing adjuncts (chewing gum or a bite wafer), Post-treatment text messaging and Brain wave music and cognitive behavioral therapy. Risk of bias in studies was also evaluated.

Vibrating devices were assessed in five studies, out of which four were at high risk of bias and one was unclear. Further, LLLT was determined in four studies, out of these two was providing evidence to reduce pain at 24 hours, six hours, three and seven days. The rest of the studies were unclear as the quality of evidence was very low. The Chewing adjuncts were evaluated in three studies, out of these two were at high risk of bias and other was unclear. Same as others, rest of two approaches evidences also at high risk of bias. However, no adverse effect was measured in any of the studies.

Hence, it is concluded from overall studies that one of the approach – laser irradiation may help to reduce pain in the short term. Except this, all other non-pharmacological interventions are either of low quality or entirely lacking. Therefore, further research is required to address the lack evidences which concerning effectiveness of a range of non-pharmacological interventions to manage orthodontic pain.