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Tuesday, June 25, 2013

Cochrane Database Syst Rev. 2011 Nov 9;(11):CD008456. doi: 10.1002/14651858.CD008456.pub2.


Source

Oral Health Unit, School of Dentistry, The University of Manchester, Manchester, UK. vishal.r.aggarwal@manchester.ac.uk.

ABSTRACT:

BACKGROUND:

Psychosocial factors have a role in the onset of chronic orofacial pain. However, current management involves invasive therapies like occlusal adjustments and splints which lack an evidence base.

OBJECTIVES:

To determine the efficacy of non-pharmacologic psychosocial interventions for chronic orofacial pain.

SEARCH METHODS:

The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 25 October 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE via OVID (1950 to 25 October 2010), EMBASE via OVID (1980 to 25 October 2010) and PsycINFO via OVID (1950 to 25 October 2010). There were no restrictions regarding language or date of publication.

SELECTION CRITERIA:

Randomised controlled trials which included non-pharmacological psychosocial interventions for adults with chronic orofacial pain compared with any other form of treatment (e.g. usual care like intraoral splints, pharmacological treatment and/or physiotherapy).

DATA COLLECTION AND ANALYSIS:

Data were independently extracted in duplicate. Trial authors were contacted for details of randomisation and loss to follow-up, and also to provide means and standard deviations for outcome measures where these were not available. Risk of bias was assessed and disagreements between review authors were discussed and another review author involved where necessary.

MAIN RESULTS:

Seventeen trials were eligible for inclusion into the review. Psychosocial interventions improved long-term pain intensity (standardised mean difference (SMD) -0.34, 95% confidence interval (CI) -0.50 to -0.18) and depression (SMD -0.35, 95% CI -0.54 to -0.16). However, the risk of bias was high for almost all studies. A subgroup analysis revealed that cognitive behavioural therapy (CBT) either alone or in combination with biofeedback improved long-term pain intensity, activity interference and depression. However the studies pooled had high risk of bias and were few in number. The pooled trials were all related to temporomandibular disorder (TMD).

AUTHORS' CONCLUSIONS:


There is weak evidence to support the use of psychosocial interventions for chronic orofacial pain. Although significant effects were observed for outcome measures where pooling was possible, the studies were few in number and had high risk of bias. However, given the non-invasive nature of such interventions they should be used in preference to other invasive and irreversible treatments which also have limited or no efficacy. Further high quality trials are needed to explore the effects of psychosocial interventions on chronic orofacial pain.
Themessl-Huber M.  Evid Based Dent. 2012 Jun;13(2):58. doi: 10.1038/sj.ebd.6400865.


Source

Oral Health and Health Research Programme, Dental Health Services Research Unit, University of Dundee, Scotland UK.

ABSTRACT:

DATA SOURCES:

Cochrane Oral Health Group's Trials Register, Central, Medline, Embase, PsycINFO.

STUDY SELECTION:

Randomised controlled trials of psychosocial interventions for chronic orofacial pain were included. Psychosocial interventions targeted towards changing thoughts, behaviours and/or feelings that may exacerbate pain symptoms through a vicious cycle were eligible. Primary outcomes were pain intensity/severity, satisfaction with pain relief and quality of life.

DATA EXTRACTION AND SYNTHESIS:

Two reviewers independently screened studies, extracted data and assessed risk of bias. Dichotomous outcomes, were expressed as risk ratios with 95% confidence intervals, continuous outcomes as mean differences with 95% confidence intervals. Heterogeneity was assessed using the Cochrane test for heterogeneity and the I2 test. Meta-analyses were conducted using the random-effect or the fixed-effect models.

RESULTS:

Fifteen of the 17 eligible studies were on temporomandibular disorders (TMDs), two on burning mouth syndrome. Psychosocial interventions improved long-term pain intensity (standardised mean difference (SMD) -0.34, 95% confidence interval (CI) -0.50 to -0.18) and depression (SMD -0.35, 95% CI -0.54 to -0.16). However, the risk of bias in these studies was high.

CONCLUSIONS:


There is weak evidence to support the use of psychosocial interventions for chronic orofacial pain.

(Originally published in the Cochrane Database Syst Rev , EBD reprinted this article.  They reviewed over 60 years of studies.  Note the the risk of bias clause).

Wednesday, December 16, 2009

Psychological therapies for the management of chronic pain

Psychological therapies for the management of chronic pain (excluding headache) in adults. Eccleston C, Williams ACDC, Morley S.: Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD007407. DOI:10.1002/14651858.CD007407.pub2.

ABSTRACT:

Background - Psychological treatments are designed to treat pain, distress and disability, and are in common practice. No comprehensive systematicreview has been published since 1999.

Objectives -To evaluate the effectiveness of psychological therapies on pain, disability, and mood.

Search strategy - Randomised controlled trials (RCTs) of psychological therapy were identified by searching MEDLINE, EMBASE and Psychlit and CENTRAL from the beginning of each abstracting service until January 2008. A further search was undertaken from January 2008 to August 2008. Additional studies were identified from the reference lists of retrieved papers and from discussion with investigators.
Selection criteria - Full publications of RCTs of psychological treatments compared with an active treatment, waiting list or treatment as usual. Studies were excluded if the pain was primarily headache, or was associated with a malignant disease. Studies were also excluded if the number of patients in any treatment arm was less than 10.

Data collection and analysis - Fifty-two studies were examined with a quality rating scale specifically designed for use with these studies. Data were extracted from 40 studies (4781 participants) by two authors. Two main classes of treatment (Cognitive Behavioural Therapy (CBT) and Behaviour
Therapy (BT)), were compared with two control conditions (Treatment as Usual (TAU) and Active control (AC)), at two assessment points (immediately following treatment and sixmonths following treatment), giving eight comparisons. For each comparison, treatment effectiveness was assessed on three outcomes: pain, disability, and mood giving a total of 24 analyses.

Main results - Overall there is an absence of evidence for BT, except for pain immediately following treatment compared with TAU. CBT has some small positive effects for pain, disability and mood. At present there is insufficient data on quality or content of treatment to investigate their influence on outcome. The quality of the trial design has improved over time but the quality of treatments has not.

Authors’ conclusions - CBT and BT have weak effects in improving pain. CBT and BT have minimal effects on disability associated with chronic pain. CBT and BT are effective in altering mood outcomes, and there is some evidence that these changes are maintained at six months.


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