Psychosocial interventions for the management ofchronic orofacial pain.

Aggarwal VR, Lovell K, Peters S, Javidi H, Joughin A, Goldthorpe J.

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.

Weak Evidence Supports the Use of Psychosocial Interventions for 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).