tag:blogger.com,1999:blog-85309492807058463932024-02-02T11:54:42.825-08:00Pain ManagementLiterature Abstracts - Orthopedic Neuromuscular DentistryClayton A. Chan, D.D.S.http://www.blogger.com/profile/17435980507660741507noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-8530949280705846393.post-75584162273707001012013-06-25T18:51:00.006-07:002013-06-25T19:34:48.318-07:00<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><b><a href="http://painmanagement-abstract.blogspot.com/2013/06/psychosocial-interventions-for.html">Psychosocial interventions for the management ofchronic orofacial pain.</a></b></span></div>
<div class="MsoNormal">
<span style="color: purple;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Aggarwal%20VR%5BAuthor%5D&cauthor=true&cauthor_uid=22071849" title="http://www.ncbi.nlm.nih.gov/pubmed?term=Aggarwal VR[Author]&cauthor=true&cauthor_uid=22071849"><strong><span style="color: #2f4a8b;">Aggarwal VR</span></strong></a></span><strong>, </strong><span style="color: black;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Lovell%20K%5BAuthor%5D&cauthor=true&cauthor_uid=22071849" title="http://www.ncbi.nlm.nih.gov/pubmed?term=Lovell K[Author]&cauthor=true&cauthor_uid=22071849"><strong><span style="color: #2f4a8b;">Lovell K</span></strong></a></span><strong>, </strong><span style="color: purple;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Peters%20S%5BAuthor%5D&cauthor=true&cauthor_uid=22071849" title="http://www.ncbi.nlm.nih.gov/pubmed?term=Peters S[Author]&cauthor=true&cauthor_uid=22071849"><strong><span style="color: #2f4a8b;">Peters S</span></strong></a></span><strong>, </strong><span style="color: purple;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Javidi%20H%5BAuthor%5D&cauthor=true&cauthor_uid=22071849" title="http://www.ncbi.nlm.nih.gov/pubmed?term=Javidi H[Author]&cauthor=true&cauthor_uid=22071849"><strong><span style="color: #2f4a8b;">Javidi H</span></strong></a></span><strong>, </strong><span style="color: purple;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Joughin%20A%5BAuthor%5D&cauthor=true&cauthor_uid=22071849" title="http://www.ncbi.nlm.nih.gov/pubmed?term=Joughin A[Author]&cauthor=true&cauthor_uid=22071849"><strong><span style="color: #2f4a8b;">Joughin A</span></strong></a></span><strong>, </strong><span style="color: purple;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Goldthorpe%20J%5BAuthor%5D&cauthor=true&cauthor_uid=22071849" title="http://www.ncbi.nlm.nih.gov/pubmed?term=Goldthorpe J[Author]&cauthor=true&cauthor_uid=22071849"><strong><span style="color: #2f4a8b;">Goldthorpe J</span></strong></a></span><strong>.<o:p></o:p></strong></div>
<h3 style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: purple; font-size: small; font-weight: normal;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/22071849##" title="http://www.ncbi.nlm.nih.gov/pubmed/22071849##"><strong><span style="color: #2f4a8b;">Cochrane Database Syst Rev.</span></strong></a></span><strong style="font-size: medium;"> 2011 Nov 9;(11):CD008456. doi: 10.1002/14651858.CD008456.pub2.</strong></h3>
<h3 style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: #724128; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><br /></span></h3>
<h3 style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: #724128; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Source<o:p></o:p></span></h3>
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">Oral Health Unit, </span></strong><strong><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><ns0:place><ns0:placetype>School</ns0:placetype>
of <ns0:placename>Dentistry</ns0:placename></ns0:place>, The <ns0:place><ns0:placetype>University</ns0:placetype>
of <ns0:placename>Manchester</ns0:placename></ns0:place>, <ns0:place><ns0:city>Manchester</ns0:city>, <ns0:country-region>UK</ns0:country-region></ns0:place>. <a href="mailto:vishal.r.aggarwal@manchester.ac.uk"><span style="font-weight: normal;">vishal.r.aggarwal@manchester.ac.uk</span></a>.</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong><br />
<h3 style="margin-bottom: 7.7pt; margin-left: 0in; margin-right: 0in; margin-top: 15.4pt;">
<span style="color: #724128; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">ABSTRACT:</span><span style="color: #724128; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></h3>
<h4 style="margin-bottom: 8.3pt; margin-left: 0in; margin-right: 0in; margin-top: 16.6pt;">
<span style="color: #59331f; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">BACKGROUND: <o:p></o:p></span></h4>
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">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.</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong><br />
<h4 style="margin-bottom: 8.3pt; margin-left: 0in; margin-right: 0in; margin-top: 16.6pt;">
<span style="color: #59331f; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">OBJECTIVES: </span><span style="color: #59331f; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></h4>
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">To determine the efficacy of non</span></strong><strong><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><ns0:personname>-</ns0:personname>pharmacologic
psychosocial interventions for chronic orofacial pain.</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong><br />
<h4 style="margin-bottom: 8.3pt; margin-left: 0in; margin-right: 0in; margin-top: 16.6pt;">
<span style="color: #59331f; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">SEARCH METHODS: </span><span style="color: #59331f; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></h4>
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">The following electronic databases were searched: the Cochrane
Oral Health Group Trials Register (to </span></strong><strong><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><ns0:date ns1:day="25" ns1:month="10" ns1:year="2010">25
October 2010</ns0:date>), 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.</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong><br />
<h4 style="margin-bottom: 8.3pt; margin-left: 0in; margin-right: 0in; margin-top: 16.6pt;">
<span style="color: #59331f; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">SELECTION CRITERIA: </span><span style="color: #59331f; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></h4>
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">Randomised controlled trials which included non</span></strong><strong><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><ns0:personname>-</ns0:personname>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).</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong><br />
<h4 style="margin-bottom: 8.3pt; margin-left: 0in; margin-right: 0in; margin-top: 16.6pt;">
<span style="color: #59331f; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">DATA COLLECTION AND ANALYSIS: </span><span style="color: #59331f; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></h4>
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">Data were independently extracted in duplicate. Trial authors were
contacted for details of randomisation and loss to follow</span></strong><strong><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><ns0:personname>-</ns0:personname>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 </span></strong><span class="highlight1"><b><span style="font-family: Arial, sans-serif;">review</span></b></span><strong><span style="font-family: Arial, sans-serif; font-size: 10pt;"> authors
were discussed and another </span></strong><span class="highlight1"><b><span style="font-family: Arial, sans-serif;">review</span></b></span><strong><span style="font-family: Arial, sans-serif; font-size: 10pt;"> author
involved where necessary.</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong><br />
<h4 style="margin-bottom: 8.3pt; margin-left: 0in; margin-right: 0in; margin-top: 16.6pt;">
<span style="color: #59331f; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">MAIN RESULTS: </span><span style="color: #59331f; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></h4>
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">Seventeen trials were eligible for inclusion into the </span></strong><span class="highlight1"><b><span style="font-family: Arial, sans-serif;">review</span></b></span><strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">.
Psychosocial interventions improved long</span></strong><strong><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><ns0:personname>-</ns0:personname>term
pain intensity (standardised mean difference (SMD) <ns0:personname>-</ns0:personname>0.34,
95% confidence interval (CI) <ns0:personname>-</ns0:personname>0.50 to <ns0:personname>-</ns0:personname>0.18) and depression (SMD <ns0:personname>-</ns0:personname>0.35,
95% CI <ns0:personname>-</ns0:personname>0.54 to <ns0:personname>-</ns0:personname>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<ns0:personname>-</ns0:personname>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).</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong><br />
<h4 style="margin-bottom: 8.3pt; margin-left: 0in; margin-right: 0in; margin-top: 16.6pt;">
<span style="color: #59331f; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">AUTHORS' CONCLUSIONS: </span><span style="color: #59331f; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></h4>
<br />
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">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</span></strong><strong><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><ns0:personname>-</ns0:personname>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.</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong>Clayton A. Chan, D.D.S.http://www.blogger.com/profile/17435980507660741507noreply@blogger.com0tag:blogger.com,1999:blog-8530949280705846393.post-5913261214499238312013-06-25T18:47:00.003-07:002013-06-25T19:32:04.578-07:00<div class="MsoNormal">
<span style="color: orange; font-family: Arial, sans-serif; font-size: 12pt;"><b><a href="http://painmanagement-abstract.blogspot.com/2013/06/weak-evidence-supports-use-of.html">Weak Evidence Supports the Use of Psychosocial Interventions for Chronic Orofacial Pain.</a></b></span></div>
<div class="MsoNormal">
<span style="color: purple;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Themessl-Huber%20M%5BAuthor%5D&cauthor=true&cauthor_uid=22722420" title="http://www.ncbi.nlm.nih.gov/pubmed?term=Themessl-Huber M[Author]&cauthor=true&cauthor_uid=22722420"><strong><span style="color: #2f4a8b;">Themessl-Huber M</span></strong></a></span><strong>. </strong><span style="color: purple;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/22722420##" title="http://www.ncbi.nlm.nih.gov/pubmed/22722420##"><strong><span style="color: #2f4a8b;">Evid Based Dent.</span></strong></a></span><strong> 2012 Jun;13(2):58. doi: 10.1038/sj.ebd.6400865.</strong></div>
<h3 style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: #724128; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><br /></span></h3>
<h3 style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: #724128; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Source<o:p></o:p></span></h3>
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">Oral Health and Health Research Programme, Dental Health Services
Research Unit, </span></strong><strong><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><ns0:place><ns0:city>University
of Dundee</ns0:city>, <ns0:country-region>Scotland</ns0:country-region></ns0:place> <ns0:country-region><ns0:place>UK</ns0:place></ns0:country-region>.</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong><br />
<h3 style="margin-bottom: 7.7pt; margin-left: 0in; margin-right: 0in; margin-top: 15.4pt;">
<span style="color: #724128; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">ABSTRACT:</span><span style="color: #724128; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></h3>
<h4 style="margin-bottom: 8.3pt; margin-left: 0in; margin-right: 0in; margin-top: 16.6pt;">
<span style="color: #59331f; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">DATA SOURCES: <o:p></o:p></span></h4>
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">Cochrane Oral Health Group's Trials Register, Central, Medline,
Embase, PsycINFO.</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong><br />
<h4 style="margin-bottom: 8.3pt; margin-left: 0in; margin-right: 0in; margin-top: 16.6pt;">
<span style="color: #59331f; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">STUDY SELECTION: </span><span style="color: #59331f; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></h4>
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">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.</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong><br />
<h4 style="margin-bottom: 8.3pt; margin-left: 0in; margin-right: 0in; margin-top: 16.6pt;">
<span style="color: #59331f; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">DATA EXTRACTION AND SYNTHESIS: </span><span style="color: #59331f; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></h4>
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">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</span></strong><strong><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><ns0:personname>-</ns0:personname>analyses
were conducted using the random<ns0:personname>-</ns0:personname>effect or the fixed<ns0:personname>-</ns0:personname>effect
models.</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong><br />
<h4 style="margin-bottom: 8.3pt; margin-left: 0in; margin-right: 0in; margin-top: 16.6pt;">
<span style="color: #59331f; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">RESULTS: </span><span style="color: #59331f; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></h4>
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">Fifteen of the 17 eligible studies were on temporomandibular
disorders (TMDs), two on burning mouth syndrome. Psychosocial interventions
improved long</span></strong><strong><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><ns0:personname>-</ns0:personname>term pain intensity (standardised mean difference (SMD) <ns0:personname>-</ns0:personname>0.34,
95% confidence interval (CI) <ns0:personname>-</ns0:personname>0.50 to <ns0:personname>-</ns0:personname>0.18) and depression (SMD <ns0:personname>-</ns0:personname>0.35,
95% CI <ns0:personname>-</ns0:personname>0.54 to <ns0:personname>-</ns0:personname>0.16). However, the risk of bias in these studies was high.</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong><br />
<h4 style="margin-bottom: 8.3pt; margin-left: 0in; margin-right: 0in; margin-top: 16.6pt;">
<span style="color: #59331f; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">CONCLUSIONS: </span><span style="color: #59331f; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></h4>
<br />
<strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">There is weak evidence to support the use of psychosocial
interventions for chronic orofacial pain.</span></strong><strong><span style="font-size: 10pt;"><o:p></o:p></span></strong><br />
<strong><span style="color: purple; font-family: Arial, sans-serif; font-size: 10pt;"><br /></span></strong>
<strong><span style="color: purple; font-family: Arial, sans-serif; font-size: 10pt;">(Originally published in the </span></strong><span style="color: purple; font-family: Arial, sans-serif; font-size: 10pt;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/22071849##" title="http://www.ncbi.nlm.nih.gov/pubmed/22071849##"><strong><span style="color: #2f4a8b;">Cochrane Database Syst Rev</span></strong></a><strong> , EBD reprinted this article. They reviewed over 60 years of studies. Note the the risk of bias clause).</strong></span>Clayton A. Chan, D.D.S.http://www.blogger.com/profile/17435980507660741507noreply@blogger.com0tag:blogger.com,1999:blog-8530949280705846393.post-42099925708411479752009-12-16T20:03:00.000-08:002013-06-25T18:50:41.307-07:00Psychological therapies for the management of chronic pain<strong>Psychological therapies for the management of chronic pain (excluding headache) in adults. </strong><strong>Eccleston C, Williams ACDC, Morley S.: </strong><strong>Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD007407. DOI:</strong><strong>10.1002/14651858.CD007407.pub2.</strong><br />
<br />
<strong>ABSTRACT:</strong><br />
<br />
<strong>Background</strong> - Psychological treatments are designed to treat pain, distress and disability, and are in common practice. No comprehensive systematicreview has been published since 1999.<br />
<br />
<strong>Objectives</strong> -To evaluate the effectiveness of psychological therapies on pain, disability, and mood.<br />
<br />
<strong>Search strategy</strong> - 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.<br />
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.<br />
<br />
<strong>Data collection and analysis</strong> - 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<br />
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.<br />
<br />
<strong>Main results</strong> - 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.<br />
<br />
<strong>Authors’ conclusions</strong> - 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.<br />
<br />
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Clayton A. Chan, D.D.S.http://www.blogger.com/profile/17435980507660741507noreply@blogger.com0