Some weak evidence for non-invasive psychosocial interventions in the management of chronic orofacial pain

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This Cochrane review  aimed to determine efficacy of psychosocial interventions in the management of chronic orofacial pain.   The authors highlight four recognisable symptom complexes of chronic orofacial pain that may coexist: temporomandibular disorder (myofacial face pain); atypical facial pain (atypical facial neuralgia); atypical odontalgia (phantom tooth pain); and burning mouth (oral dysaesthesia, glossodynia, glossopyrosis).

Searches of Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) MEDLINE, EMBASE and PsycINFO  were conducted  with no restrictions regarding language or date of publication.

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) were included. Seventeen trials were eligible for inclusion into the review

They found  that

  • 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).

The authors concluded

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.

Aggarwal VR, Lovell K, Peters S, Javidi H, Joughin A, Goldthorpe J. Psychosocial interventions for the management of chronic orofacial pain. Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD008456. DOI: 10.1002/14651858.CD008456.pub2.

 

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Derek Richards

Derek Richards
Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Glasgow Dental Hospital. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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