Cochrane · intervention · CD008456

Psychosocial interventions for the management of chronic orofacial pain

Cochrane Database of Systematic Reviews · 2011 · Cochrane Library

Oral Health Other oral health2 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

as reported

No studies 0 · 0%Ungraded 13 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Adults over 18 years of age with chronic orofacial pain, defined as those diagnosed with temporomandibular disorders (TMD), atypical facial pain, atypical odontalgia or burning mouth syndrome, with no underlying organic abnormality or pathology on clinical and radiological examination (other terms: myofacial/myofascial pain, craniomandibular/oromandibular dysfunction, mandibular stress syndrome, facial arthromyalgia, masticatory muscle disorder, masticatory myalgia, temporomandibular joint syndrome, stomatodynia)	Temporomandibular disorders (TMD) (n=15); Burning mouth syndrome (n=2); all pooled analyses limited to TMD trials
Intervention	Psychosocial interventions targeted towards changing thoughts, behaviours and/or feelings that may exacerbate pain symptoms through a vicious cycle	Cognitive behavioural therapy (n=9); Biofeedback (n=3); Combination of CBT and biofeedback (n=3); Physical self-regulation/posture self-control (n=1); Hypnosis (n=2); Habit reversal (n=1)
Comparison	Surgery; usual care; pharmacological treatment; waiting list controls	Usual care (n=12); Attention placebo (n=2); Waiting list controls (n=2); Relaxation (n=2); Placebo pills (n=1)
Outcomes	Pain intensity (short and/or long term); Pain severity - impact (activity interference, function and/or distress) scores measured by validated scales (e.g. brief pain inventory, multidimensional pain inventory, hospital anxiety and depression scale); Satisfaction with pain relief; Quality of life; Service use (number of consultations to clinicians); Compliance with intervention (recorded where reported)	Pain intensity short term (n=7); Pain intensity long term (n=7); Muscle palpation pain long term (n=3); Activity interference/disability long term (n=5); Depression long term (n=6); Depression short term (n=2); Anxiety short term (n=2); Life interference (n=1)
Study designs	Randomised controlled trials (RCTs)	Randomised controlled trials (n=17); meta-analysis possible for 9 TMD trials
Timing	Not specified (short term = 3 months or less; long term = greater than 3 months)	Short term (3 months or less); Long term (greater than 3 months)

Search date: 2010-10. Databases: Cochrane Oral Health Group's Trials Register; The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; PsycINFO via OVID

Questions and results

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Psychosocial interventions (cognitive behavioural therapy, biofeedback, combination CBT/biofeedback, physical self-regulation/posture self-control) vs Usual care (conservative treatment: education, counselling, intraoral flat plane appliance)

Population: Adults over 18 years of age with chronic orofacial pain (temporomandibular disorder (TMD))

5 questions

Outcome	Effect	Evidence	Status / GRADE
Pain intensity (long term) Long term (more than 3 months) same question in other reviews	SMD -0.34 [-0.50, -0.18]	7 studies · 658 participants	Ungraded
Muscle palpation pain (long term) Long term (more than 3 months) same question in other reviews	Muscle palpation pain long term (greater than 3 months): 3 studies; results not pooled owing to substantial heterogeneity (I2=64%); insufficient evidence to draw conclusions for any individual intervention. One study…	3 studies	Ungraded
Depression (long term) Long term (more than 3 months) same question in other reviews	SMD -0.35 [-0.54, -0.16]	6 studies · 455 participants	Ungraded
Pain intensity (short term) Short term (3 months or less) · Combination CBT/biofeedback same question in other reviews	SMD 0.46 [0.02, 0.90]	2 studies · 90 participants	Ungraded
Pain severity - impact: activity interference / disability (long term) Long term (more than 3 months) · CBT alone same question in other reviews	SMD -0.27 [-0.51, -0.03]	4 studies · 285 participants	Ungraded

Habit reversal vs Waiting list control

Population: Adults over 18 years of age with chronic orofacial pain (temporomandibular disorder (TMD))

2 questions

Outcome	Effect	Evidence	Status / GRADE
Pain intensity (short term / post-treatment) Short term (post-treatment) same question in other reviews	SMD -1.31 [-1.97, -0.65]	1 study	Ungraded
Life interference Short term (post-treatment) same question in other reviews	SMD -0.86 [-1.79, 0.06]	1 study	Ungraded

Cognitive (behavioural) therapy vs Attention placebo

Population: Adults over 18 years of age with chronic orofacial pain (burning mouth syndrome)

2 questions

Outcome	Effect	Evidence	Status / GRADE
Burning mouth pain intensity (post-treatment) Short term (post-treatment) same question in other reviews	SMD -2.40 [-3.40, -1.40]	1 study	Ungraded
Burning mouth pain intensity (6-month follow-up) Long term (6-month follow-up) same question in other reviews	SMD -2.79 [-3.83, -1.75]	1 study	Ungraded

Hypnosis vs Relaxation

Population: Adults over 18 years of age with chronic orofacial pain (temporomandibular disorder (TMD))

3 questions

Outcome	Effect	Evidence	Status / GRADE
Pain intensity (short term) Short term same question in other reviews	MD -1.84 [-3.26, -0.42]	2 studies · 81 participants	Ungraded
Depression (short term) Short term same question in other reviews	SMD -0.49 [-0.93, -0.04]	2 studies · 81 participants	Ungraded
Anxiety (short term) Short term same question in other reviews	SMD -0.42 [-0.86, 0.02]	2 studies · 81 participants	Ungraded

Cognitive behavioural (group psychotherapy) therapy vs Placebo pill

Population: Adults over 18 years of age with chronic orofacial pain (burning mouth syndrome)

1 question

Outcome	Effect	Evidence	Status / GRADE
Improvement in burning mouth symptoms Not specified same question in other reviews	RR 1.77 [0.98, 3.21]	1 study	Ungraded