title: Psychosocial interventions for the management of chronic orofacial pain.
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.
  
  
  OBJECTIVE
  To determine the efficacy of non-pharmacologic psychosocial interventions for chronic orofacial pain.
  
  
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  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).
  
  
  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.
authors.affiliation: Oral Health Unit, School of Dentistry, The University of Manchester, Manchester, UK. vishal.r.aggarwal@manchester.ac.uk.
authors.forename: Vishal R
authors.initials: VR
authors.lastname: Aggarwal
authors.forename: Karina
authors.initials: K
authors.lastname: Lovell
authors.forename: Sarah
authors.initials: S
authors.lastname: Peters
authors.forename: Hanieh
authors.initials: H
authors.lastname: Javidi
authors.forename: Amy
authors.initials: A
authors.lastname: Joughin
authors.forename: Joanna
authors.initials: J
authors.lastname: Goldthorpe
mesh_terms: D000328:Adult; D001676:Biofeedback, Psychology / Q000379:methods*; D059350:Chronic Pain; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005157:Facial Pain / Q000523:psychology / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013705:Temporomandibular Joint Disorders / Q000523:psychology / Q000628:therapy*