The effectiveness of self-management interventions in adults with chronic orofacial pain: A systematic review, meta-analysis and meta-regression.

Abstract

Psychosocial risk factors associated with chronic orofacial pain are amenable to self-management. However, current management involves invasive therapies which lack an evidence base and has the potential to cause iatrogenic harm. To determine: (a) whether self-management is more effective than usual care in improving pain intensity and psychosocial well-being and (b) optimal components of self-management interventions. Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, WHO International Clinical Trials Registry Platform and Clinical Trials.gov were searched. Meta-analysis was used to determine effectiveness, and GRADE was used to rate quality, certainty and applicability of evidence. Fourteen trials were included. Meta-analyses showed self-management was effective for long-term pain intensity (standardized mean difference [SMD] -0.32, 95% confidence interval [CI] -0.47 to -0.17) and depression (SMD -0.32, 95% CI -0.50 to -0.15). GRADE analysis showed a high score for certainty of evidence for these outcomes and significant effects for additional outcomes of activity interference (-0.29 95% CI -0.47 to -0.11) and muscle palpation pain (SMD -0.58 95% CI -0.92 to -0.24). Meta-regression showed nonsignificant effects for biofeedback on long-term pain (-0.16, 95% CI -0.48 to 0.17, p-value=0.360) and depression (-0.13, 95% CI -0.50 to 0.23, p-value=0.475). Self-management interventions are effective for patients with chronic orofacial pain. Packages of physical and psychosocial self-regulation and education appear beneficial. Early self-management of chronic orofacial pain should be a priority for future testing. This systematic review provides clear evidence for effectiveness of combined biomedical and psychological interventions (incorporating self-management approaches) on long-term outcomes in the management of chronic orofacial (principally TMD) pain. Self-management should be a priority for early intervention in primary care in preference to invasive, irreversible and costly therapies. Further research is needed firstly to clarify the relative effectiveness of specific components of self-management, both individually and in conjunction, and secondly on outcomes in other types of chronic orofacial pains.