Keele Research Repository

BACKGROUND:
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 have the potential to cause iatrogenic harm.

OBJECTIVES:
To determine: 1) whether self-management is more effective than usual care in improving pain intensity and psychosocial well-being 2) optimal components of self-management interventions. DATABASES AND DATA TREATMENT: Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, WHO International Clinical Trials Registry Platform and Clinical Trialsgov were searched. Meta-analysis was used to determine effectiveness and GRADE was used to rate quality, certainty and applicability of evidence.

RESULTS:
Fourteen trials were included. Meta-analyses showed self-management was effective for long-term pain intensity (standardised 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 non-significant 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).

CONCLUSIONS:
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 article is protected by copyright. All rights reserved.