Reviewing the evidence: can cognitive behavioral therapy improve outcomes for patients with chronic orofacial pain?

Aims: To review evidence for chronic orofacial pain management using cognitive behavioral therapy (CBT). Methods: Electronic databases were searched for randomized controlled trials in which CBT was compared either alone or in combination with other forms of therapy for management of chronic orofacial pain. The quality of trials was assessed blind by three authors using a validated scale that had been specifically designed to score the quality of randomized controlled trials for psychological interventions. Author agreement was assessed using interclass correlation co_efficients. Results: Fourteen potentially relevant randomized controlled trials were identified. Seven trials were excluded, leaving seven for analysis; two studies were merged as they included the same trial and therefore six trials were used in the final analysis. All but one of the randomized controlled trials identified were based on temporomandibular disorders (TMD). Scoring of the trials showed that the three raters were in close agreement, with four trials performing well (scores of 22-35) whilst the remaining two trials were poor (scores < 18). Of the four trials, one did not show any improvement with CBT prior to conservative treatment whilst the other three showed that CBT alone or in conjunction with conservative treatment improved both short-term and long-term outcomes in functional, dysfunctional, and chronic TMD patients. Conclusions: CBT, either alone or in combination with biofeedback, conservative treatment and/or self-care, can improve outcomes for patients with TMD in secondary care. However, further research is needed to assess its effectiveness in primary care and in management of other chronic orofacial pain conditions. Further, the number of sessions needed, mode of delivery, and cost-effectiveness also remain unclear. J OROFAC PAIN 2010;24:163-171. [ABSTRACT FROM AUTHOR]