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

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.