Comment: The quality of evidence is downgraded by study limitations(unclear allocation concealment, lack of blinding, selective outcome reporting)and byindirectness (differences between the population of interest and those studied).
A Cochrane review [Abstract] 1 [withdrawn from publication] on non-pharmacologic psychosocial interventions for chronic orofacial pain included 17 studies with a total of 1 447 subjects. Of the studies, 15 were on temporomandibular disorders (TMDs) and two trials investigated burning mouth syndrome. Control groups that usual treatment which involved conservative treatment composed of education, counselling, an intraoral flat plane appliance or placebo. Psychological interventions were grouped into cognitive behavioural therapy (CBT) alone, biofeedback alone, combination of CBT and biofeedback, and physical self-regulation. Nine TMD trials were eligible for pooling. Psychosocial interventions improved long-term pain intensity (SMD -0.34, 95% CI -0.50 to -0.18) and depression (SMD -0.35, 95% CI -0.54 to -0.16). 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. The risk of bias was high for almost all studies.
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