Group cognitive-behavioral intervention for patients with burning mouth syndrome.

This study was conducted to assess the psychological characteristics of, and determine the effectiveness of group cognitive-behavioral (CB) treatment for, patients with burning mouth syndrome (BMS). The baseline characteristics of 24 female patients (age 69.7 ± 5.9 years) and an identical number of healthy female control subjects (age 69.2 ± 5.5 years) were compared. The patient group had significantly higher anxiety scores (P < 0.05) at baseline. A brief group CB intervention was delivered in a small-group format. Two sessions were planned 6 months apart. A numeric rating scale (NRS) was used to assess pain intensity. Anxiety was evaluated using a state and trait anxiety inventories. Present pain intensity decreased after both the first and second sessions. The session effect was significant (P = 0.02), but no repeat effect was found (P = 0.19). The state anxiety inventory score also decreased after the second session. The session effect was significant (P < 0.01), as was the repeat effect (P < 0.01). The trait anxiety inventory score decreased after the second session, and the session effect was significant (P = 0.013), but the repeat effect was not (P = 0.93). The results suggest that a brief group CB intervention reduces pain intensity and anxiety in patients with BMS.

Management of neuropathic orofacial pain.

Current management of painful trigeminal neuropathies relies on pharmacological (topical and systemic), surgical, and complementary modalities. There is, however, a lack of quality research relating to the effectiveness of these modalities. In this review we analyze the available data that relates to the therapy of trigeminal neuralgia, postherpetic neuralgia, and posttraumatic neuropathies and provide clinical guidelines. The review focuses on medical management, as well as surgical and other interventions for painful neuropathies.

Counseling and physical therapy as treatment for myofascial pain of the masticatory system.

AIMS: To prospectively evaluate the effectiveness of a treatment regimen comprising counseling and physical therapy in patients with myofascial pain of the masticatory system, and to explore whether the duration of the physical therapy offered (4 vs 6 weeks) would influence the treatment result. METHODS: Twenty-six patients were randomly distributed over 2 groups. All patients received reassuring information, advice regarding relaxation of the jaws, avoiding parafunctions, and limited use of the jaws. In addition, a physical therapy program (heat application, massage, ultrasound and muscle stretching) was initiated 2 weeks after the start of the study (group I, receiving 4 weeks of physical therapy) or immediately from the start of the study (group II, receiving 6 weeks of physical therapy). The following parameters were taken at baseline, 2, 4, and 6 weeks: visual analog scale (VAS) scores of present pain; lowest and highest pain over the past period; percentage of pain relief; jaw function assessment by the Mandibular Function Impairment Questionnaire (MFIQ); and pressure pain thresholds (PPTs) of the masseter, temporalis, and thumb muscles. Statistical analysis used a linear mixed model and corrected for multiple testing (Tukey test). RESULTS: Pain and MFIQ scores decreased while PPTs increased in both groups. Only after 4 and 6 weeks, significant differences were present for the PPT of the masseter in group I (P < .02) and the temporalis in both groups (P < .01). Also, the VAS scores of present (P < .02), minimal (P < .01), and maximal (P < .0001) pain and the MFIQ score (P < .001) improved. After 6 weeks, a mean of 60% pain decrease was reported (P < .0001). There were no significant differences between the groups receiving 4 weeks vs 6 weeks of physical therapy. CONCLUSION: A conservative approach involving counseling and physical therapy resulted in significant improvement in parameters of pain and jaw function in patients with myofascial pain. A controlled study will be necessary to elucidate the specific effectiveness of physical therapy over counseling or no treatment.