Gondola Veronica [Università degli studi del Molise, Campobasso, Italy]
Laca Artur [Università degli studi del Molise, Campobasso, Italy]
Manca Virginia [Università degli studi del Molise, Campobasso, Italy]
Farella Mattia [Università degli studi del Molise, Campobasso, Italy]
Cammareri Jessica [Università degli studi del Molise, Campobasso, Italy]
Pellicciari Leonardo [Università degli studi del Molise, Campobasso, Italy]
It is well known that chronic musculoskeletal pain conditions, to be managed, need a multimodal approach and, among the possibilities, Pain Neuroscience Education (PNE) is a valid option for managing them[ 1 ]. Time spent on educating and reassuring patients is a significant factor in developing a good degree of adherence and in building therapeutic relationship[ 2 ]. Moreover, PNE increases knowledge of the biology and physiology of pain helping to improve pain catastrophizing, mid-term disability, function, psychosocial factors, pain awareness and kinesiophobia. Although last 20 years-evidence supports PNE as a valid intervention to manage chronic pain conditions, there’s no literature that investigated clearly possible benefits in people with temporomandibular disorders (TMD)[ 4 ]. It is common knowledge that psychosocial and behavioural factors may contribute to onset and perpetuation of TMDs . In fact, it is a misnomer and no longer appropriate to regard TMD solely as a localized orofacial pain condition[ 5 ].
This Systematic Review is based on a predetermined published protocol which was previously registered with PROSPERO(CRD42023432713). Bibliographical research was conducted through electronic databases: general databases (MEDLINE, EMBASE, COCHRANE CENTRAL, WEB OF SCIENCE) and specific databases (PEDro). Reference lists of previous systematic reviews and previous trials done on this topic were examined (hand search) to identify additional papers to be included. Three reviewers independently screened articles for inclusion, extracted data and assessed risk of bias with the revised Cochrane Risk-of-Bias tool for RCTs (RoB 2.0 tool).
All studies analyzed PNE compared with other education strategies or with manual therapy and exercise measuring changes in terms of pain reduction, disability related to TMD and psychosocial factors. A total of 3044 records were screened, but only 3 [ 4 ][ 6 ][ 7 ] (230 participants) satisfied the inclusion criteria. All studies showed a decrease in pain intensity, but only two showed a decrease in pain catastrophizing and an increase in pain self efficacy. It should be noted that included studies showed an overall high risk of bias.
The objective of this SR was to collect the available evidence about dosage and effectiveness of PNE compared to other treatments and define if PNE can be a valid option in terms of reduction of pain intensity and disability in people with TMDs. Several studies claim that pain caused by TMDs could be mediated by central sensitisation mechanisms and clinicians should consider the coexistence of these factors in the diagnosis and management of TMDs. For these reasons, the biopsychosocial approach is considered the most effective. Available data seems to suggest that PNE is effective in reducing pain, in enhancing self-efficacy and decreasing catastrophizing in patients with TMDs but it is impossible to draw firm and reliable conclusions at the moment. We believe that more studies are necessary to support this conclusions.
