Cognitive Behavioral Therapy for Orthodontic Pain Control

Abstract

The objective of this study was to evaluate the efficacy of cognitive behavioral therapy intervention for patients who experienced pain during orthodontic treatment. The baseline characteristics were assessed via questionnaires and oral examinations. Four hundred and fifty eligible individuals were recruited and randomized by computer-generated block randomization into three groups: cognitive behavioral therapy intervention (n = 150), ibuprofen intervention (n = 150), and no intervention (control; n = 150). Primary outcomes were the change from baseline in pain intensity measured with 100-mm Visual Analog Scale (VAS) scores at 1, 2, 3, 7, 14, and 30 days after initial archwire placement. Outcomes assessment was blinded and followed the intention-to-treat principle. One hundred forty-three (95.30%), 145 (96.70%), and 141 (94.00%) individuals in the cognitive behavioral therapy, the ibuprofen, and the control groups, respectively, completed the one-month follow-up evaluations. Those in the cognitive behavioral therapy group showed a greater decrease in mean VAS scores than did those in the control group over the previous five time-points (p < 0.001). Cognitive behavioral therapy was shown to be effective in pain control during the initial stage of orthodontic treatment. The study registration number was ChiCTR-TRC-00000556.

The effects of cognitive behavioral therapy on experimental orthodontic pain

“…One of those studies assessed the effect of CBT on orthodontic patients also using a VAS, and it reported the significant lower pain with intervention of CBT [23]. However, we did not find significant differences in the standardized VAS score or raw VAS score.…”

“…CBT was carried out according to a standard method [23] used in clinical psychology [20,21,24,25]. Briefly, the operator introduced herself, explained the experiment carefully, and then established rapport and trust with the subject.…”

“…In addition, a report from China stated that pain in orthodontic patients could be reduced by CBT [23]. However, the orthodontic force applied is dependent upon the subject, and the pain intensity could be different between studies.…”

Comparative effectiveness of pharmacologic and nonpharmacologic interventions for orthodontic pain relief at peak pain intensity: A Bayesian network meta-analysis

“…Furthermore, the therapists detailed the pain that might occur, and patients were assured that the pain would decrease gradually. 61 In the miscellaneous intervention class, the benzocaine local anaesthetic patch and transcutaneous electrical nerve stimulation were more effective (shared median rank of 20) than vibrational appliances. The lower effectiveness of vibration appliances could be because vibrations could have negated the pain-relieving ability of these appliances by actually hurting the already painful tooth from the orthodontic forces.…”

Chewing gum vs. ibuprofen in the management of orthodontic pain, a multi-centre randomised controlled trial – the effect of anxiety

“…This pain may persist for the following 3-5 days (Bradley et al 2007). The most common intervention for the management of such pain is the use of oral analgesics, for example ibuprofen or paracetamol (Xiaoting et al 2010), although other methods have been suggested including electrical stimulation (TENS machines) (Roth & Thrash 1986;Weiss & Carver 1994), plastic chews (Hwang et al 1994;Otasevic et al 2006), tooth vibration (Marie et al 2003), cognitive behavioural therapy (Wang et al 2012) and text message follow up (Keith et al 2013). Interestingly a study on the use of a follow up telephone call reported that the level of perceived orthodontic pain was reduced following the call, but was unaffected by its content, i.e.…”