'I just wanted someone to tell me it wasn't all in my mind and do something for me': Qualitative exploration of acceptability of a CBT based intervention to manage chronic orofacial pain

Goldthorpe, Joanna; Peters, Sarah; Lovell, Karina; McGowan, Linda; Aggarwal, Vishal R.

doi:10.1038/sj.bdj.2016.332

Cited by 11 publications

(10 citation statements)

References 20 publications

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“…Whilst many were “desperate for help” and “willing to try anything” some were unsure of the link between mind and pain or doubted that the intervention would have any personal benefits. This finding is consistent with other research exploring acceptability of a CBT intervention for (orofacial) pain which found barriers to engagement could include participants initially considering the intervention to be not appropriate for them, for example due to associations between CBT and depression [24]. In that study, as with the present study the belief that the study could help others could overcome this scepticism, thus displaying perhaps, evidence of unconditional altruism [25].…”

Section: Discussionsupporting

confidence: 91%

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Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability

Fraser

Beasley²,

Macfarlane³

et al. 2019

BMC Musculoskelet Disord

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Background Telephone cognitive behavioural therapy (tCBT) is an acceptable and effective treatment for patients with chronic widespread pain (CWP). Preventing the onset of CWP offers considerable benefits to the individual and society and the MAmMOTH study is the first aimed at CWP prevention. The study is a two-arm randomised trial testing a course of tCBT against usual care for prevention of CWP. This nested qualitative study explores patients’ treatment experiences, with a view to understanding their potential influences on acceptability of the intervention. Methods The MAmMOTH Study recruited 1002 participants, half of whom were randomised to receive tCBT. Participants were eligible for invitation to the trial if they had pain for which they had consulted their GP, or had pain and visited a doctor frequently, and had 2 of 3 risk factors for development of CWP. Participants randomised to tCBT who had completed treatment were eligible for invitation to qualitative interviews for this study. Individual qualitative interviews were conducted with a sub-sample ( n = 33) of patients at high risk of developing CWP who had been allocated to the intervention arm. Semi-structured telephone interviews explored treatment experiences and intervention acceptability. Data was analysed using Framework analysis. Results Participants presented with a range of musculoskeletal and auto-immune conditions and almost half described their pain as ‘chronic’ on study entry. Many participants perceived the trial intervention to be aimed at treatment of pain rather than prevention of pain. Initial expectations prior to treatment varied, with scepticism more likely for those who had little prior knowledge of CBT approaches. All participants provided positive feedback post intervention particularly in relation to the modality, therapist experience and skills and the intervention. The majority of participants described positive changes in either their subjective level of pain or pain-management post-intervention and some attributed the positive change directly to the intervention as a result of empowerment, increased self-management and cognitive restructuring. Conclusions This study extends our understanding of the acceptability and suitability of preventative interventions for chronic widespread pain and provides further evidence for the acceptability of tCBT. Trial registration Clinical Trials.gov NCT02668003 (registered 29th January, 2016). Electronic supplementary material The online version of this article (10.1186/s12891-019-2584-2) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 91%

“…This study adds to the literature by extending our understanding of the acceptability of interventions for chronic widespread pain in a preventative rather than a treatment setting and adds to the wider research literature on the suitability of psychosocial interventions for patients experiencing pain [10, 24].…”

Section: Discussionmentioning

confidence: 99%

Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability

Fraser

Beasley²,

Macfarlane³

et al. 2019

BMC Musculoskelet Disord

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“…A further study by Litt et al () also showed that somatization, self‐efficacy and readiness for treatment were significant moderators. Work by our group assessed processes of engagement with a self‐management intervention, and this showed that key mechanisms of change centred around: identification with the intervention; feeling believed and understood; obtaining a plausible explanation for symptoms; degree of perceived effort required to engage; acceptance of having a long‐term condition; and receiving demonstrative, positive feedback (Goldthorpe, Peters, Lovell, McGowan, & Aggarwal, ). These studies indicate that self‐efficacy, pain control, and understanding and accepting the chronicity of the conditions are important biopsychosocial predictors of patient improvement and should be incorporated into future interventions.…”

Section: Discussionmentioning

confidence: 99%

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

Aggarwal

Main

et al. 2019

European Journal of Pain

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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 has the potential to cause iatrogenic harm. Objectives To determine: (a) whether self‐management is more effective than usual care in improving pain intensity and psychosocial well‐being and (b) 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 Trials.gov 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 (standardized 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 nonsignificant 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. Significance This systematic review provides clear evidence for effectiveness of combined biomedical and psychological interventions (incorporating self‐management approaches) on long‐term outcomes in the management of chronic orofacial (principally TMD) pain. Self‐management should be a priority for early intervention in primary care in preference to invasive, irreversible and costly therapies. Further research is needed firstly to clarify the relative effectiveness of specific components of self‐management, both individually and in conjunction, and secondly on outcomes in other types of chronic orofacial pains.

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“…Although Goldthorpe et al reported that CBT is effective for patients with unexplained chronic orofacial pain, their study was excluded from a systematic review because it was not a case-control study [21]. As outlined above, although there are many practical studies of the use of CBT for TMD and MFP, few discuss unexplained disorders such as atypical toothache and atypical facial pain.…”

Section: Discussionmentioning

confidence: 99%

Effects of cognitive behavioral therapy on orofacial pain conditions

et al. 2021

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'I just wanted someone to tell me it wasn't all in my mind and do something for me': Qualitative exploration of acceptability of a CBT based intervention to manage chronic orofacial pain

Cited by 11 publications

References 20 publications

Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability

Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability

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

Effects of cognitive behavioral therapy on orofacial pain conditions

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