Does combined individualized orofacial manual therapy, pain neuroscience education, and brain training change orofacial pain, chronic face dysfunction, (facial) body perception and pain? An observational mixed methods case series study

ABSTRACT

Background

Orofacial pain is a complex disabling condition. Multimodal physical therapy intervention may be helpful, yet studies of such approaches are not available and are the basis of this study.

Objective

To identify whether combined orofacial manual therapy, pain neuroscience education, graded motor imagery, and face emotional expression training has an impact on orofacial pain and associated features.

Design

Mixed-methods case series report

Methods

Eight subjects (five females) with predominant chronic unilateral face pain (mean duration 7.3 years) were given six individualized treatment sessions and a home program. The primary outcome was orofacial pain, while secondary outcomes were depression, quality of life, alexithymia, 2-point discrimination (TPD), laterality and emotional recognition, as well as qualitative analysis were evaluated post intervention.

Results

Following the intervention orofacial pain intensity significantly reduced (p = 0.03) from 3.0 (0.53) to 2.2 (1.75) on the Graded Chronic Pain Status questionnaire. As well, secondary outcome measures depression, alexithymia, TPD, and quality of life also significantly improved. Changes were not significant in aspects of facial perception. Qualitative analysis of perception of therapy is discussed.

Conclusion

Multimodal therapy had a positive outcome in terms of improvement in unilateral persistent facial pain, depression score, facial body perception and quality of life, and pain in people with chronic unilateral facial pain. Based on the qualitative analysis of their perception of the therapy, multimodal therapy had beneficial effects through increased motivation and joy to exercise.

KEYWORDS:

• Case-report
• facial pain
• body image
• manual therapy
• pain neuroscience education

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors contributions

HP developed the project, the conceptional ideas and manuscript writing and was responsible for the logistics. GG contributes to writing and the logistics and the recruitment of the volunteers in the study. DM and TH gave a critical reflection of the manuscript and support writing. RB and GG were responsible for the qualitative part of the study. HP and TH were responsible for the corrections and the final writing.

Ethics approval

The study was conducted in accordance with the Helsinki guidelines and approved by the local ethics committee of the University of Applied Sciences Osnabrück (WiSO WiSO MS-MP-WS 1617-10).

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Notes on contributors

Harry Von Piekartz

Harry Von Piekartz is Professor for Physical Therapy, course director of the MSc in musculoskeletal Therapy on the University of Applied Science in Osnabrück(Germany), clinician and researcher in head, face and neck pain.