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

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.