Introduction: Chronic orofacial pain (COFP) is distressing and disabling to sufferers and can be costly to patients, health services and society. Frequently, no underlying medical pathology can be found to account for the condition. Despite this, patients are treated according to a biomedical model, often by mechanistic and invasive procedures, which tend to be unsuccessful and not evidence based. Evidence suggests that cognitive behavioural therapy (CBT) based management may produce improved outcomes for patients. However, published studies can tell us little about which intervention components are effective, or recommend an optimum way for these components to be applied. Aim: To develop an evidence based intervention for the management of COFP that is feasible and acceptable to patients and practitioners. Method: The Medical Research Council’s guidelines for developing complex interventions were used as a framework for the research. Evidence from multiple sources was synthesised to produce the draft components of an intervention to manage COFP. An exploratory trial investigated preliminary outcomes, acceptability, feasibility and explored parameters for a full scale randomised control trial. Results: The intervention was acceptable to participants and could be feasibly implemented. No conclusions could be drawn relating to the effectiveness of the intervention. Participants were not affected at baseline for a number of outcomes, which implies that cut off points should be introduced into the inclusion and exclusion criteria of any future studies. Conclusion: The study produced an intervention which is acceptable and feasible to participants, however it is not known if it is effective. A number of recommendations are made for progression to a larger, definitive trial.

SyfteUndersöka påverkan av kronisk orofacial smärta och psykologiska faktorer på sömnkvalitet vid käkmuskelmyalgi.Material och metoderDenna retrospektiva studie omfattade 37 patienter (6 män, 31 kvinnor, medelålder: 49 år) med käkmuskelmyalgi. Sömnkvalitet (Pittsburgh Sleep Quality Index), smärtintensitet och smärtrelaterad funktionsnedsättning (Graded Chronic Pain Scale), depression (Patient Health Questionnaire-9), ångest (General Anxiety Disorder-7), stress (Perceived Stress Scale-10) och katastrofiering (Patient Catastrophizing Scale) undersöktes med varierade formulär. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) användes för att identifiera patienter med myalgi i käkmuskulatur.Resultat75% av patienterna rapporterade dålig sömnkvalitet, 73% rapporterade minst mild depressionsgrad, 54% rapporterade minst mild ångest, 59% rapporterade måttlig stressnivå och 38% rapporterade kliniskt relevant katastrofiering. Försämrad sömnkvalitet var relaterad till depression (rs = 0.45, n = 37, p = 0.008) ångest (rs = 0.46, n = 37, p = 0.007), stress (rs = 0.43, n = 37, p = 0.014) och katastrofiering (rs = 0.37, n = 37, p = 0.034). Multivariat logistisk regression visade att smärtintensitet, smartrelaterad funktionsnedsättning, depression, ångest, stress, katastrofiering och antal käkmuskler med refererad palpationssmärta förklarade dålig sömnkvalitet signifikant (p = 0.031).KonklusionSömnkvaliteten hos patienter med käkmuskelmyalgi påverkas i hög grad av kronisk smärtintensitet, smärtrelaterad funktionsnedsättning, antal käkmuskler med refererad palpationssmärta och depression samt ångest, stress och katastrofiering. / AimInvestigate the influence of chronic orofacial pain and psychological factors on sleep quality in patients with myalgia of the masticatory muscles.Material and methodsThis retrospective study included 37 patients (6 men, 31 women, mean age: 49 years) with masticatory muscle myalgia. Sleep quality (Pittsburgh Sleep Quality Index), pain intensity and pain-related disability (Graded Chronic Pain Scale), depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), stress (Perceived Stress Scale-10) and catastrophizing (Patient Catastrophizing Scale) were assessed by questionnaires. The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were used to identify patients with myalgia.Results75% of the patients reported poor sleep quality, 73% reported at least mild depression degree, 54% reported at least mild degree of anxiety, 59% reported at least a moderate stress level and 38% reported a clinically relevant degree of catastrophizing. Impaired sleep quality was related to degree of depression (rs = 0.45, n = 37, p = 0.008), anxiety (rs = 0.46, n = 37, p = 0.007), stress (rs = 0.43, n = 37, p = 0.014) and catastrophizing (rs = 0.37, n = 37, p = 0.034). Multivariate logistic regression showed that characteristic pain intensity, degree of pain-related disability, depression, anxiety, stress, catastrophizing and number of masticatory muscle sites with referred pain significantly explained poor sleep quality (p = 0.031).ConclusionSleep quality in patients with masticatory myalgia is influenced by chronic pain intensity and related disability, number of masticatory muscle sites with referred pain as well as depression, anxiety, stress and catastrophizing.

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