Feasibility of brief behavioral telehealth interventions for sleep and pain in adults with chronic musculoskeletal orofacial pain: An idiographic clinical trial

Objective: Brief behavioral interventions targeting pain (Physical Self-Regulation, PSR) or sleep (Brief Behavioral Intervention for Insomnia, BBTI) show promise for interdisciplinary management of chronic pain, though their feasibility with chronic musculoskeletal orofacial pain (MSK-OFP) populations remains underexplored. This pilot study assessed the feasibility of a randomized clinical trial (RCT) of these interventions in a university-affiliated tertiary OFP clinic and explored clinical changes in pain, sleep, and other secondary outcomes. Methods: Treatment-seeking participants (N=19) with chronic MSK-OFP and insomnia were randomized to three-session PSR or BBTI. At pre- and post-intervention, participants completed questionnaires (assessing pain intensity, insomnia symptomatology, sleep quality, headache disability, fatigue, jaw-movement limitations, and quality of life), 8 consecutive days of actigraphy and morning/evening diaries. Feasibility outcomes were recruitment, retention, and adherence rates. Clinical outcomes included clinically-meaningful reductions in insomnia symptoms (Insomnia Severity Index [ISI]<15) and pain intensity (>2.5 point on 0–10 Numerical Rating Scale). Results: Over a 17-month period, of 19 consenting participants (88.9% females, 38.4±12.2y/o, recruitment rate: 1.1/month),12 (92% females, 38.5±11.5y/o) completed the study (retention rate: 63.2%) with high completion rate (questionnaires: 95.8%, daily diaries: 95%, actigraphy: 100%). Despite no significant changes in pain, ISI scores decreased by 6.0 and 4.8-points among BBTI and PSR groups. Improvements in sleep quality, headache disability, fatigue, jaw-movement limitations, and quality of life wereobserved. Conclusion: RCTs of brief behavioral interventions are feasible in tertiary-OFP clinics.