# Neurorehabilitation-Based Movement Representation Techniques in the Management of Craniocervical and Orofacial Pain: A Systematic Review of Randomized Controlled Trials

## TL;DR

This paper reviews studies on using movement-based cognitive techniques to manage craniocervical and orofacial pain, finding that these methods can improve pain thresholds and function.

## Contribution

The study provides a systematic review of randomized controlled trials on Movement Representation Techniques for craniocervical and orofacial pain, highlighting their potential and limitations.

## Key findings

- MRTs significantly increased Pressure Pain Threshold in masseter, trapezius, and cervical regions.
- Action observation showed superior outcomes compared to other MRTs.
- Evidence for symptomatic orofacial pain populations remains lacking.

## Abstract

Background: Craniocervical pain and temporomandibular disorders (TMDs) are prevalent, interconnected conditions. While Movement Representation Techniques (MRTs) are cognitive interventions targeting central pain mechanisms, their specific efficacy here lacks synthesis. This study systematically analyzes the effectiveness of MRTs, such as motor imagery (MI) and action observation (AO), on pain and function in individuals with craniocervical and orofacial pain. Methods: A systematic review of RCTs (PROSPERO: CRD420251155428) was conducted following PRISMA guidelines. Four databases were searched for studies applying MRTs (MI, AO, laterality discrimination) to adults with craniocervical or orofacial pain. Primary outcomes were pain and functionality. Methodological quality was assessed using the PEDro scale and Cochrane RoB 2 tool. Results: Eight RCTs (n = 362) were included. Methodological quality was high (PEDro scores 8–9). MRTs significantly increased Pressure Pain Threshold (PPT) in the masseter, trapezius, and cervical regions. Functional improvements included enhanced cervical range of motion and sensorimotor control. AO consistently demonstrated superior outcomes. However, results for orofacial variables were derived from asymptomatic subjects. Results for cervical muscle strength were inconsistent. Conclusions: MRTs, especially AO, show potential to reduce pain and improve function in craniocervical disorders. Evidence in symptomatic orofacial pain populations is non-existent. Protocol heterogeneity and limited research groups necessitate further high-quality, multicenter RCTs to establish robust clinical guidelines.