Brief group cognitive-behavioral intervention for temporomandibular disorders

Abstract

Temporomandibular disorders (TMD) are currently viewed as an interrelated set of clinical conditions presenting with signs and symptoms in masticatory and related muscles of the head and neck, and the soft tissue and bony components of the temporomandibular joint. Epidemiologic and clinical studies of TMD confirm its status as a chronic pain problem. In this report we present results from a randomized clinical trial which compared, at 3- and 12-month follow-ups, the effects of usual TMD treatment on TMD pain and related physical and psychological variables with the effects of a cognitive-behavioral (CB) intervention delivered to small groups of patients before usual TMD treatment began. The purpose of this study was to determine whether a minimal CB intervention followed by dental TMD treatment enhanced the effects of usual clinical dental treatment. A second purpose of the study was to determine whether patients classified as high in somatization and psychosocial dysfunction would respond less favorably to this minimal intervention than would those low in somatization and dysfunction. Patients who participated in the CB intervention followed by usual treatment showed greater long-term decreases in reported pain level and pain interference in daily activities than did patients who received only usual treatment. The benefits of CB intervention were not seen when the CB and UT groups were compared at 3-month follow-up. During the 3-12-month follow-up interval, however, the UT group maintained essentially the same level of improvement in characteristic pain while the CB group continued to improve, as hypothesized. During this same follow-up interval, the CB group also showed a strong trend toward continued improvement in pain interference. Such effects were not observed for depression, somatization, or clinical measures of jaw range of motion. Additionally, as hypothesized, dysfunctional chronic pain patients did not appear to benefit from the brief CB intervention. Intent to treat analyses were also performed to assess generalizability of the results.

Cognitive-Behavioral Therapy for Somatization and Symptom Syndromes: A Critical Review of Controlled Clinical Trials

“…Twenty-five studies focused on specific symptoms or symptom syndromes: 5 on back pain, 3 on chronic fatigue syndrome, 3 on irritable bowel syndrome, 3 on chest pain, 2 on tinnitus, 2 on fibromyalgia and 7 on a variety of other symptoms [14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38]. Six studies focused on general somatization: 3 on unexplained physical symptoms and 3 on hypochondriasis [39, 40, 41, 42, 43, 44].…”

Association between Orthopedic and Dental Findings: What Level of Evidence is Available?

“…Zusätzlich wurde nach Khan et al [156] Osamu Komiyama et al (Chiba, Japan) [166] included 60 patients with myofascial pain and limited jaw opening in a 1-year trial [74]. The study participants were randomized into one of three groups: Patients in group 1 received cognitive behavioral therapy every month according to the method of Dworkin et al [75] (patient information; training in pain-and stress-coping strategies such as progressive relaxation), group 2 received monthly cognitive behavioral therapy plus instructions in posture correction during sitting, standing, sleeping, eating, walking, and carrying heavy loads, and group 3 (controls) received every month general instructions emphasizing optimum jaw function as described by Burgess et al [25]. The trial results do suggest that posture correction in addition to cognitive behavioral therapy, as compared to cognitive behavioral interventions alone, may increase the therapeutic benefit at least in part.…”

The cognitive behavioral therapy causes an improvement in quality of life in patients with chronic musculoskeletal pain

“…This is also the conclusion of a study that used the same quality of life scale in chronic patients and obtained the lowest results in the items physical limitations and vitality 21 . However, the results are still below the expected average, confirming some studies that have used this scale and demonstrated that patients with chronic pain present low quality of life [22][23][24] . The fact that there was no increase in the scores of SF-36 in all items demonstrates that these patients can, from the moment the intervention is done, learn how to deal with everyday life in more adaptive ways.…”