The Relaxation Response Resiliency Enhancement Program in the Management of Chronic Refractory Temporomandibular Joint Disorder: Results from a Pilot Study

Abstract

Objectives This is an open-pilot study to evaluate the feasibility, acceptability and efficacy of a pain-specific version of an established mind–body medicine program, the Relaxation Response [RR] Resiliency Program [R3P], in patients with chronic temporomandibular disorder [TMD]. Methods Male and female with at least a six-month history of pain involving the masticatory muscles were sought in the Orofacial Pain Centers of the Massachusetts General Hospital [MGH] or through an advertisement sent to MGH employees from 2008 to 2010. Eligible participants underwent the R3P intervention [eight group sessions] after standard medical management. Pre- and post-group patients underwent objective measures of impairment [vertical and lateral range of motion with and without pain, temporomandibular joint and muscle pain palpation, and algometer measures] and completed psychosocial measures [Symptom Severity Index, Perceived Stress Scale, the Symptom Checklist-90-Revised and Short Form 36 Health Survey]. Results Twenty-four subjects [16 females, 90% from MGH Orofacial Pain Centers,10% from among MGH employees], mean age 38 years, met eligibility criteria and participated in the study. The intervention was highly feasible and accepted by patients, as evidenced by a 92% rate of completion. Paired t-test analyses revealed improvement on self-reported pain measures: pain intensity [p<0.02], pain frequency [p<0.002], pain duration [p<0.027], pain tolerability [p<0.009] and on several objective tests. Conclusions The pain specific R3P is efficacious in reducing objective and subjective symptoms in patients with chronic refractory TMD. The comprehensive intervention, which combines educational information about pain with RR, cognitive behavioral and resiliency-enhancement skills, is accepted by patients and may be more efficacious than other treatments with fewer elements.

A preliminary RCT of a mind body skills based intervention addressing mood and coping strategies in patients with acute orthopaedic trauma

“…for PTSD [13,14,15,16], catastrophic thinking and pain anxiety [17][18][19], depression [20][21][22], perceived disability [23] and pain intensity and overall medical symptom reduction [24][25][26][27].…”

The impact of a virtual mind–body program on symptoms of depression and anxiety among international English‐speaking adults with neurofibromatosis

“…Our 3RP-NF intervention was adapted from the original 3RP program, designed to elicit the "relaxation response" (RR), a state of calm awareness, through relaxation and mindfulness skills. Like other mindfulness-based interventions (Marino et al, 2021;Sanada et al, 2017), the 3RP program has demonstrated ability to improve health indicators and well-being for a number of health conditions but required adaptation to suit the unique needs of individuals with NF (Bhasin et al, 2013;Denninger et al, 2014;Kuo et al, 2015;Vranceanu et al, 2013Vranceanu et al, , 2014. In the first fully powered single-blinded randomized controlled trial of a psychosocial NF intervention, 3RP-NF demonstrated sustained improvements in QoL compared with a dose-matched health education control (the Health Enhancement Program for NF, HEP-NF; Vranceanu et al, 2023).…”

Treatment protocol for temporomandibular joint derangement using an anterior repositioning splint with modification (one year prospective study).

“…The TMD non-surgical approach consists of a recognized health care protocol set that includes; a) cognitive-behavioral therapy aiming for relaxation and habit-breaking (36,37) , b) pharmacological approach (using Anti-inflammatories and muscle relaxants or anti-depressants in severe cases) (38,39) , c) modalities of physical therapy (electro-physical, massage, or physical exercise) (40,41) , d) Wearing an oral appliance (OAs) or an occlusal orthotic (splint) (42) , e) a combination of these approaches.…”