Tempromandibular pain disorders (TMDs) are characterized by a dysfunction of the TMD joint and cause orofacial pain, masticatory dysfunction or both. A new study published in The Journal of Pain showed that standard treatment approaches yield modest to large improvement in pain, but the addition of cognitive behavioral therapy may be helpful.
Some 10 to 36 million U.S. adults, primarily women, have TMD pain, making this condition the second most frequent pain disorder following low-back pain. MD pain usually can be managed with conservative treatment with non-steroidal anti-inflammatory pain medications (NSAIDS), supportive patient education, diet modifications and an intraoral splint and/or occlusal therapy. Not all patients benefit, however, and previous research has shown that many TMD patients benefit from cognitive behavioral therapy (CBT). But the reasons behind CBT treatment success or failure are unclear.
Researchers from the University of Connecticut Health Center evaluated 101 TMD patients on a daily basis for three months. Study subjects reported having TMD pain for an average of 6.7 years. They were randomly assigned to one of two treatment groups: standard conservative care and standard care with CBT added, which included coping skills training. The purpose of the study was to determine if specific subtypes of treatment nonresponsive TMD patients could be identified to determine if CBT could be helpful.
The authors hypothesized that certain CBT treatment-related outcomes, such as lower retention in treatment and less adaptive changes in coping, self efficacy and catastrophizing, might be predictive of treatment non-response.
Results showed that nonresponders scored higher on depression scores, exhibited lower self efficacy and coping ability, and catastrophized more than more adaptive patients. It was noted that nonresponsive patients did not show more joint pathology than patients who responded well to treatment. Despite lack of joint pathology, the nonresponsive subjects were more likely to report being disabled by their TMD pain.
The study concluded it is important to recognize the importance of the heterogeneous nature of TMD pain, and that treating TMD patients as a homogeneous group is likely to result in suboptimal therapy for many patients. Even though no treatment is successful for all TMD patients, certain psychosocial factors can make some patients unresponsive to CBT.
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