DIFFERENTIAL TREATMENT RESPONSES OF TMD PATIENTS AS A FUNCTION OF PSYCHOLOGICAL CHARACTERISTICS

A number of studies have reported that psychological factors play a si gnificant role in TMD. Several studies have identified subgroups of pa tients based on their responses to psychological assessments; however, none of these studies have reported on the clinical utility of classi fications of TMD patients on these various measures. In this study, th e differential response of 133 TMD patients classified within 3 psycho social-behaviorally based subgroups to a conservative, standardized tr eatment was examined. The treatment consisted of the combination of an intra-oral appliance, biofeedback, and stress management. Follow-up a ssessments were conducted 6 months after treatment termination. The re sults demonstrated that overall as a group patients significantly impr oved and maintained improvements on physical, psychosocial, and behavi oral measures (P < 0.0001). Comparisons across patient subgroups, howe ver, revealed differential patterns of improvement on the outcome meas ures. Most notably, reliable change indices demonstrated that the pati ents classified into a subgroup characterized by the greatest degree o f psychological distress (Dysfunctional) demonstrated significantly gr eater improvements on measures of pain intensity (P < 0.001), perceive d impact of TMD symptoms on their lives (P < 0.001), depression (P < 0 .01), and negative thoughts (P < 0.001), compared with groups characte rized by greater interpersonal problems (Interpersonally Distressed) a nd those patients who appeared to be the least disabled by TMD (Adapti ve Copers). These data provide support for the clinical utility of a p sychosocial-behavioral classification system and suggest that in futur e research individualizing treatments and outcome measures based on pa tient characteristics may improve treatment efficacy and outcome evalu ation.