DO CHANGES IN PATIENT BELIEFS AND COPING STRATEGIES PREDICT TEMPOROMANDIBULAR DISORDER TREATMENT OUTCOMES

Objective: This study examined the applicability of the cognitive-beha vioral model for temporomandibular disorders (TMD) by determining whet her changes in TMD patient pain-related beliefs and coping over the co urse of treatment related to improvement in symptoms and disability an d whether patients' posttreatment beliefs and coping predicted future pain and functioning. Patients/Setting: We studied 139 TMD patients at a health maintenance organization or a university dental school who c ompleted a clinical trial comparing usual treatment with or without a brief cognitive-behavioral intervention. Outcome Measures/Design: Pain , disability, depression, objective physical impairment, and pain beli efs and coping strategies were assessed pretreatment and at 3- and 12- month follow-ups. Results: Increased ability to control pain and decre ased Disease Conviction and Passive Coping scores were associated with improved pain, jaw opening, and depression from pretreatment to 3-mon th follow-up. Patient beliefs and coping at 3-month follow-up did not contribute much to the prediction of pain or physical and psychologica l functioning at 12-month follow-up after controlling for 3-month pain and functioning scores. However, passive coping and low ability to co ntrol pain at 3 months predicted greater activity interference at 12 m onths. Conclusions: Pretreatment to 3-month follow-up changes in belie fs and coping are associated modestly with TMD patient improvement aft er conservative dental treatment with and without a brief cognitive-be havioral intervention. Research is needed to develop interventions tha t produce greater decreases in disease conviction, passive coping, and perceived inability to control pain and to determine whether these ch anges mediate symptom and disability improvement.