BRIEF GROUP COGNITIVE-BEHAVIORAL INTERVENTION FOR TEMPOROMANDIBULAR DISORDERS

Temporomandibular disorders (TMD) are currently viewed as an interrela ted set of clinical conditions presenting with signs and symptoms in m asticatory and related muscles of the head and neck, and the soft tiss ue and bony components of the temporomandibular joint. Epidemiologic a nd clinical studies of TMD confirm its status as a chronic pain proble m. In this report we present results from a randomized clinical trial which compared, at 3- and 12-month follow-ups, the effects of usual TM D treatment on TMD pain and related physical and psychological variabl es with the effects of a cognitive-behavioral (CB) intervention delive red to small groups of patients before usual TMD treatment began. The purpose of this study was to determine whether a minimal CB interventi on followed by dental TMD treatment enhanced the effects of usual clin ical dental treatment. A second purpose of the study was to determine whether patients classified as high in somatization and psychosocial d ysfunction would respond less favorably to this minimal intervention t han would those low in somatization and dysfunction. Patients who part icipated in the CB intervention followed by usual treatment showed gre ater long-term decreases in reported pain level and pain interference in daily activities than did patients who received only usual treatmen t. The benefits of CB intervention were not seen when the CB and UT gr oups were compared at 3-month follow-up. During the 3-12-month follow- up interval, however, the UT group maintained essentially the same lev el 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 pa in interference. Such effects were not observed for depression, somati zation, or clinical measures of jaw range of motion. Additionally, as hypothesized, dysfunctional chronic pain patients did not appear to be nefit from the brief CB intervention. Intent to treat analyses were al so performed to assess generalizability of the results.