Physical self-regulation training for the management of temporomandibular disorders

Aims: To evaluate the long-term effectiveness of a brief skills training pr ogram for the management of chronic facial muscle pain. This program of phy sical self-regulation (PSR) involved primarily training in breathing, postu ral relaxation, and proprioceptive re-education. Methods: Physical self-reg ulation training was presented by a dentist during two 50-minute sessions s paced at 3-week intervals and was compared to a standard dental care (SDC) program that included a flat-plane intraoral appliance and self-care instru ctions provided by a dentist. Participants (n = 44) were initially evaluate d by a dentist experienced in the diagnosis and management of orofacial pai n and were determined to have myofascial pain (Type 1a and 1b diagnoses per the Research Diagnostic Criteria) prior to random assignment to either the PSR or SDC conditions. Posttreatment evaluations 6 weeks and 26 weeks afte r treatment had begun were conducted by a dentist who was not aware of whic h treatment the participants received. Results: Initial results indicated t hat pain severity and life interference from pain were reduced in both grou ps (P < 0.001), while perception of control was increased (P < 0.001), as w as incisal opening without pain (P < 0.05). At the 26-week follow-up, the P SR group reported less pain (P < 0.04) and greater incisal opening, both wi th (P < 0.04) and without (P < 0.01) pain, than the SDC group. There were a lso significant decreases (P < 0.05) in affective distress, somatization, o bsessive-compulsive symptoms, tender point sensitivity, awareness of tooth contact, and sleep dysfunction for both groups over time. Conclusions: The findings support the use of PSR for the short- and long-term management of muscle pain in the facial region. These results are discussed in terms of t he potential mechanisms by which self-regulation treatment strategies are e ffective for the management of these pain disorders.