Brief Cognitive-Behavioral Treatment for TMD Pain: Initial Results

Objectives: To determine whether a brief (6-8 sessions) cognitive-behavioral treatment for temporomandibular dysfunction-related pain could be efficacious in reducing pain, pain-related interference with lifestyle and depressive symptoms. Methods: Patients were 84 men and women with pain in the area of the temporomandibular joint of at least 3 months duration, assigned to either Standard Treatment (STD; n=39) or to Standard Treatment + Cognitive-Behavioral skills training (STD+CBT; n=45). Standard Treatment consisted of prescription of soft diet and NSAID agents, and the placement of a maxillary flat plane occlusal splint. The STD+CBT condition added relaxation training, stress management, cognitive restructuring intended to promote self-efficacy, and habit modification. All patients were seen for 6 weekly visits. Patients were assessed at posttreatment (6 weeks), 12 weeks, 24 weeks and 36 weeks. Results: Linear mixed model analyses of reported pain out to 9 months indicated that both treatments yielded significant decreases in pain (p < .002), with the STD+CBT condition resulting in steeper decreases in pain over time than the STD condition (p < .05), and average pain ratings decreasing to below 0.8 on a scale to 6.0. Somatization was a significant moderator of outcome, such that those low in somatization treated with STD+CBT reported lower pain. Similar models indicated that both treatments resulted in decreases in Interference (p < .009), but no effects for Treatment or Treatment X Time emerged. Somatization was also a significant moderator of treatment effects on Interference, with those low on somatization reporting less pain interference over time when treated in the STD+CBT condition. Similar results were obtained for depressive symptom scores. Conclusion: It was concluded that brief treatments can yield significant reductions in pain, life interference and depressive symptoms in TMD sufferers, and the addition of cognitive-behavioral coping skills will add to efficacy, especially for those low in somatization. Support for this project was provided by NIDCR grant R01 DE-14607 and General Clinical Research Center grant M01-RR06192 from the National Institutes of Health.