Brief Treatment for Temporomandibular Pain
Condition: Temporomandibular Joint Syndrome; Myofascial Pain Dysfunction Syndrome; Orofacial Pain
MeSH terms: Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome; Fibromyalgia; Myofascial Pain Syndromes; Syndrome; Facial Pain
Study type: Interventional

Summary: 
      Temporomandibular Disorder (TMD) is a widespread chronic pain condition. Successful
      psychosocial treatments for TMD have been developed, but the mechanisms by which these
      treatments achieve their effects are not well known. The goal of this project is to evaluate
      the possible mechanisms responsible for treatment gains in TMD treatment.
    

Detailed description: 
      TMD is a widespread chronic pain condition. Successful psychosocial treatments for TMD have
      been developed, but the mechanisms by which these treatments achieve their effects are not
      well known. The goal of this project is to evaluate the possible mechanisms responsible for
      treatment gains in TMD treatment. Men and women (N=106) with complaints of chronic facial
      pain for at least 3 months' duration will be recruited from the University Dental Clinics and
      from the community via advertisements and randomly assigned to either a Standard Conservative
      Treatment (STD) employing an intraoral splint plus anti-inflammatory agents, or to a Standard
      Treatment + Cognitive-Behavioral Treatment Program (STD+CBT), that will include standard
      treatment but also focus on changing self-efficacy and decreasing catastrophization. Both
      treatments will entail 6 clinic visits. Dispositional and situational variables derived from
      a comprehensive model of pain coping will be measured before and after treatment. The
      situational variables, including coping responses, mood states, situational appraisals and
      self-efficacy, will be measured in an experience sampling paradigm four times daily using a
      hand-held computer. This will be done to minimize retrospective biases that may have hampered
      earlier studies of treatment process. Dependent variables will be self-report measures of
      distress, pain, and interference with activities, as well as blood plasma levels of cortisol
      and selected cytokines, measured at the end of the 6-week treatment period, and at follow-up
      points thereafter up to a 12-month follow-up. It is expected that the STD+CBT treatment will
      result in measurable changes in constructs such as self-efficacy and catastrophization, and
      that these changes will be related to improved outcomes compared to the STD controls. It is
      also expected that outcome differences between groups will be associated with changes in
      inflammatory mediators (cytokine levels). Finally, it is suggested that changes in
      situational treatment process variables will be associated with changes in cytokine levels.
      The results may indicate the true active mechanisms of successful TMD treatment. If these
      mechanisms can be successfully identified it would have important implications for the
      development of more effective treatment programs.
    

Intervention name(s): Cognitive-Behavioral treatment; Attention and lifestyle counseling
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Cognitive-Behavioral skills training for chronic pain; Attention and lifestyle counseling added to Standard Care
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment