Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: A randomized, controlled trial
ABSTRACT We evaluated the short- and long-term efficacy of a brief cognitive-behavioral therapy (CBT) for chronic temporomandibular disorder (TMD) pain in a randomized controlled trial. TMD clinic patients were assigned randomly to four sessions of either CBT (n=79) or an education/attention control condition (n=79). Participants completed outcome (pain, activity interference, jaw function, and depression) and process (pain beliefs, catastrophizing, and coping) measures before randomization, and 3 (post-treatment), 6, and 12 months later. As compared with the control group, the CBT group showed significantly greater improvement across the follow-ups on each outcome, belief, and catastrophizing measure (intent-to-treat analyses). The CBT group also showed a greater increase in use of relaxation techniques to cope with pain, but not in use of other coping strategies assessed. On the primary outcome measure, activity interference, the proportion of patients who reported no interference at 12 months was nearly three times higher in the CBT group (35%) than in the control group (13%) (P=0.004). In addition, more CBT than control group patients had clinically meaningful improvement in pain intensity (50% versus 29% showed > or =50% decrease, P=0.01), masticatory jaw function (P<0.001), and depression (P=0.016) at 12 months (intent-to-treat analyses). The two groups improved equivalently on a measure of TMD knowledge. A brief CBT intervention improves one-year clinical outcomes of TMD clinic patients and these effects appear to result from specific ingredients of the CBT.
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ABSTRACT: To determine the effectiveness and cost-effectiveness of non-invasive interventions for temporomandibular disorders (TMD). We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central register from 1990 to 2014 for effectiveness studies and the Cochrane Health Technology Assessment Database, EconLit, NHS Economic Evaluation Database, and Tufts Medical Center Cost-effectiveness Analysis Register from 1990 to 2014 for cost-effectiveness studies. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Evidence from eligible studies was synthesized using best-evidence synthesis methodology. Our search for effectiveness studies yielded 16,995 citations; 31 were relevant and seven RCTs (published in 8 articles) had a low risk of bias. We found no relevant cost-effectiveness studies. The evidence suggests that for persistent TMD: (1) cognitive behavioural therapy and self-care management lead to similar improvements in pain and disability but cognitive behavioural therapy is more effective for activity interference and depressive symptoms; (2) cognitive behavioral therapy combined with usual treatment provides short-term benefits in pain and ability to control pain compared to usual treatment alone; (3) intraoral myofascial therapy may reduce pain and improve jaw opening; and (4) structured self-care management may be more effective than usual treatment. The evidence suggests that occlusal devices may not be effective in reducing pain and improving motion for TMD of variable duration. Evidence on the effectiveness of biofeedback is inconclusive. The available evidence suggests that cognitive behavioral therapy, intraoral myofascial therapy and self-care management are therapeutic options for persistent TMD.The Clinical journal of pain 04/2015; DOI:10.1097/AJP.0000000000000247 · 2.70 Impact Factor
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ABSTRACT: Background: Psychological interventions for chronic pain often require substantial individualisation, which can undermine links with the research evidence on which treatment is based. To ensure patients receive effective therapy, evaluation is needed. This paper demonstrates the use of individual level change indices, which may be more appropriate for assessing effectiveness of person-centred treatment than traditional group-level statistics. Aims: To evaluate the efficacy of a psychological chronic pain service at individual level and to recommend improvements for future service evaluation. Method: Indices of reliable and clinically significant change were used to assess outcomes on the HADS, CORE-10 and PSEQ. Results: Fifty-six out of 83 patients had usable outcome data. On the most widely administered outcome measure, the CORE-10, n=15 met reliable change and n=22 met clinically significant change criteria. Eighteen showed no reliable change. Only one person deteriorated. Conclusions: The person-centred treatment provided by this service was effective and achieved outcomes similar to published data from a structured group programme. However, missing data reduced the reliability of these conclusions and led to reduced usefulness of the evaluation for service planning. Recommendations for future evaluation are made.
Klinische Neurophysiologie 12/2012; 43(04):266-273. DOI:10.1055/s-0032-1327670 · 0.33 Impact Factor