Turner JA, Manic L, Aaron LA. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibukar disorder pain: a randomized, controlled trial

Department of Psychiatry and Behavioral Sciences, University of Washington Seattle, Seattle, Washington, United States
Pain (Impact Factor: 5.21). 05/2006; 121(3):181-94. DOI: 10.1016/j.pain.2005.11.017
Source: PubMed


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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    • "Few trials of psychological interventions count to two. Where they have done so, the tendency has been to dichotomize a continuous measure [16]. This problem is not unique to psychological measures. "
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    ABSTRACT: This is an editorial commentary on an article by Sil et al. It discusses the merits of dichotomous outcomes.
    Pain 03/2014; · 5.21 Impact Factor
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    • "Temporomandibular Disorders (TMD) are characterized by chronic facial pain and restricted jaw movements. Therapies have been evaluated in randomized controlled trials (RCTs) after a constant period of treatment of 6 to 10 weeks in TMD studies [1-4]. However, the duration of treatment varies in clinical care as it depends on the type of therapy as well as on a patient’s speed of recovery. "
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    ABSTRACT: Treatment duration varies with the type of therapy and a patient's recovery speed. Including such a variation in randomized controlled trials (RCTs) enables comparison of the actual therapeutic potential of different therapies in clinical care. An index, Treatment Duration Control (TDC) of outcome scores was developed to help decide when to end treatment and also to determine treatment outcome by a blinded assessor. In contrast to traditional Routine Outcome Monitoring which considers raw score changes, TDC uses relative change. Our theory shows that if a patient with the largest baseline scores in a sample requires a relative decrease by treatment factor T to reach a zone of low score values (functional status), any patient with smaller baselines will attain functional status with T. Furthermore, the end score values are proportional to the baseline. These characteristics concur with findings from the literature that a patient's assessment of 'much improved' following treatment (related to attaining functional status) is associated with a particular relative decrease in pain intensity yielding a final pain intensity that is proportional to the baseline. Regarding the TDC-procedure: those patient's scores that were related to pronounced signs and symptoms, were selected for adaptive testing (reference scores). A Contrast-value was determined for each reference score between its reference level and a subsequent level, and averaging all Contrast-values yielded TDC. A cut-off point related to factor T for attaining functional status, was the TDC-criterion to end a patient's treatment as being successful. The use of TDC has been illustrated in RCT data from 118 chronic pain patients with myogenous Temporomandibular Disorders, and the TDC-criterion was validated. The TDC-criterion of successful/unsuccessful treatment approximated the cut-off separating two patient subgroups in a bimodal post-treatment distribution of TDC-values. Pain intensity decreased to residual levels and Health-Related Quality of Life (HRQoL) increased to normal levels, following successful treatment according to TDC. The post-treatment TDC-values were independent from the baseline values of pain intensity or HRQoL, and thus independent from the patient's baseline severity of myogenous Temporomandibular Disorders. TDC enables RCTs that have a variable therapy- and patient-specific duration.
    BMC Medical Research Methodology 10/2013; 13(1):123. DOI:10.1186/1471-2288-13-123 · 2.27 Impact Factor
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    • "The successful outcome of this study suggests that moves towards training patients in the self-management of chronic conditions, now widely promoted in Western countries [32], can be experimentally applied in Asian countries. Whilst the role of culture in adaptation to pain was not examined in this study, local cultural beliefs were addressed in applying some of the psychological techniques and cognitive–behavioural principles. "
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    ABSTRACT: Self-management of chronic illnesses has been widely recognised as an important goal on quality of life, health service utilisation and cost grounds. This study describes the first published account on the application of this approach to people suffering from chronic pain conditions in a Southeast Asian country, Malaysia. A heterogeneous sample of chronic pain patients in Malaysia attended a 2-week cognitive-behavioural pain management programme (PMP) aimed at improving daily functional activities and general psychological well-being. Complete datasets from 70 patients out of 102 patients who attended 11 programmes conducted from 2002 to 2007, as well as the 1-month and 1-year follow-up sessions at the hospital clinic, are reported. The pre- to post-treatment results on self-report measures indicate that significant gains were achieved on the dimensions of pain, disability and psychological well-being. These gains were maintained at both 1-month and 1-year follow-ups. The results mirror those reported from similar interventions in Europe and North America and indicate the concept of self-management of a chronic illness is acceptable and meaningful to Asian patients. Importantly, the achieved outcomes were independent of gender and ethnic group status.
    03/2012; 2(1):30-37. DOI:10.1007/s13142-011-0095-2
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