Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: A randomized, controlled trial A randomized clinical trial of a tailored comprehensive care treatment program for temporomandibular disorders. Efficacy of stabilisation splint therapy combined with non-splint multimodal therapy for treating RDC/TMD axis I patients: a randomised controlled trial. Headache and Temporomandibular Disorders: Evidence for Diagnostic and Behavioural Overlap Mediators, moderators, and predictors of therapeutic change in cognitive–behavioral therapy for chronic pain Biofeedback-based Cognitive-Behavioral Treatment Compared With Occlusal Splint for Temporomandibular Disorder: A Randomized Controlled Trial Brief cognitive-behavioral treatment for TMD pain: Long-term outcomes and moderators of treatment Momentary pain and coping in temporomandibular disorder pain: Exploring mechanisms of cognitive behavioral treatment for chronic pain Clinical Evaluation of Amitriptyline for the Control of Chronic Pain Caused by Temporomandibular Joint Disorders Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy.
Abstract We evaluated the short‐ and long‐term efficacy of a brief cognitive‐behavioral therapy ( CBT ) for chronic temporom and ibular disorder ( TMD ) pain in a r and omized controlled trial . TMD clinic patients were assigned r and omly 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 r and omization , 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 clinical ly meaningful improvement in pain intensity ( 50 % versus 29 % showed ≥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 AIMS To test the usefulness of tailoring cognitive-behavioral therapy ( CBT ) for patients with temporom and ibular disorders ( TMD ) who demonstrated poor psychosocial adaptation to their TMD condition , independent of physical diagnosis . METHODS A r and omized clinical trial compared a 6-session CBT intervention delivered in conjunction with the usual TMD treatment to the usual conservative treatment by TMD specialist dentists . For study inclusion , Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) , Axis II criteria , were used to target patients with elevated levels of TMD pain-related interference with daily activities , independent of physical diagnosis ( i.e. , Axis I ) . RESULTS At the post-treatment assessment , about 4 months after the baseline evaluations , the comprehensive care group , when compared to the usual treatment group , showed significantly lower levels of characteristic pain intensity , significantly higher self-reported ability to control their TMD pain , and a strong trend ( P = .07 ) toward lower pain-related interference in daily activities . From post-intervention to 1-year follow-up , all subjects showed improvement . At the 1-year follow-up , the comprehensive care group , while not losing any of its early gains , was not significantly different from the usual care group with regard to reported levels of pain , ability to control pain , and levels of interference in activities . For many of these psychosocially disabled TMD patients , pain and interference 1 year after treatment remained at the same or higher levels than those observed at baseline among a group of patients selected for a separate r and omized clinical trial on the basis of better psychosocial adaptation . CONCLUSION The 6-session CBT intervention for patients with heightened psychologic and psychosocial disability was effective in improving pain-related variables over the course of the CBT in conjunction with usual treatment , but was too brief an intervention to result in further improvement after the sessions ended . Patient ratings of treatment satisfaction and helfulness were high for both groups , but they were significantly higher for the comprehensive care group Stabilisation splint therapy has long been thought to be effective for the management of temporom and ibular disorders ( TMD ) . However , the superiority of stabilisation splint therapy compared to other TMD treatments remains controversial . The aim of this study was to determine the efficacy of stabilisation splint therapy combined with non-splint multimodal therapy for TMD . A total of 181 TMD participants were r and omly allocated to a non-splint multimodal therapy ( NS ) group ( n = 85 ) or a non-splint multimodal therapy plus stabilisation splint ( NS+S ) group ( n = 96 ) . Non-splint multimodal therapy included self-exercise of the jaw , cognitive-behavioural therapy , self-management education and additional jaw manipulation . Three outcome measurements were used to assess treatment efficacy : mouth-opening limitation , oro-facial pain and temporom and ibular joint sounds . A two-factor repeated- measures analysis of variance ( anova ) was used to evaluate the efficacy of the two treatment modalities ( NS vs. NS+S ) , and Scheffe 's multiple comparison test was used to compare the treatment periods . Subgroup analyses were performed to disclose the splint effects for each TMD diagnostic group . All three parameters significantly decreased over time in both groups . However , there were no significant differences between the two treatment groups in the total comparison or subgroup analyses ; an exception was the group with degenerative joint disease . No significant difference between the NS and NS+S treatment approaches was revealed in this study . Therefore , we conclude that the additional effects of stabilisation splint are not supported for patients with TMD during the application of multimodal therapy To assess the diagnostic and behavioural overlap of headache patients with temporom and ibular disorders ( TMD ) , individuals recruited from the general population with self-described headaches were compared with non-headache controls . The examination and diagnostic procedures in the Research Diagnostic Criteria ( RDC ) for TMD were applied to both sets of subjects by a blinded examiner . Following their examination , subjects used experience sampling methods to obtain data on pain , tooth contact , masticatory muscle tension , emotional states and stress . Results showed that a significantly higher proportion of the headache patients received an RDC/TMD diagnosis of myofascial pain than non-headache controls . Headache patients also reported significantly more frequent and intense tooth contact , more masticatory muscle tension , more stress and more pain in the face/head and other parts of the body than non-headache controls . These results are similar to those reported for TMD patients and they suggest that headache patients and TMD patients overlap considerably in diagnosis and oral parafunctional behaviours Abstract Although cognitive – behavioral therapies ( CBT ) have been demonstrated to be effective for a variety of chronic pain problems , patients vary in their response and little is known about patient characteristics that predict or moderate treatment effects . Furthermore , although cognitive – behavioral theory posits that changes in patient beliefs and coping mediate the effects of CBT on patient outcomes , little research has systematic ally tested this . Therefore , we examined mediators , moderators , and predictors of treatment effects in a r and omized controlled trial of  CBT for chronic temporom and ibular disorder ( TMD ) pain . Pre‐ to post‐treatment changes in pain beliefs ( control over pain , disability , and pain signals harm ) , catastrophizing , and self‐efficacy for managing pain mediated the effects of CBT  on pain , activity interference , and jaw use limitations at one year . In individual mediator analyses , change in perceived pain control was the mediator that explained the greatest proportion of the total treatment effect on each outcome . Analyzing the mediators as a group , self‐efficacy had unique mediating effects beyond those of control and the other mediators . Patients who reported more pain sites , depressive symptoms , non‐specific physical problems , rumination , catastrophizing , and stress before treatment had higher activity interference at one year . The effects of CBT generally did not vary according to patient baseline characteristics , suggesting that all patients potentially may be helped by this therapy . The results provide further support for cognitive – behavioral models of chronic pain and point to the potential benefits of interventions to modify specific pain‐related beliefs in CBT and in other health care encounters Objectives : Cognitive-behavioral treatment has proven efficacy for chronic temporom and ibular disorder ( TMD ) . However , most patients receive dental treatment that may not address psychological comorbidities often present in TMD . The aim of the present study was to evaluate the efficacy of biofeedback-based cognitive-behavioral treatment ( BFB-CBT ) versus dental treatment with occlusal splint ( OS ) . Moreover , changes in nocturnal masseter muscle activity ( NMMA ) were investigated . Methods : Fifty-eight patients with chronic TMD were r and omly assigned to receive either 8 weekly sessions of BFB-CBT or 8 weeks of OS treatment . Diagnoses were established using Research Diagnostic Criteria for TMD . Pain intensity and disability were defined as primary outcomes . Secondary outcomes included emotional functioning , pain coping , somatoform symptoms , treatment satisfaction , and adverse events . NMMA was assessed during 3 nights pretreatment and posttreatment with portable devices . Follow-up assessment took place 6 months after the treatment . Results : Both treatments result ed in significant reductions in pain intensity and disability , with similar amounts of clinical ly meaningful improvement ( 45 % for BFB-CBT and 48 % for OS ) . Patients receiving BFB-CBT showed significantly larger improvements in pain coping skills . Satisfaction with treatment and ratings of improvement were higher for BFB-CBT . Effects were stable over 6 months , and tended to be larger in the BFB-CBT group for all outcomes . No significant changes were observed in NMMA . Discussion : The fact that BFB-CBT result ed in larger improvements in pain coping skills , and was well accepted by the patients , underlines the importance and feasibility of psychological treatments in the clinical management of TMD & NA ; The purpose of this study was to determine whether a brief ( 6–8 sessions ) cognitive‐behavioral treatment for temporom and ibular dysfunction‐related pain could be efficacious in reducing pain , pain‐related interference with lifestyle and depressive symptoms . The patients were 101 men and women with pain in the area of the temporom and ibular joint of at least 3 months duration , r and omly assigned to either st and ard treatment ( STD ; n = 49 ) or st and ard treatment + cognitive‐behavioral skills training ( STD + CBT ; n = 52 ) . Patients were assessed at posttreatment ( 6 weeks ) , 12 weeks , 24 weeks , 36 weeks , and 52 weeks . Linear mixed model analyses of reported pain indicated that both treatments yielded significant decreases in pain , with the STD + CBT condition result ing in steeper decreases in pain over time compared to the STD condition . Somatization , self‐efficacy and readiness for treatment emerged as significant moderators of outcome , such that those low in somatization , or higher in self‐efficacy or readiness , and treated with STD + CBT reported of lower pain over time . Somatization was also a significant moderator of treatment effects on pain‐related interference with functioning , with those low on somatization reporting of less pain interference over time when treated in the STD + CBT condition . It was concluded that brief treatments can yield significant reductions in pain , life interference and depressive symptoms in TMD sufferers , and that the addition of cognitive‐behavioral coping skills will add to efficacy , especially for those low in somatization , or high in readiness or self‐efficacy ABSTRACT The purpose of this study was to determine whether cognitive – behavioral treatment ( CBT ) operates by effecting changes in cognitions , affects , and coping behaviors in the context of painful episodes . Patients were 54 men and women with temporom and ibular dysfunction‐related orofacial pain ( TMD ) enrolled in a study of brief ( 6 weeks ) st and ard conservative treatment ( STD ) or st and ard treatment plus CBT ( STD + CBT ) . Momentary affects , pain , and coping processes were recorded on a cell phone keypad four times per day for 7 days prior to treatment , and for 14 days after treatment had finished , in an experience sampling paradigm . Analyses indicated no treatment effects on general retrospective measures of pain , depression , or pain‐related interference with lifestyle at post‐treatment . However , mixed model analyses on momentary pain and coping recorded pre‐ and post‐treatment indicated that STD + CBT patients reported greater decreases in pain than did STD patients , significantly greater increases in the use of active cognitive and behavioral coping , and significantly decreased catastrophization . Analyses of experience sampling data indicated that post‐treatment momentary pain was negatively predicted by concurrent active coping , self‐efficacy , perceived control over pain , and positive‐high arousal affect . Concurrent catastrophization was strongly predictive of pain . Active behavioral coping and self‐efficacy reported at the prior time point ( about 3 h previously ) were also protective , while prior catastrophization and negative‐high arousal mood were predictive of momentary pain . The results suggest that CB treatment for TMD pain can help patients alter their coping behaviors , and that these changes translate into improved outcomes ABSTRACT Temporom and ibular disorder ( TMD ) is characterized by a combination of symptoms affecting the temporom and ibular joint and /or chewing muscles . The two most common clinical TMD symptoms are pain and dysfunction . Pain is usually caused by dysfunction , and emergency therapy has focused on controlling it . Recent investigations into TMD have led to the recommendation of antidepressants as a supporting treatment against constant neuralgic pain . The aim of this double-blind study was to verify the efficiency of antidepressants ( amitriptyline ) as a support in the treatment of chronic TMD pain .  Twelve female volunteers presenting chronic TMD pain were divided into two groups and treated for 14 days : Group 1 with 25 mg/day of amitriptyline and Group 2 with a placebo . The intensity of pain and discomfort was evaluated daily , using a visual analog scale ( VAS ) , over a period of seven days preceding the treatment ( baseline ) , during the 14-day treatment , and for seven days after the treatment . The results revealed a significant reduction of pain and discomfort in Group 1 ( 75 % ) compared to Group 2 ( 28 % ) during the three weeks beginning at baseline ( p < 0.01 ) . Amitriptyline proved to be an efficient alternative treatment for chronic pain in TMD patients The objective of this study was to assess variations in the occurrence of temporom and ibular disorders ( TMDs ) and the risk of developing pain and function impairment of the temporom and ibular complex in obstructive sleep apnea syndrome ( OSAS ) patients treated with either an oral appliance ( m and ibular advancement device )  or continuous positive airway pressure ( CPAP )  in a 2-year follow-up study . In addition , we assessed the relationship between the mean m and ibular protrusion and the frequency of wearing the appliance during follow-up with the occurrence of pain and function impairment of the temporom and ibular complex . Fifty-one patients were r and omized to oral appliance therapy and 52 patients to CPAP therapy .  TMDs ( diagnosed according to the Axis I Research Diagnostic Criteria for TMD ) , pain intensity and disability and m and ibular function impairment were recorded at baseline , after 2 months , 1 year and 2 years of therapy . Only in the initial period of treatment the occurrence of pain-related TMDs was considerably higher ( 24 % ) in the oral appliance group compared to CPAP ( 6 % ) . Oral appliance therapy furthermore result ed in more temporom and ibular pain compared to CPAP ( odds ratio 2.33 , 95 % confidence interval ( 1.22–4.43 ) ) . However , there were no limitations in m and ibular function in both groups during the ( entire ) follow-up period . Although generally not serious and of transient nature , oral appliance therapy results in more pain-related TMDs in the initial period of use compared with CPAP therapy . Oral appliance therapy is associated with increased pain in the temporom and ibular complex in the initial period of use . Because of the transient nature , this pain is not a reason to contra-indicate an oral appliance in OSAS patients . Moreover , TMDs and the risk of developing pain and function impairment of the temporom and ibular complex appear limited with long-term oral appliance use The aim of this study was to investigate the frequency of otologic symptoms and their relationship to orofacial signs and symptoms of temporom and ibular disorder ( TMD ) , and the effect of orofacial myofunctional therapy . The study was conducted on eight asymptomatic subjects ( Group C ) and 20 subjects with articular TMD , r and omly distributed over two groups :  one  treated using orofacial myofunctional therapy ( OMT Group ) and a control group with TMD ( Group CTMD ) . Patient selection was based upon the Research Diagnostic Criteria for TMD ( RDC/TMD ) . All subjects su bmi tted to a clinical examination with self-reporting of symptom severity , and to orofacial myofunctional and electromyographic evaluation at diagnosis and again , at the end of the study . Correlations were calculated using the Pearson test and inter- and intragroup comparisons were made ( p < 0.05 ) . In the diagnosis phase , subjects with TMD reported earache ( 65 % ) , tinnitus ( 60 % ) , ear fullness ( 90 % ) , and 25 % of the asymptomatic subjects reported tinnitus . The otologic symptoms were correlated with tenderness to palpation of the temporom and ibular muscles and joints and with orofacial symptoms . Only the OMT group showed a reduction of otologic and orofacial symptoms , of tenderness to palpation and of the asymmetric index between muscles .  OMT may help with muscle coordination and a remission of TMD symptoms
There is insufficient evidence to make firm recommendations for the use of CBT over other intervention for the treatment of TMD .
Cognitive-behavioural therapy ( CBT ) and its effects on  temporom and ibular disorders ( TMD ) have been examined in several studies .
We are trying to combine results of these studies and to explore the effectiveness .