Brief cognitive-behavioral therapy for temporomandibular disorder pain: Effects on daily electronic outcome and process measures

• Published in: Pain (Amsterdam) Vol. 117; no. 3; pp. 377 - 387
• Main Authors: Turner, Judith A., Mancl, Lloyd, Aaron, Leslie A.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.10.2005; Lippincott Williams & Wilkins, Inc; Elsevier
• Subjects: Activities of Daily Living; Adult; Beliefs; Biological and medical sciences; Case-Control Studies; Chronic pain; Cognitive Behavioral Therapy - methods; Cognitive-behavioral therapy; Coping; Daily electronic diary; Electronic Data Processing - methods; Female; Fundamental and applied biological sciences. Psychology; Humans; Illness and personality; Illness, stress and coping; Interviews as Topic - methods; Male; Middle Aged; Pain - etiology; Pain Management; Pain Measurement - methods; Psychology and medicine; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Randomized controlled trial; Regression Analysis; Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors; Temporomandibular disorders; Temporomandibular Joint Disorders - complications; Temporomandibular Joint Disorders - therapy; Time Factors; TMD; Treatment Outcome; Vertebrates: nervous system and sense organs; Temporomandibular disorders; Beliefs; TMD; Cognitive-behavioral therapy; Daily electronic diary; Coping; Randomized controlled trial; Chronic pain; Cognitive disorder; Catastrophizing; Diseases of the osteoarticular system; Temporomandibular joint dysfunction; Improvement; Pain; Self-management; Maxillary disease; Belief; Human; Cognitive therapy; Stomatology; Attention; Interference; Regression analysis; Care; Mood; Treatment; Arthropathy
• ISSN: 0304-3959; 1872-6623
• DOI: 10.1016/j.pain.2005.06.025

We used patient daily electronic ratings of outcome (activity interference, pain intensity, jaw use limitations, negative mood) and process (pain-related beliefs, catastrophizing, and coping) variables to evaluate a brief cognitive-behavioral (CB) treatment for chronic temporomandibular disorder (TMD) pain. TMD clinic patients ( N=158) were assigned randomly to four biweekly sessions of either CB pain management training (PMT) or an education/attention control condition [self-care management (SCM)] and were asked to complete electronic interviews three times daily for the 8-week treatment. We analyzed diary data from 126 participants who completed >50% of requested interviews for >6 weeks. Multilevel regression analyses indicated no statistically significant difference between the study groups in rate of within-subject change over time on the daily outcome measures, but consistently greater within-subject improvement in the PMT group on the daily process measures. Significantly ( P<0.05) greater proportions of PMT than of SCM patients showed clinically important (>50%) improvement from weeks 1 to 8 in daily activity interference and jaw use limitations. This study is novel in its application of electronic diary methods for assessing outcome and process variables in a chronic pain treatment trial, and supports the feasibility and utility of such methods. The brief CB treatment was efficacious in decreasing catastrophizing and increasing perceived control over pain, and in improving activity interference and jaw use limitations for a subgroup of patients. Longer-term follow-ups are ongoing to determine if there is an impact on outcomes over time.