Kimberly Hanson Huggins

The roles of beliefs, catastrophizing, and coping in the functioning of patients with temporomandibular disorders

&NA; Pain‐related beliefs, catastrophizing, and coping have been shown to be associated with measures of physical and psychosocial functioning among patients with chronic musculoskeletal and rheumatologic pain. However, little is known about the relative importance of these process variables in the functioning of patients with temporomandibular disorders (TMD). To address this gap in the literature, self‐report measures of pain, beliefs, catastrophizing, coping, pain‐related activity interference, jaw activity limitations, and depression, as well as an objective measure of jaw opening impairment, were obtained from 118 patients at a TMD specialty clinic. Controlling for age, gender, and pain intensity, significant associations were found between (1) pain beliefs and activity interference, depression, and non‐masticatory jaw activity limitations, (2) catastrophizing and activity interference, depression, and non‐masticatory jaw activity limitations, and (3) coping and activity interference and depression. Controlling for age, gender, pain intensity, and the other process variables, significant associations were found between (1) beliefs and activity interference and depression, and (2) catastrophizing and depression. No process variable was associated significantly with the objective measure of jaw impairment. The results suggest that for patients with moderate or high levels of TMD pain and dysfunction, beliefs about pain play an important role in physical and psychosocial functioning.

Brief group cognitive-behavioral intervention for temporomandibular disorders

&NA; Temporomandibular disorders (TMD) are currently viewed as an interrelated set of clinical conditions presenting with signs and symptoms in masticatory and related muscles of the head and neck, and the soft tissue and bony components of the temporomandibular joint. Epidemiologie and clinical studies of TMD confirm its status as a chronic pain problem. In this report we present results from a randomized clinical trial which compared, at 3‐ and 12‐month follow‐ups, the effects of usual TMD treatment on TMD pain and related physical and psychological variables with the effects of a cognitive‐behavioral (CB) intervention delivered to small groups of patients before usual TMD treatment began. The purpose of this study was to determine whether a minimal CB intervention followed by dental TMD treatment enhanced the effects of usual clinical dental treatment. A second purpose of the study was to determine whether patients classified as high in somatization and psychosocial dysfunction would respond less favorably to this minimal intervention than would those low in somatization and dysfunction. Patients who participated in the CB intervention followed by usual treatment showed greater long‐term decreases in reported pain level and pain interference in daily activities than did patients who received only usual treatment. The benefits of CB intervention were not seen when the CB and UT groups were compared at 3‐month follow‐up. During the 3–12‐month follow‐up interval, however, the UT group maintained essentially the same level of improvement in characteristic pain while the CB group continued to improve, as hypothesized. During this same follow‐up interval, the CB group also showed a strong trend toward continued improvement in pain interference. Such effects were not observed for depression, somatization, or clinical measures of jaw range of motion. Additionally, as hypothesized, dysfunctional chronic pain patients did not appear to benefit from the brief CB intervention. Intent to treat analyses were also performed to assess generalizability of the results.

The relationship of somatization and depression to experimental pain response in women with temporomandibular disorders

Objective: Patients with temporomandibular pain disorders (TMD) have greater experimental pain perception when compared with pain-free controls. Common psychological features of TMD include somatization and depression. The impact of depression on experimental pain perception has received considerable attention. However, the role of somatization on experimental pain in a chronic pain population has not been explored. Methods: Fifty-six women with TMD and 59 pain-free controls underwent three experimental pain procedures, including palpation at fixed amounts of pressure, pressure pain thresholds, and an ischemic pain task. Levels of depression and somatization were assessed using the Research Diagnostic Criteria for TMD. Multiple regression analyses were performed to determine the extent to which depression and somatization were associated with experimental pain response. Results: After controlling for characteristic pain intensity and depression, somatization explained a significant proportion of variance in numbers of masticatory sites rated as painful (R2 change = 6.7%, p = .046) with the full model explaining 16.4% of the variance (p = .024). This did not meet an adjusted level of statistical significance (p = .008). After controlling for characteristic pain, only depression added significantly to the model predicting ischemic pain threshold and tolerance. The full models including characteristic pain and depression explained 49% and 20% of the variance in ischemic pain threshold and tolerance, respectively. Conclusions: These findings suggest that depression and somatization are associated with different measures of experimental pain. Somatization may be related to more attentional and perceptual measures of clinically relevant pain while depression may be related to more behavioral measures of pain. TMD = temporomandibular disorders; TMJ = temporomandibular joint; RDC = research diagnostic criteria; MTPS = Manual Tender Point Survey; CPI = characteristic pain intensity; IPT = ischemic pain threshold; IPTol = ischemic pain tolerance; IPS = ischemic pain sensitivity; PPT = pressure pain threshold; Kpa/s = kilo-Pascals per second.

Targeting Temporomandibular Disorder Pain Treatment to Hormonal Fluctuations: A Randomized Clinical Trial

Summary Dental hygienist‐delivered pain self‐management training was superior to continuous oral contraceptive therapy for women with TMD pain; focusing on menstrually‐related changes in symptoms did not increase its efficacy. ABSTRACT Mounting evidence supports the importance of hormonal fluctuations in temporomandibular disorder (TMD) pain among women. Stabilizing influential hormones or having a plan and skills for coping with hormonally related increases in TMD pain, therefore, may be beneficial for women with TMD pain. This randomized clinical trial evaluated the short‐ and long‐term efficacy of 3 interventions for women with TMD pain: (1) dental hygienist‐delivered pain self‐management training (SMT; n = 59); (2) the same dental hygienist‐delivered pain self‐management training, but with a focus on menstrual cycle‐related changes in pain and other symptoms (targeted SMT, or TSMT; n = 55); and (3) continuous oral contraceptive therapy (6‐month trial) aimed at stabilizing hormones believed to be influential in TMD pain (COCT; n = 57). Study participants completed outcome (pain, activity interference, depression) and process (pain beliefs, catastrophizing, coping effectiveness) measures before randomization, and 6 and 12 months later. Intent‐to‐treat analyses supported the benefits of the SMT and TSMT interventions relative to COCT. Targeting the self‐management treatment to menstrual cycle‐related symptoms did not increase the treatment’s efficacy. The benefits of the self‐management interventions relative to COCT for pain and activity interference were statistically significant at 12 months, but not at 6 months, whereas the benefits for the process measures generally were apparent at both time points. COCT was associated with multiple adverse events (none serious). The study provides further support for long‐term benefits of a safe, low‐intensity (2 in‐person sessions and 6 brief telephone contacts), dental hygienist‐delivered self‐management treatment for TMD pain.

Generalized Joint Hypermobility (GJH) may be a Risk Factor for Temporomandibular Disorders (TMD)

PURPOSE/QUESTION The objective of this study was to determine whether generalized joint hypermobility is a risk factor for temporomandibular disorders as defined by the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). SOURCE OF FUNDING This study was supported by the Public Health Research Association, Saxony, Germany. TYPE OF STUDY/DESIGN Population-based cross-sectional cohort study LEVEL OF EVIDENCE Level 2: Limited-quality, patent-oriented evidence. STRENGTH OF RECOMMENDATION GRADE Not applicable.