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Biobehavioral Studies in TMD

PI: Samuel F. Dworkin, D.D.S., Ph.D., Professor, Oral Medicine and Psychiatry and Behavioral Sciences, University of Washington

The long range objective of these studies remains to assess whether complementing biomedical classification and treatment of TMD with classification and treatment protocols derived from a biobehavioral perspective yields enhanced possibilities for effective management of TMD which are inherently safe, reduce pain-related interference and disability, facilitate realistic treatment expectations and result in lower health care use over time.

Two studies are being performed whose overall goal is to assess the usefulness of distinguishing (Study 1) psychosocially non-dysfunctional and (Study 2) dysfunctional chronic TMD pain patients when making treatment decisions for TMD. Dysfunctional chronic pain is defined as chronic-recurrent pain of moderate-severe intensity that limits activities and is often associated with emotional and psychosocial disturbance.

Study 1. Minimal self-care intervention for functional TMD patients. A randomized clinical trial will evaluate whether a minimal treatment condition (n=74) using psycho-educational methods delivered by a registered dental hygienist (RDH) TMD care manager will be as effective as usual treatment (n=74) for psychosocially functional TMD patients. Functional TMD patients are defined as minimally impacted by their TMD condition, reporting low-moderate pain which is not excessively persistent and which is not associated with psychological disturbance, activity limitation or undue reliance on health care.

Study 1 required a 3-session intervention with an RDH in lieu of usual treatment for TMD in the experimental arm of the study while usual TMD treatment comprises the control arm of the study; this portion of the study is complete, 124 subjects were enrolled, 63% of those who were deemed eligible. We have been granted a no-cost grant extension to allow one-year follow-up to continue beyond 4/30/99, which represents the final date of the 05 Year.

Study 2. Cognitive-behavioral treatment (CBT) of dysfunctional chronic TMD pain patients. A randomized clinical trial will evaluate whether a uniquely designed CBT condition (n=77) integrated with usual care is more effective than usual treatment alone (n=77) in ameliorating TMD pain and discomfort during normal jaw use and at rest, as well as ameliorating disability, depression, somatization and excessive use of health care resources.

Study 2 has a more complex design than Study 1, involving psychosocially dysfunctional TMD patients/subjects in a 6-session RCT of comprehensive management program for TMD integrated with usual care and delivered by one of three clinical psychologists. We enrolled 63% of those eligible to participate, n=114 subjects, randomly divided between the experimental and usual treatment arms of the study. As with Study 1, we have been granted a no-cost extension to allow one-year follow-up to continue beyond 4/30/99.

In both studies, intervention and usual treatment groups will be evaluated at baseline and at 6- and 12-month follow-ups to assess differences in grade of dysfunctional pain; clinical diagnosis; jaw disability; coping strategies used; and level of psychosocial functioning.

Follow-up data collection is well underway. Preliminary analyses have been conducted on data for both Studies 1 and 2, see Publications, (IASP) 1999 Abstracts Dworkin and Huggins). Established protocols for data coding, editing and entering, for each of the studies is also well underway.

The 12 month data collection will continue through completion, 6/30/99. Additionally, we will continue data analyses and preparation of manuscripts for publication and presentation.

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