The primary goal of the proposed project is to test the efficacy of psychological interventions, a pharmacological intervention, and the combination of these interventions in reducing pain and improving function in persons with temporomandibular disorders (TMD). Since psychological interventions are costly and require expertise that is frequently unavailable in primary care settings, the proposed project will also examine the efficacy of a minimal contact/self help psychological intervention based on cognitive-behavioral therapy for pain management. In addition to examining the separate and combined effects of psychological and pharmacological interventions for TMD pain, the proposed study will examine whether the minimal contact cognitive-behavioral intervention can accomplish comparable reductions in pain and improvements in function relative to the therapist-administered treatment. Since patients with TMD pain show high utilization of health care services, this study will examine the cost-effectiveness of psychological and pharmacological treatments. The study will also examine whether individual patient characteristics, such as depression, predict response to treatment and whether treatment gains are maintained at 6-month follow-up. Persons with persistent facial pain due to TMD for 3 months or longer will be enrolled in this randomized controlled study which incorporates a 2 group (nortriptyline vs. active placebo - benztropine) by 3 group (cognitive-behavioral vs. minimal contact CBT vs. education and usual care) design. Following completion of the 8-week active phase of treatment, patients will enter a 6-month maintenance and follow-up period. Outcome measures will assess pain and physical and psychological functioning. Findings derived from this project will lead to further studies that determine which treatments, or combinations of treatments are effective for which subgroups of patients with TMD. Evaluation of a treatment approach combining commonly used psychological and pharmacological approaches promises to promote the development of truly effective pain management programs, contribute to the management of these individuals, and improve the quality of their lives.
|Edwards, Robert R; Haythornthwaite, Jennifer A; Sullivan, Michael J et al. (2004) Catastrophizing as a mediator of sex differences in pain: differential effects for daily pain versus laboratory-induced pain. Pain 111:335-41|