Two studies are proposed whose overall goal is to demonstrate the usefulness of distinguishing (Study 1) psychosocially non-dysfunctional and (Study 2) dysfunctional chronic pain patients when making treatment decisions for TMD. TMD refers to a set of disorders characterized by pain and tenderness in the muscles of mastication and/or the temporomandibularjoint (TMJ), limitations of jaw opening often accompanied by deviations in mandibular path, and clicking, popping or grating TMJ sounds. Dysfunctional chronic pain is defined as chronic-recurrent pain of moderate-severe intensity that limits activities. Dysfunctional chronic pain is associated with emotional disturbance, elevated rates of illness behavior and impaired performance of major social roles. Study 1. Minimal self-care intervention for functional TMD patients. A randomized clinical trial will evaluate whether a minimal treatment condition {{(n=74)}} delivered by a registered dental hygienist TMD Care Manager using self-instructional materials and current concepts and methods for self-care for the management of chronic pain, 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 associated with activity limitation, undue reliance on health care or psychological disturbance. Study 2. Cognitive-behavioral treatment (CBT) of dysfunctional chronic TMD pain patients. A randomized clinical trial will evaluate whether a uniquely designed intensive 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. The CBT intervention coordinates the participation of the treating dentist with a clinical psychologist TMD Pain Management Specialist, and emphasizes a biopsychosocial explanatory model, skills for monitoring signs and symptoms of TMD and for coping with disabling aspects of chronic pain, and patient-managed self-help groups to provide ongoing education, support, and less health care. Studies l and 2 will each evaluate patients at baseline, post- intervention, and 6- and 12-month follow-up using shared measures to assess clinical status, pain and grade of dysfunctional chronic pain, psychosocial functioning and coping strategies for pain and other physical symptoms. Our long range goal is to demonstrate that complementing clinical TMD classification and treatment with biobehavioral classification and treatment yields methods for effective management of TMD which are safe, facilitate realistic expectations and require less health care use over time.
