The specific aims of the present proposal are to: (a) provide data on the electromyographic (EMG) levels of specific muscle groups in subjects with distinct patterns of facial pain and/or mandibular dysfunction; (b) determine if elevated EMG levels of these muscles are associated with a facial pain state; (c) determine if there are any differences among groups of subjects who exhibit specific patterns of mandibular dysfunction and/or facial pain in relation to measures of anxiety, depression, assertiveness, life stressors, or oral habits; (d) determine the differential effectiveness of EMG biofeedback and relaxation training on reducing subjective ratings of facial pain and objective dental ratings of mandibular dysfunction and muscle tenderness; and (e) determine if EMG levels of activity or the presence of TMJ sounds are factors related to the differential effectiveness of EMG biofeedback and relaxation training. Study 1 will involve assessment of four groups, each with 20 female subjects, with specific symptom patterns involving temporomandibular joint pain (TMJ pain) and/or TMJ sounds of popping or clicking (TMJ sound). The four groups are as follows: TMJ pain and TMJ sound; TMJ pain and non-TMJ sound; non-TMJ pain and TMJ sound; and non-TMJ pain and non-TMJ sound. Bilateral EMG recordings will be monitored in a standardized laboratory session. The TMJ pain subjects will be assessed both in a pain and non-pain state, with the assessment sequence counter-balanced across subjects. Study 2 will involve 100 females reporting problems with facial pain. After subjects are matched on masseter EMG levels and the presence of TMJ sounds, 20 subjects will be assigned randomly to one of five experimental conditions: (a) masseter EMG biofeedback, (b) frontalis EMG biofeedback, (c) progressive relaxation training, (d) progressive relaxation training and masseter EMG biofeedback, or (e) waiting list control. The dependent measures assessed in the second study will include: subjective ratings of pain and medication intake; EMG recordings; a dental evaluation; and life stress measures. Data will be collected four weeks pre-/post-treatment and at three and six months follow-up. Treatment will be conducted twice weekly over a seven-week period.
