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Targeting temporomandibular disorder pain treatment to hormonal fluctuations: A randomized clinical trial

Turner, Judith A.a,b,*; Mancl, Lloydc; Huggins, Kimberly Hansond; Sherman, Jeffrey J.b; Lentz, Gretchene; LeResche, Lindad

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doi: 10.1016/j.pain.2011.05.005
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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.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

aDepartment of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA

bDepartment of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA

cDepartment of Dental Public Health Sciences, University of Washington School of Dentistry, Seattle, WA, USA

dDepartment of Oral Medicine, University of Washington School of Dentistry, Seattle, WA, USA

eDepartment of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA

*Corresponding author at: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA 98195, USA. Tel.: +1 206 543 3997; fax: +1 206 685 1139.

E-mail address:jturner@u.washington.edu

Article history: Received 31 March 2011; Received in revised form 5 May 2011; Accepted 10 May 2011.

© 2011 Lippincott Williams & Wilkins, Inc.
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