Dworkin Samuel F, Turner Judith A, Wilson Leanne, Massoth Donna, Whitney Coralyn, Huggins Kimberly H, Burgess Jeffrey, Sommers Earl, Truelove Edmond
Departments of Oral Medicine (SC-63), School of Medicine, University of Washington, Seattle, WA 98195 USA Departments of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA 98195 USA Departments of Dental Public Health Sciences, School of Medicine, University of Washington, Seattle, WA 98195 USA Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195 USA.
Pain. 1994 Nov;59(2):175-187. doi: 10.1016/0304-3959(94)90070-1.
Temporomandibular disorders (TMD) are currently viewed as an interrelated set of clinical conditions presenting with signs and symptoms in masticatory and related muscles of the head and neck, and the soft tissue and bony components of the temporomandibular joint. Epidemiologic and clinical studies of TMD confirm its status as a chronic pain problem. In this report we present results from a randomized clinical trial which compared, at 3- and 12-month follow-ups, the effects of usual TMD treatment on TMD pain and related physical and psychological variables with the effects of a cognitive-behavioral (CB) intervention delivered to small groups of patients before usual TMD treatment began. The purpose of this study was to determine whether a minimal CB intervention followed by dental TMD treatment enhanced the effects of usual clinical dental treatment. A second purpose of the study was to determine whether patients classified as high in somatization and psychosocial dysfunction would respond less favorably to this minimal intervention than would those low in somatization and dysfunction. Patients who participated in the CB intervention followed by usual treatment showed greater long-term decreases in reported pain level and pain interference in daily activities than did patients who received only usual treatment. The benefits of CB intervention were not seen when the CB and UT groups were compared at 3-month follow-up. During the 3-12-month follow-up interval, however, the UT group maintained essentially the same level of improvement in characteristic pain while the CB group continued to improve, as hypothesized. During this same follow-up interval, the CB group also showed a strong trend toward continued improvement in pain interference. Such effects were not observed for depression, somatization, or clinical measures of jaw range of motion. Additionally, as hypothesized, dysfunctional chronic pain patients did not appear to benefit from the brief CB intervention. Intent to treat analyses were also performed to assess generalizability of the results.
颞下颌关节紊乱病（TMD）目前被视为一组相互关联的临床病症，其症状体征表现在头颈部咀嚼肌及相关肌肉，以及颞下颌关节的软组织和骨组织。TMD的流行病学和临床研究证实了其作为慢性疼痛问题的地位。在本报告中，我们呈现了一项随机临床试验的结果，该试验在3个月和12个月随访时，比较了常规TMD治疗对TMD疼痛及相关生理和心理变量的影响，以及在常规TMD治疗开始前对一小群患者进行认知行为（CB）干预的效果。本研究的目的是确定在牙科TMD治疗前进行最小化的CB干预是否能增强常规临床牙科治疗的效果。该研究的第二个目的是确定那些被归类为躯体化和心理社会功能障碍程度高的患者对这种最小化干预的反应是否不如那些躯体化和功能障碍程度低的患者。与仅接受常规治疗的患者相比，先接受CB干预然后接受常规治疗的患者在报告的疼痛水平和日常活动中的疼痛干扰方面表现出更大的长期下降。在3个月随访时比较CB组和常规治疗（UT）组时，未发现CB干预的益处。然而，在3至12个月的随访期间，正如所假设的，UT组在特征性疼痛方面基本保持相同的改善水平，而CB组则持续改善。在同一随访期间，CB组在疼痛干扰方面也呈现出持续改善的强烈趋势。在抑郁、躯体化或下颌运动范围的临床测量方面未观察到此类效果。此外，正如所假设的，功能失调性慢性疼痛患者似乎未从简短的CB干预中获益。还进行了意向性分析以评估结果的普遍性。
