Turner J A, Whitney C, Dworkin S F, Massoth D, Wilson L
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195, USA.
Clin J Pain. 1995 Sep;11(3):177-88. doi: 10.1097/00002508-199509000-00004.
This study examined the applicability of the cognitive-behavioral model for temporomandibular disorders (TMD) by determining whether changes in TMD patient pain-related beliefs and coping over the course of treatment related to improvement in symptoms and disability and whether patients' posttreatment beliefs and coping predicted future pain and functioning.
PATIENTS/SETTING: We studied 139 TMD patients at a health maintenance organization or a university dental school who completed a clinical trial comparing usual treatment with or without a brief cognitive-behavioral intervention. OUTCOME MEASURES/DESIGN: Pain, disability, depression, objective physical impairment, and pain beliefs and coping strategies were assessed pretreatment and at 3- and 12-month follow-ups.
Increased ability to control pain and decreased Disease Conviction and Passive Coping scores were associated with improved pain, jaw opening, and depression from pretreatment to 3-month follow-up. Patient beliefs and coping at 3-month follow-up did not contribute much to the prediction of pain or physical and psychological functioning at 12-month follow-up after controlling for 3-month pain and functioning scores. However, passive coping and low ability to control pain at 3 months predicted greater activity interference at 12 months.
Pretreatment to 3-month follow-up changes in beliefs and coping are associated modestly with TMD patient improvement after conservative dental treatment with and without a brief cognitive-behavioral intervention. Research is needed to develop interventions that produce greater decreases in disease conviction, passive coping, and perceived inability to control pain and to determine whether these changes mediate symptom and disability improvement.
本研究通过确定颞下颌关节紊乱病（TMD）患者在治疗过程中与疼痛相关的信念和应对方式的变化是否与症状和功能障碍的改善相关，以及患者治疗后的信念和应对方式是否能预测未来的疼痛和功能，来检验认知行为模型对TMD的适用性。
患者/研究背景：我们在一家健康维护组织或一所大学牙科学院对139名TMD患者进行了研究，这些患者完成了一项临床试验，比较了常规治疗与接受或不接受简短认知行为干预的情况。
结果测量/设计：在治疗前以及3个月和12个月随访时评估疼痛、功能障碍、抑郁、客观身体损伤以及疼痛信念和应对策略。
从治疗前到3个月随访，控制疼痛能力的提高以及疾病确信度和被动应对得分的降低与疼痛、张口度和抑郁的改善相关。在控制了3个月时的疼痛和功能得分后，3个月随访时患者的信念和应对方式对预测12个月时的疼痛或身体及心理功能作用不大。然而，3个月时的被动应对和控制疼痛能力低预示着12个月时活动干扰更大。
无论有无简短认知行为干预，在保守牙科治疗后，从治疗前到3个月随访期间信念和应对方式的变化与TMD患者的改善有一定关联。需要开展研究以开发能更大程度降低疾病确信度、被动应对和感知到的无法控制疼痛的干预措施，并确定这些变化是否介导了症状和功能障碍的改善。
