The purpose of the present study was to determine if we could identify a specific subtype of temporomandibular disorder (TMD) pain patients that does not respond to treatment. Patients were 101 men and women with chronic TMD pain recruited from the community and randomly assigned to one of two treatment conditions: a standard conservative care (STD) condition or a standard care plus cognitive-behavioral treatment condition (STD+CBT) in which patients received all elements of STD, but also received cognitive-behavioral coping skills training. Growth mixture modeling, incorporating a series of treatment-related predictors, was used to distinguish several distinct classes of responders or non-responders to treatment based on reported pain over a one-year follow-up period. Results indicated that treatment non-responders accounted for 16% of the sample, and did not differ from treatment responders on demographics or temporomandibular joint pathology, but that they reported more psychiatric symptoms, poorer coping, and higher levels of catastrophizing. Treatment-related predictors of membership in treatment responder groups versus the non-responder group included the addition of CBT to standard treatment, treatment attendance, and decreasing catastrophization. It was concluded that CBT may be made more efficacious for TMD patients by placing further emphasis on decreasing catastrophization and on individualizing care.
Background: Due to the variety of factors involved in TMDs it is not surprising to see a wide range of treatment modalities being suggested for TMD patients. However, one determinant of treatment for TMD that is often overlooked is the practitioner's knowledge and beliefs about the syndrome itself. Objectives: To evaluate changes in experts' knowledge and beliefs regarding Temporomandibular Disorders (TMD) since the administration of the first such survey by Le Resche, Truelove and Dworkin in 1993. Patients and Methods: A survey invitation was emailed to 62 dentists and 19 psychologists, all determined to be experts in the orofacial pain/TMD field. All dentists selected to be part of this survey were members of the American Academy of Orofacial Pain. Psychologists were selected based on their publications in this field. The Le Resche et al. questionnaire was used with the following adaptations: four new statements were inserted; one statement was removed; and a 6-point Likert agreement scale for each statement was used instead of the original 11-point scale. Reminder emails were sent at one week and one month to maximize the response rate. Changes in responses to each item from the original survey were assessed using z-test. Results: Thirty-four dentists but only three psychologists responded to the survey. Therefore only responses from dentists were used in the analysis. Overall there was a high level of agreement between the original sample and the current sample. Of the 34 original items there was very clear consensus on 24. There was consensus on two new items in the survey on the need for a tomogram and splint therapy. Conclusions: Twenty years after the original survey, the knowledge and beliefs regarding TMDs among experts in this field have not changed significantly.
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