Effectiveness of cognitive-behavioral therapy and amitriptyline in patients with chronic temporomandibular disorders: a pilot study

Abstract

The aim of this pilot study was to evaluate the effectiveness of cognitive-behavioral therapy (CBT) and use of amitriptyline, a tricyclic antidepressant, in patients with chronic temporomandibular disorders (TMD). Forty-seven women (mean age = 35.4 years old) with chronic TMD were enrolled in the study and divided into 4 groups: amitriptyline; amitriptyline and CBT; placebo and CBT; and placebo only (control). Patients were managed for 7 consecutive weeks. Follow-up evaluations were done at the 1st, 7th and 11th weeks of treatment. The presence and severity of pain, levels of depression, and quality of life and sleep were measured. Data were analyzed using ANOVA, Chi-square and Cochran tests, considering a significance level of 5%. Improvements were found for all factors considered in the intragroup analysis, although no significant differences were detected among groups. However, at the end of the treatment (11 weeks of follow-up), these positive outcomes persisted only for the women treated with amitriptyline and CBT. The obtained results suggest that the combination of amitriptyline and CBT may be effective in reducing pain and depression levels as well as in improving the quality of life and sleep in patients with chronic TMD.

Integração da Psicologia e Odontologia na DTM: revisão sistematizada

“…O tratamento cognitivo comportamental tem eficácia comprovada na DTM 14 . No entanto, a maioria dos pacientes recebe apenas o tratamento dentário sem abarcar as demandas psicológicas muitas vezes presentes nesta disfunção.…”

“…Resultados favoráveis também foram encontrados com a TCC associada ao tratamento convencional de DTM e associação à terapia com Amitriptilina 11,14,15,22 . Dentre os benefícios foi descrito auxilio tanto no tratamento da dor quanto no enfrentamento da dor na íntegra, demonstrandose a necessidade da inclusão do tratamento psicológico dentro da clínica de DTM 15,22 .…”

Group cognitive-behavioral therapy for chronic pain adults: review of Brazilian trials

“…Psychological treatment is often integrated to multi-and interdisciplinary programs which gather the action of different health professionals, among them: physiotherapists, occupational therapists, physicians and others 5 . With regard to intervention programs objectives, it was observed that, among selected studies, two have evaluated the efficacy of sequentially applied GCBT and physiotherapy 20,21 ; one has evaluated the effect of a single intervention by physician, occupational therapist, physiotherapist, psychologist and social worker, where some GCBT techniques were inserted 22 ; one has compared the effects of pharmacological treatment versus GCBT 23 ; and two have evaluated the effect of GCBT alone. Table 1 shows major data characterizing studies, especially with regard to evaluation, intervention and results.…”

Estudo do efeito analgésico do laser de baixa potência na mialgia dos músculos mastigatórios: estudo clínico randomizado duplo-cego

“…Por isso,um aspecto a ser considerado na resposta ao tratamento é o efeito placebo, que é definido como mudanças psicológicas e fisiológicas positivas associadas com a administracao de substâncias inertes ou procedimentos (Calderon et al, 2011).…”

“…O uso do placebo em estudos controlados é sugerido como a mais apropriada forma de comprovar ou contestar uma modalidade de tratamento, especialmente em casos de entidades multifatoriais, quando não há método universal disponível (Calderon et al, 2011).…”