title: Targeting temporomandibular disorder pain treatment to hormonal fluctuations: a randomized clinical trial.
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 12months 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.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA Department of Dental Public Health Sciences, University of Washington School of Dentistry, Seattle, WA, USA Department of Oral Medicine, University of Washington School of Dentistry, Seattle, WA, USA Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Turner
authors.forename: Lloyd
authors.initials: L
authors.lastname: Mancl
authors.forename: Kimberly Hanson
authors.initials: KH
authors.lastname: Huggins
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sherman
authors.forename: Gretchen
authors.initials: G
authors.lastname: Lentz
authors.forename: Linda
authors.initials: L
authors.lastname: LeResche
mesh_terms: D000328:Adult; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D016503:Drug Delivery Systems / Q000379:methods*; D005260:Female; D006801:Humans; D010146:Pain / Q000097:blood* / Q000188:drug therapy* / Q000523:psychology; D010147:Pain Measurement / Q000187:drug effects* / Q000379:methods / Q000523:psychology; D013705:Temporomandibular Joint Disorders / Q000097:blood* / Q000188:drug therapy* / Q000523:psychology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003278:Contraceptives, Oral, Hormonal