Comparative effectiveness of traditional Chinese medicine and psychosocial care in the treatment of temporomandibular disorders-associated chronic facial pain.
This dual-site study sought to identify the appropriate role for traditional Chinese medicine (TCM; acupuncture and herbs) in conjunction with a validated psychosocial self-care (SC) intervention for treating chronic temporomandibular disorders (TMD)-associated pain. Participants with Research Diagnostic Criteria for Temporomandibular Disorders-confirmed TMD (n = 168) entered a stepped-care protocol that began with a basic TMD class. At weeks 2 and 10, patients receiving SC whose worst facial pain was above predetermined levels were reallocated by minimization to SC or TCM with experienced practitioners. Characteristic facial pain (CFP: mean of worst pain, average pain when having pain, and current pain; each visual analog scale [VAS] 0-10) was the primary outcome. Social activity interference (VAS 0-10) was a secondary outcome. Patients were monitored for safety. TCM provided significantly greater short-term (8-week) relief than SC (CFP reduction difference, -.60 [standard deviation of the estimate .26], P = .020) and greater reduction in interference with social activities (-.81 [standard deviation of the estimate .33], P = .016). In 2 of 5 treatment trajectory groups, more than two thirds of participants demonstrated clinically meaningful responses (≥30% improvement) in pain interference over 16 weeks. This study provides evidence that TMD patients referred for TCM in a community-based model will receive safe treatment that is likely to provide some short-term pain relief and improved quality of life. Similar designs may also apply to evaluations of other kinds of chronic pain. (ClinicalTrials.gov number NCT00856167).


CONCLUSIONS
This short-term comparative effectiveness study of chronic facial pain suggests that TCM is safe and frequently efficacious alone or subsequent to standard psychosocial interventions. TCM is widely available throughout North America and may provide clinicians and patients with a reasonable addition or alternative to other forms of therapy.
Departments of Family and Community Medicine and Anthropology, University of Arizona, Tucson, AZ, USA. ritenbau@email.arizona.edu
Cheryl
C
Ritenbaugh
Richard
R
Hammerschlag
Samuel F
SF
Dworkin
Mikel G
MG
Aickin
Scott D
SD
Mist
Charles R
CR
Elder
Richard E
RE
Harris
D015670:Acupuncture Therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000209:etiology / Q000523:psychology / Q000628:therapy; D003376:Counseling; D003625:Data Collection; D005157:Facial Pain / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D029001:Herbal Medicine; D006801:Humans; D008019:Life Style; D008297:Male; D008405:Massage; D008516:Medicine, Chinese Traditional; D008875:Middle Aged; D009071:Moxibustion; D044623:Nutrition Therapy; D018579:Patient Selection; D012944:Social Support; D011795:Surveys and Questionnaires; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000150:complications / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult