Cognitivebehavioral therapy for temporomandibular disorder complicated by chronic pain: challenges, prospects and limitations

To determine the conditions of cognitive-behavioral therapy (CBT) of temporomandibular disorders (TMD), complicated by chronic pain, execution the randomized controlled analysis of 61 clinical cases has been carried out. Research methods. RTMD research diagnostic criteria - axis II (Dworkin S.F., LeResche L., 1992). Tendon-muscle trigger points have been identified using the Travell J.G. and Simons D.G. (1989) method. Local convulsive response and pain reproducibility have been determined in points according to Klineberg I., Jagger R. (2006). Clinical diagnosis of psychological phenomena and communicative deviations according to Rogers C.R. (2002). On the background of psychological phenomena and communicative deviancy the patients have been divided into group A and B. From this patients using random sampling technique two therapeutic groups of patients have been formed (control group - 20 patients; test group - 41 patients). The inclusion criterion - patients with musculoskeletal pain; the exclusion criteria - patients with chronic pain of cancer etiology. Therapy with the use of occlusal splints, non-steroidal anti-inflammatory drugs, physiotherapy (magnet-laser) have been prescribed in the control group. The test group has been divided into two subgroups. In the subgroup 1 and 2, in addition to the Protocol of the control group, a course of combined individualized pathogenetic pharmacotherapy has been carried out. In the subgroup 2 the CBT has been prescribed. Results. Psychosocial factors - etiological and pathogenetic basis of TMD chronization and pain syndrome development. In the test group in 93% of clinical cases the stable remission has been observed. In the control group, remission has been observed in 35% of cases in patients from group A. All adverse outcomes in control and test groups was observed in patients from group B. Conclusions. The indication for CBT carrying out are communicative deviations and phenomenological dysfunction, pain syndrome, with a therapy planning horizon for at least two years. The inclusion of a CBT course in the therapeutic protocol permit significantly extend the remission period change the psychological attitudes of the patient from expectation of recurrence or adverse outcome to self-detection and fixation ofpositive functional achievements.

temporomandibular joint, temporomandibular disorders, cognitive behavioral therapy, chronic pain