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Randomized Controlled Trial
. 2011 Sep;152(9):2074-2084.
doi: 10.1016/j.pain.2011.05.005. Epub 2011 Jun 15.

Targeting temporomandibular disorder pain treatment to hormonal fluctuations: a randomized clinical trial

Judith A Turner  1 , Lloyd Mancl, Kimberly Hanson Huggins, Jeffrey J Sherman, Gretchen Lentz, Linda LeResche
Affiliations
Randomized Controlled Trial

Targeting temporomandibular disorder pain treatment to hormonal fluctuations: a randomized clinical trial

Judith A Turner et al. Pain. 2011 Sep.

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.

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Conflict of interest statement

Conflict of interest statement

None of the authors have any financial or other relationships that might lead to a conflict of interest.

Figures

Fig. 1
Fig. 1
Participant flow through the study COCT, Continuous Oral Contraceptive Therapy; SMT, Self-Management Training; TSMT, Targeted Self-Management Training a 1 participant was unable to follow study protocol b 1 participant moved out of state; 1 was discovered to be ineligible (due to psychiatric problems) after randomization c 1 participant moved out of the country, 1 was found to be ineligible after randomization, 15 were ineligible upon medical evaluation after randomization due to medical contra-indications to COCT d Follow-up completion rates based on number of participants randomized and not withdrawn e Excluded from analysis due to no post-treatment or 12-month data, although included in the multiple imputation analyses
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