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J Am Dent Assoc, Vol 137, No 3, 339-347. © 2006 American Dental Association

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JADA Continuing Education

A one-year outcome study

Background. The authors conducted a randomized clinical trial to evaluate the efficacy of a biopsychosocial intervention for patients who were at high risk (HR) of progressing from acute to chronic temporomandibular disorder (TMD)–related pain.

Methods. The authors classified subjects’ risk using a predictive algorithm and randomized them into an early-intervention (EI) or a nonintervention (NI) group. The EI included cognitive behavioral skills training and biofeedback. The authors assessed pain and psychosocial measures at intake and at a one-year follow-up. Subjects’ self-reported pain levels were measured on an analog scale and as a response to palpation.

Results. At one year, EI-group subjects had significantly lower levels of self-reported pain and depression. At one year, more NI-group subjects than EI-group subjects had utilized health care for jaw-related pain. NI-group subjects were 12.5 times as likely to have a somatoform disorder, more than seven times as likely to have an anxiety disorder, and 2.7 times more likely to have an affective disorder at one year, compared with EI-group subjects.

Conclusions. EI-group subjects had reduced pain levels, improved coping abilities and reduced emotional distress at one year.

Clinical Implications. The TMD-related pain experience is complex and requires early identification with a biopsychosocial EI to achieve maximal, sustainable results.

Key Words: Biopsychosocial; temporomandibular disorder; pain; early intervention

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