Predicting response to treatment for temporomandibular disorders

This study examined whether pretreatment psychological characteristics of temporomandibular disorder (TMD) patients were related to the response to treatment in a TMD and facial pain clinic. The care provided to patients was either an evaluation only or an evaluation followed by a course of physical medicine/dental procedures (occlusal appliances, physical therapy, anti-inflammatory medications). Outcomes were assessed in terms of pain levels, jaw function difficulties, and satisfaction with care at 6 months posttreatment by phone and 16 months posttreatment by mail. There were no pretreatment differences between treated and evaluated patients except for higher pretreatment jaw function difficulty scores in the evaluated only patients. Factor analysis of pretreatment scores revealed distrust, pain, anxiety, and somatization. Somatization predicted follow-up pain levels at both follow-ups in the treated patients but only at the 16-month follow-up in the evaluated only patients. Pretreatment pain levels predicted posttreatment pain in both groups only at the 6-month follow-up. Posttreatment jaw function difficulties were related inconsistently to the pretreatment dimensions, while satisfaction was not predicted by pretreatment scores except for a possible connection between this outcome and distrust. It is concluded that an overconcern about bodily functioning appears to decrease the likelihood that patients obtain pain relief from physical medicine care.