Differential treatment responses of TMD patients as a function of psychological characteristics

A number of studies have reported that psychological factors play a significant role in TMD. Several studies have identified subgroups of patients based on their responses to psychological assessments; however, none of these studies have reported on the clinical utility of classifications of TMD patients on these various measures. In this study, the differential response of 133 TMD patients classified within 3 psychosocial-behaviorally based subgroups to a conservative, standardized treatment was examined. The treatment consisted of the combination of an intra-oral appliance, biofeedback, and stress management. Follow-up assessments were conducted 6 months after treatment termination. The results demonstrated that overall as a group patients significantly improved and maintained improvements on physical, psychosocial, and behavioral measures (P < 0.0001). Comparisons across patient subgroups, however, revealed differential patterns of improvement on the outcome measures. Most notably, reliable change indices demonstrated that the patients classified into a subgroup characterized by the greatest degree of psychological distress (Dysfunctional) demonstrated significantly greater improvements on measures of pain intensity (P < 0.001), perceived impact of TMD symptoms on their lives (P < 0.001), depression (P < 0.01), and negative thoughts (P < 0.001), compared with groups characterized by greater interpersonal problems (Interpersonally Distressed) and those patients who appeared to be the least disabled by TMD (Adaptive Copers). These data provide support for the clinical utility of a psychosocial-behavioral classification system and suggest that in future research individualizing treatments and outcome measures based on patient characteristics may improve treatment efficacy and outcome evaluation.