Integrating multimodal behavioral therapy into temporomandibular disorders management: A randomized attention-controlled trial using DC/TMD axis II outcomes.

BACKGROUND Temporomandibular disorders (TMD) involve physical symptoms like pain and jaw dysfunction, and psychosocial factors including anxiety and depression, evaluated using Axis II of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). This study assessed a structured, multicomponent behavioral therapy program-integrating pain neuroscience education, cognitive-behavioral therapy (CBT), relaxation techniques, and electromyographic biofeedback-as an adjunct to standard TMD care.

METHODS In a randomized controlled trial, 120 TMD patients (ages 18-65) diagnosed via DC/TMD were assigned either to an 8-week behavioral therapy program (n = 60) or standard care with analgesics and physical therapy (n = 60). Outcomes measured at baseline, post-treatment (8 weeks), and 6-month follow-up included pain intensity (Visual Analog Scale, VAS; primary), jaw function (maximum mouth opening, MMO, and Jaw Functional Limitation Scale-20, JFLS-20), pain-related disability and characteristic pain intensity (Graded Chronic Pain Scale, GCPS), psychological distress (Generalized Anxiety Disorder-7 [GAD-7] and Patient Health Questionnaire-9 [PHQ-9]), and pain catastrophizing (Pain Catastrophizing Scale, PCS). Intervention reporting follows the TIDieR guideline.

RESULTS Behavioral therapy participants showed greater reductions in pain intensity (VAS mean difference 1.8 points at 8 weeks [Cohen's d = 1.2] and 2.5 points at 6 months [Cohen's d = 1.4]), improved jaw function (MMO mean difference 6.6 mm at 8 weeks and 7.3 mm at 6 months; Cohen's d ≈ 0.92-1.12), and reduced anxiety (GAD-7) and depression (PHQ-9) (Cohen's d ≈ 0.62-0.65). Improvements were sustained at 6 months across all outcomes.

CONCLUSION Behavioral therapy may enhance outcomes in TMD management when added to standard care, supporting further exploration of multidisciplinary approaches.