Traumatic onset of temporomandibular disorders: Positive effects of a standardized conservative treatment program

Objective: To compare presenting problems and response to treatment of chronic temporomandibular (TMD) patients who perceive the onset of their symptoms to be related to trauma with those who report symptoms of unknown origin. Design: Prospective treatment outcome study. Setting: Outpatient multidisciplinary pain treatment center at a university medical center. Patients: A total of 361 were evaluated initially, including 103 who perceived traumatic onset of symptoms and 258 who did not perceive onset to be related to trauma. Two hundred thirty-three (59 trauma and 174 nontrauma) returned for follow-up evaluation 6 months after the conclusion of treatment. Interventions: Standardized six-session treatment program consisting of intraoral appliance, biofeedback, and stress management training. Outcome Measures: Clinical changes in muscle pain, temporomandibular joint pain, and mandibular opening. Self-report of change in perceived pain severity (MPQ-short form), depressive symptoms (BDI), catastrophizing about pain (CSQ-catastrophizing scale), MPI-interference scale, oral parafunctional habits, global evaluation of improvement, and use of pain medications at follow-up. Results and Conclusions: Regression of onset type on pretreatment variables indicated that a small but statistically significant proportion of pretreatment variability (8.7%) could be accounted for by onset. Both traumatic and nontraumatic onset groups showed positive outcomes following treatment. No significant differences between groups were found for any of the clinical or self-reported outcome measures with the exception that a significantly higher percentage of the trauma group reported using pain medication at follow-up. These findings are in contrast with previous suggestions that post-traumatic TMD patients show poorer response to treatment than nontrauma TMD patients.