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.