Presented at the 2012 AAPM Annual Meeting « Back

A Cognitive Behavioral Hypnosis Protocol with Demonstrated Efficacy as Part of the Standard Conservative Treatment for Temporomandibular Patients: A Randomized Research with Muscular Diagnosis Patients

Maite Ferrando, PhD, teresa.ferrando@uv.es, University of Valencia, Valencia, Valencia, Spain

Objective: The poster presents a Cognitive Behavioral Treatment including hypnosis and the results of a randomized trial performed with a sample of patients with temporomandibular disorders with muscular diagnosis, under conservative standard treatment. Study Design: Seventy-two patients were assigned to the experimental group (N = 41), receiving a comprehensive program six sessions cognitive-behavioral therapy, and a control group (N = 31). The patients were examined for symptoms and signs of temporomandibular disorders according to the Research Diagnostic Criteria for TMD and both groups received standard treatment for TMD (splint use, jaw exercises, anti-inflammatory medication, and/or muscle relaxants). The assessment included pain variables and psychological distress. The study was approved by the ethical committee of the Faculty of Psychology of the University of Valencia as well as the ethical committee at the Valencia General University Hospital, where it was conducted. Results: There were significant differences (Wilks’ Lambda = 0.60; F=3.69; p<0.001) between both groups, showing the patients assigned to the experimental condition a higher improvement in the variables evaluated. Concretely, 90% of the patients in the experimental group reported a significant improvement (33% reduction) for frequency of pain and 70% reported a clinical improvement in emotional distress. The improvement was stable over time, with no significant differences between post-treatment and at 9 months follow-up. Conclusion: Cognitive-behavioral therapy protocol, including hypnosis techniques, significantly improved the results of the conservative standard treatment applied to TMD patients with muscular diagnosis. References: 1)Nielson WR, Weir R. Biopsychosocial Approaches to the Treatment of Chronic Pain. Clin J Pain 2001;17: S114-S127. 2)Malone MD, Strube JM. Meta-analysis of non-medical treatments for chronic pain. Pain 1988;34:231-244. 3)Dworkin SF, Leresche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6: 302-355. 4)Patterson DR, Jensen MP. Hypnosis and clinical pain. Psychol Bull 2003;129:495-521. 5)Morley G, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behavioural therapy and behaviour for chronic pain in adults excluding headache. Pain 1999; 80:1-13. 6)Dworkin RH, Turk DC, Farrar JT et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005;113:9-19. 7)Dworkin RH, Turk DC, Wyrwich et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain 2008;9:105-121. 8)Aggarwal VR, Tickle M, Javidi H, Peters S. Reviewing the Evidence: Cant Cognitive Behavioural Therapy Improve Outcomes for Patients with Chronic Orofacial Pain? J Orofac Pain 2010;24:167-171. 9)Jensen MP. Hypnosis for chronic pain management: A new hope. Pain 2009;146:235-237.

Funding: The research has been funded by the Spanish Ministry of Science and Technology (SEJ2009-02440) and the Valencian Regional Government of Industry, University and Science (GV06/373).