Physical Self-Regulation Training for the Management of Temporomandibular Disorders

Aims: To evaluate the long-term effectiveness of a brief skills training program for the management of chronic facial muscle pain. This program of physical self-regulation (PSR) involved primarily training in breathing, postural relaxation, and proprioceptive re-education. Methods: Physical self-regulation training was presented by a dentist during two 50-minute sessions spaced at 3- week intervals and was compared to a standard dental care (SDC) program that included a flat-plane intraoral appliance and selfcare instructions provided by a dentist. Participants (n = 44) were initially evaluated by a dentist experienced in the diagnosis and management of orofacial pain and were determined to have myofascial pain (Type 1a and 1b diagnoses per the Research Diagnostic Criteria) prior to random assignment to either the PSR or SDC conditions. Posttreatment evaluations 6 weeks and 26 weeks after treatment had begun were conducted by a dentist who was not aware of which treatment the participants received. Results: Initial results indicated that pain severity and life interference from pain were reduced in both groups (P 0.001), while perception of control was increased (P 0.001), as was incisal opening without pain (P 0.05). At the 26-week follow-up, the PSR group reported less pain (P 0.04) and greater incisal opening, both with (P 0.04) and without (P 0.01) pain, than the SDC group. There were also significant decreases (P 0.05) in affective distress, somatization, obsessive-compulsive symptoms, tender point sensitivity, awareness of tooth contact, and sleep dysfunction for both groups over time. Conclusion: The findings support the use of PSR for the short- and long-term management of muscle pain in the facial region. These results are discussed in terms of the potential mechanisms by which self-regulation treatment strategies are effective for the management of these pain disorders. Keywords: pain, myofascial pain, self-regulation, removable orthodontic appliance, relaxation techniques