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Comparative Effectiveness of Traditional Chinese Medicine and Psychosocial Care in the Treatment of Temporomandibular Disorders–Associated Chronic Facial Pain

Published:October 10, 2012DOI:https://doi.org/10.1016/j.jpain.2012.08.002

      Abstract

      This dual-site study sought to identify the appropriate role for traditional Chinese medicine (TCM; acupuncture and herbs) in conjunction with a validated psychosocial self-care (SC) intervention for treating chronic temporomandibular disorders (TMD)-associated pain. Participants with Research Diagnostic Criteria for Temporomandibular Disorders–confirmed TMD (n = 168) entered a stepped-care protocol that began with a basic TMD class. At weeks 2 and 10, patients receiving SC whose worst facial pain was above predetermined levels were reallocated by minimization to SC or TCM with experienced practitioners. Characteristic facial pain (CFP: mean of worst pain, average pain when having pain, and current pain; each visual analog scale [VAS] 0–10) was the primary outcome. Social activity interference (VAS 0–10) was a secondary outcome. Patients were monitored for safety. TCM provided significantly greater short-term (8-week) relief than SC (CFP reduction difference, −.60 [standard deviation of the estimate .26], P = .020) and greater reduction in interference with social activities (−.81 [standard deviation of the estimate .33], P = .016). In 2 of 5 treatment trajectory groups, more than two thirds of participants demonstrated clinically meaningful responses (≥30% improvement) in pain interference over 16 weeks. This study provides evidence that TMD patients referred for TCM in a community-based model will receive safe treatment that is likely to provide some short-term pain relief and improved quality of life. Similar designs may also apply to evaluations of other kinds of chronic pain. (ClinicalTrials.gov number NCT00856167).

      Perspective

      This short-term comparative effectiveness study of chronic facial pain suggests that TCM is safe and frequently efficacious alone or subsequent to standard psychosocial interventions. TCM is widely available throughout North America and may provide clinicians and patients with a reasonable addition or alternative to other forms of therapy.

      Key words

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      References

        • Aickin M.
        A program for balancing the allocation of subjects to treatment in a clinical trial.
        Comput Biomed Res. 1982; 15: 519-524
        • Aickin M.
        Some large trial properties of minimum likelihood allocation.
        J Stat Plan Inference. 1983; 8: 11-20
        • Aickin M.
        Randomization, balance, and the validity and efficiency of design-adaptive allocation methods.
        J Stat Plan Inference. 2001; 94: 97-119
        • Aickin M.
        Effect of design-adaptive allocation on inference for a regression parameter: Two-group, single and double covariate cases.
        Stat Probab Lett. 2009; 79: 16-20
      1. Aickin M: A simulation study of the validity and efficiency of design-adaptive allocation to two groups in the regresson situation. Int J Biostat 5:article 19 issue 1, 2009

        • Al-Badawi E.
        • Mehta N.
        • Forgione A.
        • Lobo S.
        • Zawawi K.
        Efficacy of pulsed radio frequency energy therapy in temporomandibular joint pain and dysfunction.
        Cranio. 2004; 22: 10-20
        • Allen A.
        • Escobar J.
        • Lehrer P.
        • Gara M.
        • Woolfolk R.
        Psychosocial treatments for multiple unexplained physical symptoms: A review of the literature.
        Psychosom Med. 2002; 64: 939-950
        • Bell I.
        • Cunningham V.
        • Caspi O.
        • Meek P.
        • Ferro L.
        Development and validation of a new global well-being outcomes rating scale for integrative medicine research.
        BMC Complement Altern Med. 2004; 4: 1
        • Bensky D.
        • Barolet R.
        Chinese Herbal Medicine: Formulas and Strategies.
        Eastland Press, Seattle,WA1990
        • Brinkhaus B.
        • Hummelsberger J.
        • Kohnen R.
        • Seufert J.
        • Hempen C.H.
        • Leonhardy H.
        • Nögel R.
        • Joos S.
        • Hahn E.
        • Schuppan D.
        Acupuncture and Chinese herbal medicine in the treatment of patients with seasonal allergic rhinitis: A randomized-controlled clinical trial.
        Allergy. 2004; 59: 953-960
        • Campbell C.
        • Weisner C.
        • LeResche L.
        • Ray G.
        • Saunders K.
        • Sullivan M.
        • Banta-Green C.
        • Merrill J.
        • Silverberg M.
        • Boudreau D.
        • Satre D.
        • Von Korff M.
        Age and gender trends in long-term opioid analgesic use for noncancer pain.
        Am J Public Health. 2010; 100: 2541-2547
        • Chen J.
        • Chen T.
        Chinese Medical Herbology and Pharmacology.
        Art of Medicine Press, City of Industry, CA2004
        • DeBar L.
        • Vuckovic N.
        • Schneider J.
        • Ritenbaugh C.
        Use of complementary and alternative medicine for temporomandibular disorders.
        J Orofac Pain. 2003; 17: 224-236
        • Dworkin S.
        Psychosocial impact of orofacial pain.
        in: Turp J. Sommer C. Hugger A. The Puzzle of Orofacial Pain. Karger AG, Basel, CH2007
        • Dworkin S.
        • Truelove E.
        Temporomandibular disorders.
        in: Rakel R. Conn’s Current Therapy. W.B. Saunders, New York, NY1997
        • Dworkin S.F.
        • Huggins K.H.
        • Wilson L.
        • Mancl L.
        • Turner J.A.
        • Massoth D.
        • LeResche L.
        • Truelove E.
        A randomized clinical trial using research diagnostic criteria for temporomandibular disorders-axis II to target clinic cases for a tailored self-care TMD treatment program.
        J Orofac Pain. 2002; 16: 48-63
        • Dworkin S.F.
        • Turner J.A.
        • Mancl L.
        • Wilson L.
        • Massoth D.
        • Huggins K.H.
        • LeResche L.
        • Truelove E.
        A randomized clinical trial of a tailored comprehensive care treatment program for temporomandibular disorders.
        J Orofac Pain. 2002; 16: 259-276
        • Dworkin S.F.
        • Turner J.A.
        • Wilson L.
        • Massoth D.
        • Whitney C.
        • Huggins K.H.
        • Burgess J.
        • Sommers E.
        • Truelove E.
        Brief group cognitive-behavioral intervention for temporomandibular disorders.
        Pain. 1994; 59: 175-187
        • Dworkin S.F.
        • Von Korff M.
        • Le Resche L.
        Multiple pains and psychiatric disturbance: An epidemiologic investigation.
        Arch Gen Psychiatry. 1990; 47: 239-244
        • Elder C.
        • Ritenbaugh C.
        • Aickin M.
        • Hammerschlag R.
        • Dworkin S.
        • Mist S.
        • Harris R.E.
        Reduction in medication use associated with traditional Chinese medicine for chronic pain.
        Perm J. 2012; 16: 18-23
      2. Gatchel R. Turk D. Psychological Approaches to Pain Management: A Practitioner's Handbook. Guilford Press, New York, NY2002
        • Gatchel R.J.
        • Stowell A.W.
        • Wildenstein L.
        • Riggs R.
        • Ellis 3rd, E.
        Efficacy of an early intervention for patients with acute temporomandibular disorder-related pain: A one-year outcome study.
        J Am Dent Assoc. 2006; 137: 339-347
        • Gilbody S.
        • Richards D.
        • Brealey S.
        • Hewitt C.
        Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): A diagnostic meta-analysis.
        J Gen Intern Med. 2007; 22: 1596-1602
        • Goddard G.
        • Karibe H.
        • McNeill C.
        • Villafuerte E.
        Acupuncture and sham acupuncture reduce muscle pain in myofascial pain patients.
        J Orofac Pain. 2002; 16: 71-76
        • Greene C.S.
        Managing TMD patients: Initial therapy is the key.
        J Am Dent Assoc. 1992; 123: 43-45
        • Howie J.G.
        • Heaney D.J.
        • Maxwell M.
        • Walker J.J.
        A comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations.
        Fam Pract. 1988; 15: 165-171
        • Institute of Medicine (IOM)
        Initial national priorities for comparative effectiveness research.
        The Institute of Medicine, The National Academies Press, Washington DC2009 (pp 37-39)
        • Jerjes W.
        • Upile T.
        • Abbas S.
        • Kafas P.
        • Vourvachis M.
        • Rob J.
        • Mc Carthy E.
        • Angouridakis N.
        • Hopper C.
        Muscle disorders and dentition-related aspects in temporomandibular disorders: Controversies in the most commonly used treatment modalities.
        Int Arch Med. 2008; 1: 1-13
        • Johansson A.
        • Wenneberg B.
        • Wagersten C.
        • Haraldson T.
        Acupuncture in treatment of facial muscular pain.
        Acta Odontol Scand. 1991; 49: 153-158
        • Kulekcioglu S.
        • Sivrioglu K.
        • Ozcan O.
        • Parlak M.
        Effectiveness of low-level laser therapy in temporomandibular disorder.
        Scand J Rheumatol. 2003; 32: 114-118
        • La Touche R.
        • Goddard G.
        • De-la-Hoz J.L.
        • Wang K.
        • Paris-Alemany A.
        • Angulo-Diaz-Parreo S.
        • Mesa J.
        • Hernandez M.
        Acupuncture in the treatment of pain in temporomandibular disorders: A systematic review and meta-analysis of randomized controlled trials.
        Clin J Pain. 2010; 26: 541-550
        • Lei H.
        • Nahum-Shani I.
        • Lynch K.
        • Oslin D.
        • Murphy S.A.
        A “SMART” design for building individualized treatment sequences.
        Annu Rev Clin Psychol. 2012; 8: 14.1-14.28
        • LeResche L.
        • Drangsholt M.
        Temporomandibular disorders.
        in: Goldman M. Hatch M. Women and Health. Academic Press, San Diego2000: 1120-1128
        • List T.
        • Helkimo M.
        • Andersson S.
        • Carlsson G.
        Acupuncture and occlusal splint therapy in the treatment of craniomandibular disorders. Part I. A comparative study.
        Swed Dent J. 1992; 16: 125-141
        • Litt M.D.
        • Shafer D.M.
        • Kreutzer D.L.
        Brief cognitive-behavioral treatment for TMD pain: Long-term outcomes and moderators of treatment.
        Pain. 2010; 151: 110-116
        • Manfredini D.
        • Ahlberg J.
        • Winocur E.
        • Guarda-Nardini L.
        • Lobbezoo F.
        Correlation of RDC/TMD axis I diagnoses and axis II pain-related disability. A multicenter study.
        Clin Oral Investig. 2011; 15: 749-756
        • Manfredini D.
        • Marini M.
        • Pavan C.
        • Pavan L.
        • Guarda-Nardini L.
        Psychosocial profiles of painful TMD patients.
        J Oral Rehabil. 2009; 36: 193-198
        • Menk Otto L.
        • Howerter A.
        • Bell I.
        • Jackson N.
        Exploring measures of whole person wellness: Integrative well-being and psychological flourishing.
        Explore. 2010; 6: 364-370
        • Mist S.
        • Ritenbaugh C.
        • Aickin M.
        Effects of questionnaire-based diagnosis and training on inter-rater reliability among practitioners of traditional Chinese medicine.
        J Altern Complement Med. 2009; 15: 703-709
        • Ohrbach R.
        • Dworkin S.F.
        Five-year outcomes in TMD: Relationship of changes in pain to changes in physical and psychological variables.
        Pain. 1998; 74: 315-326
        • Peroz I.
        • Chun Y.-H.
        • Karageorgi G.
        • Schwerin C.
        • Bernhardt O.
        • Roulet J.-F.
        • Freesmeyer W.B.
        • Meyer G.
        • Lange K.-P.
        A multicenter clinical trial on the use of pulsed electromagnetic fields in the treatment of Temporomandibular disorders.
        J Prosthet Dent. 2004; 91: 180-187
        • Raphael K.
        • Klausner J.
        • Nayak S.
        • Marbach J.
        Complementary and alternative therapy use by patients with myofascial Temporomandibular disorders.
        J Orofac Pain. 2003; 17: 36-41
        • Raustia A.
        • Pohjola R.
        • Virtanen K.
        Acupuncture compared with stomatognathic treatment for TMJ dysfunction. Part I: A randomized study.
        J Prosthet Dent. 1985; 54: 581-585
        • Reivich K.
        • Shatte A.
        The Resilience Factor: 7 Essential Skills for Overcoming Life’s Inevitable Obstacles.
        Broadway Books, New York, NY2003
        • Ritenbaugh C.
        • Hammerschlag R.
        • Calabrese C.
        • Mist S.
        • Aickin M.
        • Sutherland E.
        • Leben J.
        • deBar L.
        • Elder C.
        • Dworkin S.F.
        A pilot whole systems clinical trial of traditional Chinese medicine and naturopathic medicine for the treatment of temporomandibular disorders.
        J Altern and Complement Med. 2008; 14: 475-487
        • Rosted P.
        Practical recommendations for the use of acupuncture in the treatment of temporomandibular disorders based on the outcome of published controlled studies.
        Oral Dis. 2001; 7: 109-115
        • Schmid-Schwap M.
        • Simma-Kletschka I.
        • Stockner A.
        • Sengstbratl M.
        • Gleditsch J.
        • Kundi M.
        • Piehslinger E.
        Oral acupuncture in the therapy of craniomandibular dysfunction syndrome – a randomized controlled trial.
        Wien Klin Wochenschr. 2006; 118: 36-42
        • Shen Y.F.
        • Goddard G.
        The short-term effects of acupuncture on myofascial pain patients after clenching.
        Pain Pract. 2007; 7: 256-264
        • Smith P.
        • Mosscrop D.
        • Davies S.
        • Sloan P.
        • Al-Ani Z.
        The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: A randomised controlled trial.
        J Dent. 2007; 35: 259-267
        • Suvinen T.I.
        • Reade P.C.
        • Kemppainen P.
        • Könönen M.
        • Dworkin S.F.
        Review of aetiological concepts of temporomandibular pain disorders: Towards a biopsychosocial model for integration of physical disorder factors with psychological and psychosocial illness impact factors.
        Eur J Pain. 2005; 9: 613-633
        • Taves D.
        Minimization: A new method of assigning patients to treatment and control groups.
        Clin Pharmacol Ther. 1974; 15: 443-453
        • Truelove E.
        • Huggins K.H.
        • Mancl L.
        • Dworkin S.F.
        The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: A randomized controlled trial.
        J Am Dent Assoc. 2006; 137: 1099-1107
        • Von Korff M.
        • Dworkin S.F.
        • Le Resche L.
        • Kruger A.
        An epidemiologic comparison of pain complaints.
        Pain. 1988; 32: 173-183
        • Xue C.
        • Thien F.
        • Zhang J.
        • Yang W.
        • DaCosta C.
        • Li C.
        Effect of adding a Chinese herbal preparation to acupuncture for seasonal allergic rhinitis: Randomised double-blind controlled trial.
        Hong Kong Med J. 2003; 9: 427-434
        • Yap A.
        • Chua E.
        • Dworkin S.F.
        • Tan H.
        • Tan K.
        Multiple pains and psychosocial functioning/psychologic distress in TMD patients.
        Int J Prosthodont. 2002; 15: 461-466