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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Article info
Publication history
Published online: October 10, 2012
Accepted:
August 4,
2012
Received in revised form:
July 22,
2012
Received:
January 10,
2012
Footnotes
The project was supported by NIH/NCCAM grant U01AT002570. The authors have no conflicts of interest to declare.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
