Temporomandibular disorders (TMDs) are conditions that affect the jaw joint and the muscles that move it. They are often associated with pain that lasts more than 3 months. Other symptoms include limited mouth opening, and jaw clicking and locking. All symptoms can interfere with quality of life and mood. This review explores whether psychological therapies can help to treat TMDs. Psychological therapies are sometimes known as “talking therapies”. They can be delivered one-to-one or in group sessions. An important aim of psychological therapies for TMD is to support self‐management. Self‐management refers to a person’s use of a range of strategies to enable them to live well with pain. Although it is considered to be an important aspect of living with pain, successful self‐management can be difficult to achieve. An instinctive response to pain is to try to fight or avoid it. Psychological therapies support self‐management by encouraging behaviours that are helpful and reducing responses that are potentially harmful.
What was the research?
A systematic review to find out how effective psychological therapies are for adults and young people over the age of 12 years who have painful TMD that has lasted at least 3 months.
Who conducted the research?
The research was conducted by a team led by Chris Penlington of the School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK on behalf of Cochrane Oral Health. Charlotte Bowes, Greig Taylor, Adetunji Adebowale Otemade, Paula Waterhouse, Justin Durham and Richard Ohrbach were also on the team.
What evidence was included in the review?
22 randomised controlled trials with 2001 participants were included. Most of the reports we found compared psychological therapy to drug treatments or the use of a special mouthguard.
We wanted to know whether psychological treatments reduced the amount of pain and distress in people with TMDs.We looked for details of these measures immediately after treatment and a few months later. We also looked for information on any negative side effects of the treatments.
What did the evidence say?
Most of the studies reported on one particular form of psychological therapy called cognitive behaviour therapy (CBT). We did not have enough information to draw any conclusions about any other psychological therapies.
The results told us that CBT was no different from other treatments or usual care/no treatment in reducing the intensity of the TMD pain by the end of treatment. There was some evidence that people who had CBT might have slightly less pain a few months after treatment.
There was some evidence that CBT might be better than other treatments for reducing psychological distress both at the end of treatment and a few months later. This was not seen in the one study that compared CBT against usual care.
In terms of how much pain interfered with activities, there was no evidence that there was any difference between CBT and other treatments.
There was too little information to be sure about whether psychological treatments cause problems such as feeling ill or worse pain. Only six of the 22 studies measured the negative side effects participants experienced. In these six studies, the side effects associated with psychological treatment seemed to be minor in general and to occur less often than in alternative treatment groups.
How good was the evidence?
We have little confidence in the evidence because many of the studies had design limitations. There was also variation in the length of treatment and in how it was delivered. This means that we need to be cautious in interpreting the results that we found and they may not be reliable.
What are the implications for practitioners and the general public?
Healthcare professionals who are not psychologists can consider referring people for psychological therapies to manage TMDs if this is the patient’s preference.
For psychology professionals, in the absence of evidence about the superiority of one psychological therapy over another, treatment decisions should continue to be based on a careful assessment of each patient.
The findings of this review are not robust, but clinicians in practice may consider psychological treatment as a potential intervention for painful TMD.
What should researchers look at in the future?
There is a need for further, good‐quality research trials of psychological therapies for painful TMDs. These should cover a range of psychological approaches, including CBT but also looking at other psychological therapies which are under-researched. There is also a need for good‐quality RCTs of psychological therapies for TMD in adolescents, as it is common for symptoms to start at this age. We found only two relevant studies from one group that focused on adolescents and these used relaxation as an intervention. Researchers should consider planning good‐quality trials of psychological therapies against alternative treatments (such as oral splints) or usual care, and include longer‐term follow‐up data.
Link
Penlington C, Bowes C, Taylor G, Otemade AA, Waterhouse P, Durham J, Ohrbach R. Psychological therapies for temporomandibular disorders (TMDs). Cochrane Database of Systematic Reviews 2022, Issue 8. Art. No.: CD013515. DOI: 10.1002/14651858.CD013515.pub2.
This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Editorial Base.
Cochrane Oral Health 