DO CHANGES IN PATIENT BELIEFS AND COPING STRATEGIES PREDICT TEMPOROMANDIBULAR DISORDER TREATMENT OUTCOMES

Objective: This study examined the applicability of the cognitive-behavioral model for temporomandibular disorders (TMD) by determining whether changes in TMD patient pain-related beliefs and coping over the course of treatment related to improvement in symptoms and disability and whether patients' posttreatment beliefs and coping predicted future pain and functioning. Patients/Setting: We studied 139 TMD patients at a health maintenance organization or a university dental school who completed a clinical trial comparing usual treatment with or without a brief cognitive-behavioral intervention. Outcome Measures/Design: Pain, disability, depression, objective physical impairment, and pain beliefs and coping strategies were assessed pretreatment and at 3- and 12-month follow-ups. Results: Increased ability to control pain and decreased Disease Conviction and Passive Coping scores were associated with improved pain, jaw opening, and depression from pretreatment to 3-month follow-up. Patient beliefs and coping at 3-month follow-up did not contribute much to the prediction of pain or physical and psychological functioning at 12-month follow-up after controlling for 3-month pain and functioning scores. However, passive coping and low ability to control pain at 3 months predicted greater activity interference at 12 months. Conclusions: Pretreatment to 3-month follow-up changes in beliefs and coping are associated modestly with TMD patient improvement after conservative dental treatment with and without a brief cognitive-behavioral intervention. Research is needed to develop interventions that produce greater decreases in disease conviction, passive coping, and perceived inability to control pain and to determine whether these changes mediate symptom and disability improvement.