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Comparison of treatment modes in the management of myofascial pain dysfunction syndrome Foreman, Michael Ernest

Abstract

Reviews of treatment studies dealing with TMJ syndromes and myofascial pain dysfunction (MPD) typically point out the lack of controlled comparative research. The purpose of this study was to provide such research, comparing three treatment modes for the management of MPD: dental splints and physiotherapy; relaxation training, biofeedback, and stress management; and transcutaneous electrical nerve stimulation. Also of interest was the analysis of variables which may be related to treatment outcome. Twenty-one females ranging in age from 19 to 45 years (M=27.2; SD = 7.1), assessed as meeting specific criteria for MPD and consenting to participate in a research project on treatment issues, were randomly assigned, over blocks of 3, to one of the three treatment conditions. Pre-treatment assessment included dental assessment of pain and jaw mobility, self-report measures of pain, EMG assessment of masseter muscle activity under baseline and task conditions, and psychometric questionnaires. The pre-treatment assessment was replicated post-treatment, and daily symptoms self-monitoring over the course of treatment was also included for treatment evaluation. The groups formed were assessed and found equivalent with respect to age, duration of pain history, measure of mouth opening, baseline masseter EMG, adjectival pain rating index, and expectations for treatment success.by multivariate analysis of variance (MANOVA). The treatment programs were balanced with respect to total duration (8 weekly sessions) and at-home programs. Post-treatment follow-up was limited to 3 months, and assessment was limited to whether or not further treatment was sought within that time. Analyses by 2-way MANOVA across groups pre- to post-treatment revealed no differences between groups with respect to dental assessment of pain remission or increased jaw mobility, or reduction of EMG activity, but overall effects pre- to post-treatment were significant for these variables (dental assessment: approx. F(3,16) =9.22, p_ = .0009; EMG assessment: approx. F(4,15) =10.38, p=.0003). Self-report measures were significant overall pre- to post-treatment (approx F(4,15) =3.27, p = .036) and indicated group differences (approx. F(10,28) =2.47, p_=. 029), suggesting superiority of the relaxation/stress group in the reduction of daily self-monitored pain ratings and the incidence of reported pain. From the overall pattern;of results, however, it was concluded that the principal response to treatment derived from "non-specific effects" — the provision of an explanation for the problem and treatment ostensibly specifically oriented to symptom relief. Diagnostic and assessment issues, and psychometric interests with this chronic pain population are also discussed.

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