Complementary and alternative therapy use by patients with myofascial temporomandibular disorders.

AIMS: To examine the prevalence and predictors of complementary and alternative medicine (CAM) use among patients with temporomandibular disorders (TMD), prior to their first treatment with an intraoral splint. METHODS: Sixty-three women with a diagnosis of myofascial TMD, and who had never been prescribed an intraoral appliance, reported on their use of CAM and other treatments for their facial pain. In addition to providing a comprehensive symptom history, participants completed a 2-week daily diary in which they described the nature of daily efforts to reduce their facial pain. RESULTS: Although more than half of all participants had not sought any prior treatment for their facial pain, 22.2% had received CAM treatment. The only single type of treatment more commonly used than CAM treatment was medication (28.6%). The most common type of CAM treatment was relaxation therapy (12.7%), followed by chiropractic treatment (9.5%). Although pain duration, pain severity, or mood did not predict CAM use, users were significantly more likely to report work or social disability associated with their facial pain and were more likely to report onset associated with an accident. CAM users were more likely than non-users to employ multiple pain reduction strategies over the 2-week daily diary report, including prescription medication use. CONCLUSION: A sizeable minority of women with myofascial TMD report CAM treatment for their pain, even prior to an initial treatment with an intraoral splint. Since empirical reports have not adequately demonstrated their safety or efficacy, there is a need for controlled clinical trials evaluating the utility of CAM treatments for TMD.

Dietary fiber intake in patients with myofascial face pain.

AIMS: To determine the impact of myofascial face pain (MFP) on dietary intake of selected nutrients. METHODS: Sixty-one MFP women meeting the criteria for the myofascial subtype of temporomandibular disorders completed a 4-day daily food intake diary, as well as self-report of pain severity, pain interference with eating, and depressive symptomatology. Nutrient intake for the MFP women was compared with a demographically-equivalent sample of community women participating in the federally-sponsored Continuing Survey of Food Intakes by Individuals (CFSII). Within the MFP sample, multiple linear regression analysis was used to test whether dietary fiber intake reduction was most likely due to pain adaptation, or to depressive symptomatology or associated appetite reduction. RESULTS: Only the subgroup of MFP patients with above-average pain severity showed reduced dietary fiber intake compared with the community sample. MFP patients did not differ from the community sample on other nutrient intake measures (i.e., total calories, protein, fat, carbohydrates and dietary fiber, calcium, and iron). Within the MFP sample, pain severity was significantly associated with reduced dietary fiber intake. This relationship persisted, after controlling for depressive symptomatology, appetite, and total calories. CONCLUSION: Myofascial face pain patients with more severe pain intensity are likely to reduce their intake of dietary fiber. This is likely due to an effort to decrease masticatory activity to avoid exacerbating facial pain. Since low dietary fiber, especially in combination with commonly prescribed medications for MFP, increases the risk of constipation and may exacerbate comorbid medical conditions, clinicians should recommend alternative dietary fiber sources for MFP patients.

Myofascial face pain: seasonal variability in pain intensity and demoralization.

Seasonal variability has been detected in a variety of illnesses. The purpose of this study is to examine seasonal variability in pain intensity, demoralization and range of mandibular motion among patients suffering from myofascial face pain. Pain and demoralization for cases (n = 140) and demoralization for controls (n = 133) were measured in each of 10 monthly interviews. Range of motion was measured once only for cases. Their pain intensity (P < 0.009) and demoralization (P < 0.04) were significantly greater in the peak dark months than in the peak light months. There was a non-significant trend (P < 0.07) toward elevated demoralization in the darker months for controls. Range of motion, assessed cross-sectionally, did not demonstrate a seasonal pattern. These data support our prior finding that myofascial face pain and depressed mood are co-morbid and may be maintained by common risk factors.

Illness and injury among children of temporomandibular pain and dysfunction syndrome (TMPDS) patients.

This paper examines findings on illnesses and injuries among patients suffering from temporomandibular pain and dysfunction syndrome (TMPDS). Data from the longitudinal component of a case-control study of 151 TMPDS patients and 139 healthy controls were examined, focusing especially on the 31 cases and 41 controls with children. Patients are significantly more likely to report illnesses but not injuries among their children across 10 monthly interviews. The patients' excess in reporting of illnesses is not found for spouses or additional significant others. Overreporting does not appear to be due to illness attitudes or other discernible reporting biases, but may be partially attributable to higher rates of demoralization among the cases. Findings are discussed in view of hypotheses about familially transmitted vulnerability to pain and illness.

Candidate risk factors for temporomandibular pain and dysfunction syndrome: psychosocial, health behavior, physical illness and injury.

The purpose of this paper is to identify potential risk factors for the temporomandibular pain and dysfunction syndrome (TMPDS). The investigation focuses on the relations of TMPDS to personal, social and recent experiential factors, especially health behaviors and physical illnesses and injuries, that contribute to life stress. The data come from a retrospective case-control study of 151 TMPDS patients and 139 healthy controls. Results show that cases and controls are similar on most measures of personality characteristics although cases are somewhat more external in locus of control expectancy and appear far more distressed than do controls. There are no case/control differences in reports of desirable and undesirable life events that do not involve physical illness and injury. The social situations of cases and controls differ in that cases have fewer sources of emotional support than controls. No differences were found in the proportion of cases and controls who reported that they ever ground or clenched their teeth, although cases were told they do so more frequently by dentists than were controls. Excluding never married women, cases were less likely than controls to have children. This could not be explained on the basis of birth control and may provide a clue to a biologic base for the much higher rates of women than men who are treated for TMPDS. Cases reported more past pain-related illnesses, more life-threatening physical problems and more recent events involving injury and non-pain-related physical illnesses. There was no difference between cases and controls in reports of physical problems prior to age 13. TMPDS patients appear to be unusually distressed individuals who are beleaguered by physical illnesses and injuries as well as by pain, who tend to attribute their fate to external factors, and who have fewer sources of emotional support.