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Cited by 33Temporomandibular Joint DisordersDigital Mental Health InterventionsMusculoskeletal pain and rehabilitation

Internet-Based Multimodal Pain Program With Telephone Support for Adults With Chronic Temporomandibular Disorder Pain: Randomized Controlled Pilot Trial

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Lam, Julia, Svensson, Peter, Alstergren, Per·2020·Journal of Medical Internet Research
DOI 10.2196/22326PMC PMC7592067

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Abstract

Background: Chronic pain from temporomandibular disorders remains an undertreated condition with debate regarding the most effective treatment modalities. Objective: The aim of the study was to investigate the treatment effect of an internet-based multimodal pain program on chronic temporomandibular disorder pain and evaluate the feasibility of a larger randomized controlled trial. Methods: An unblinded randomized controlled pilot trial was conducted with 43 participants (34 females, 9 males; median age 27, IQR 23-37 years) with chronic temporomandibular pain. Participants were recruited within the Public Dental Health Service and randomized to intervention (n=20) or active control (n=23). The intervention comprised a dentist-assisted internet-based multimodal pain program with 7 modules based on cognitive behavior therapy and self-management principles. The control group received conventional occlusal splint therapy. Primary outcomes included characteristic pain intensity, pain-related disability, and jaw functional limitation. Secondary outcomes were depression, anxiety, catastrophizing, and stress. Outcomes were self-assessed through questionnaires sent by mail at 3 and 6 months after treatment start. Feasibility evaluation included testing the study protocol and estimation of recruitment and attrition rates in the current research setting. Results: Only 49% of participants (21/43) provided data at the 6-month follow-up (internet-based multimodal pain program: n=7; control: n=14). Of the 20 participants randomized to the internet-based multimodal pain program, 14 started treatment and 8 completed all 7 modules of the program. Between-group analysis showed no significant difference for any outcome measure at 3- or 6-month follow-up—characteristic pain intensity (3 months: P=.58; 6 months: P=.41), pain-related disability (3 months: P=.51; 6 months: P=.12), jaw functional limitation (3 months: P=.45; 6 months: P=.90), degree of depression (3 months: P=.64; 6 months: P=.65), anxiety (3 months: P=.93; 6 months: P=.31), stress (3 months: P=.66; 6 months: P=.74), or catastrophizing (3 months: P=.86; 6 months: P=.85). Within-group analysis in the internet-based multimodal pain program group showed a significant reduction in jaw functional limitation score at the 6-month follow-up compared to baseline (Friedman: χ2=10.2, P=.04; Wilcoxon: z=–2.3, P=.02). In the occlusal splint group, jaw function limitation was also reduced at the 6-month follow-up (Friedman: χ2=20.0, P=.045; Wilcoxon: z=–2.3, P=.02), and there was a reduction in characteristic pain intensity at the 3- and 6-month follow-up (Friedman: χ2=25.1, P=.01; Wilcoxon 3 months: z=–3.0, P=.003; Wilcoxon 6 months: z=-3.3, P=.001). Conclusions: This study was not able to demonstrate a difference in treatment outcome between an internet-based multimodal pain program and occlusal splint therapy in patients with chronic temporomandibular pain. However, the findings suggested that the internet-based multimodal pain program improves jaw function. The results also confirmed the treatment effect of occlusal splint therapy for chronic temporomandibular pain. Furthermore, because of the high attrition rate, this pilot study showed that a randomized controlled trial with this design is not feasible. Trial Registration: ClinicalTrials.gov NCT04363762; https://clinicaltrials.gov/show/NCT04363762

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  • One trial administered CBT via an internet programme supported by asynchronous therapist feedback.

    “one trial administered therapy via a programme on the internet supported by asynchronous therapist feedback.37”

    From Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline (2023) · cites this paper as [37]

    Methods > Treatment Modalities describes an internet program based on CBT and self-management principles, with asynchronous chat support from a dentist. It says individualized feedback was provided in follow-up phone calls, not that a therapist gave asynchronous feedback. (LLM, conf=0.86)

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Authors
Lam, J., Svensson, P., & Alstergren, P.
Affiliations
  • Aarhus University (DK)
  • Skåne University Hospital (SE)
Corresponding author
Lam, Julia
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2020-10-13
Volume
22
Issue
10
Pages
e22326
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/22326
PMC
PMC7592067
OpenAlex
W3092423926
Cited by
33
References
45
Citations by year
2026: 5 · 2025: 8 · 2024: 5 · 2023: 7 · 2022: 5 · 2021: 3
FWCI
4.23
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Region Skåne
Topics
  • Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
chronic temporomandibular disorders, multimodal pain management, cognitive behavioral therapy, self-management, telephone support, occlusal splint, jaw functional limitation, pain-related disability, pain intensity, depression, anxiety, stress, pain catastrophizing, feasibility, adults, pilot trial, attrition, recruitment (clinical trials), medication adherence
MeSH terms
Smartphone, Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Pilot Projects, Surveys and Questionnaires, Temporomandibular Joint Disorders, Treatment Outcome, Telemedicine, Internet, Young Adult, Chronic Pain

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