Cognitive-behavioral therapy as an adjunct to physical management of chronic painful temporomandibular disorders: A DC/TMD Axis II guided randomized controlled trial

Background Emotional distress is central to TMD (DC/TMD Axis II). Benefits of adding structured behavioral therapy to standard physical care remain unclear.Methods 100 adults (18–65 y) with myofascial pain/arthralgia ≥3 months, VAS ≥4, and HADS ≥8 were randomized to standard care plus an 8-week multicomponent program (CBT, progressive relaxation, EMG biofeedback, pain education) or standard care alone. Outcomes (VAS pain primary, JFLS, MMO, HADS, success) were assessed at baseline, 1, 3, and 6 months.Results 89 completed follow-up. The behavioral group showed greater 3-month gains in VAS pain (d=1.15), JFLS (d=1.20), HADS (d=0.90), and MMO (d=1.05; all p<.001), sustained to 6 months. Reduced distress mediated 38–42% of effects. Success rates: 84% vs 56% (OR 4.13; NNT=3.6).Conclusion Adding multicomponent behavioral therapy produced large, lasting improvements in pain, function, and distress.