Biofeedback and a cognitive behavioral approach to treatment of myofascial pain dysfunction syndrome

doi:10.1016/S0005-7894(79)80006-4

Behavior Therapy

Volume 10, Issue 1, January 1979, Pages 29-36

https://doi.org/10.1016/S0005-7894(79)80006-4 Get rights and content

Thirteen subjects suffering from long-standing myofascial pain dysfunction syndrome (MPDS) were selected from a large group of myofascial pain patients attending a pain clinic. MPDS subjective and objective measures were recorded prior to and following a treatment program. This program included relaxation training, sensory awareness training, and coping skills training. In addition, half the subjects were given masseter muscle EMG biofeedback during relaxation training, while, for the others, masseter muscle tension was recorded, but not fed back. All subjects manifested reductions both in masseter muscle tension and in subjective measures of pain. Although the subjects receiving biofeedback experienced less subjective pain, there were no noticeable differences on EMG measures.

References (26)

CarlssonS.G. et al.
A treatment of temporomandibular joint syndrome with biofeedback training
Journal of the American Dental Association
(1975)
EpsteinL.H. et al.
An analysis of biofeedback training effects for tension headache patients
Behavior Therapy
(1977)
GesselA.H. et al.
Management of myofascial pain dysfunction syndrome of the temporomandibular joint by tension control training
Psychosomatics
(1971)
GlassD.C. et al.
Behavioral consequences of adaptation to controllable and uncontrollable noise
Journal of Experimental Social Psychology
(1971)
GrossS.M. et al.
Personality correlates of patients with temporomandibular joint dysfunction
Journal of Prosthetic Dentistry
(1973)
LuptonD.E.
Psychological aspects of temporomandibular joint dysfunction
Journal of the American Dental Association
(1969)
MarbachJ.J. et al.
Chronic MPD, group therapy and psychodynamics
Journal of the American Dental Association
(1975)
BanduraA.
Self-efficacy: Toward a unifying theory of behavioral change
Psychological Review
(1977)
BudyznskiT. et al.
An electromyographic feedback technique for teaching voluntary relaxation of biofeedback training
Journal of Dental Research
(1973)
CarlssonS.G. et al.
Biofeedback in the treatment of long-term temporomandibular joint pain
Biofeedback and Self-regulation
(1977)

CorahN.L. et al.

Perceived control, self-observation and response to aversive stimulation

Journal of Personality and Social Psychology

(1970)

CurranJ.P.

Skills training as an approach to the treatment of heterosexual-social anxiety: A review

Psychological Bulletin

(1977)

EllisA. et al.

Guide to rational living

(1968)

Cited by (63)

Home Exercise Program for the Temporomandibular Patients
2016, Pathology and Intervention in Musculoskeletal Rehabilitation
Attentional focus of feedback and instructions in the treatment ofmusculoskeletal dysfunction: A systematic review
2013, Manual Therapy
Citation Excerpt :
In order to describe all studies comparing different attentional foci, studies were included that did not have a comparison of AF conditions as their stated aim, but included at least one intervention that clearly induced participants to focus their attention internally or externally. While confounding factors made it impossible to differentiate AF effects from the effects of feedback versus no feedback in these studies (Budzynski et al., 1973; Stenn et al., 1979; Yip and Ng, 2006; Thiengwittaporn et al., 2009), they demonstrate how AF is inherent to many common clinical scenarios and provide a template which can be refined by future researchers to enable the isolation of AF effects. The duration of symptoms was not reported by the majority of authors (Alexander et al., 1978; Stenn et al., 1979; Yip et al., 2006; Laufer et al., 2007; Thiengwittaporn et al., 2009), however, the stage of dysfunction may have a major bearing on patients' motor control.
An external focus of attention (EFA) during the learning of a motor task improves performance and retention in healthy individuals. People with musculoskeletal dysfunction also learn motor tasks and could potentially benefit from adopting an EFA during practice.
To determine whether instructions and feedback provided to individuals with musculoskeletal dysfunction is more effective in improving function and decreasing pain when inducing an external rather than an internal focus of attention (IFA).
Systematic review
MEDLINE, Embase, CINAHL, AMED, the Cochrane Library and five additional databases were searched.
Randomised, quasi-randomised and non-randomised controlled trials, cross over trials and observational studies involving participants with any form of musculoskeletal dysfunction, comparing IFA or EFA with a different attentional focus (AF), control, placebo or no focus condition.
Two review authors independently screened titles, abstracts and full texts, then extracted data and appraised the quality of trials using the GRADE system of rating methodological quality.
Seven studies were included with a total of 202 participants. Two studies compared an IFA with an EFA, two compared IFA with biofeedback with a different focus condition, and three compared IFA with biofeedback with a no focus condition. Statistically significant improvements in motor performance directly attributable to the focus of attention were only found in the EFA groups. There were no significant improvements in function or pain.
There is insufficient evidence to draw conclusions regarding the effects of attentional focus of instructions and feedback on outcomes in musculoskeletal dysfunction.
Brief cognitive-behavioral therapy for temporomandibular disorder pain: Effects on daily electronic outcome and process measures
2005, Pain
We used patient daily electronic ratings of outcome (activity interference, pain intensity, jaw use limitations, negative mood) and process (pain-related beliefs, catastrophizing, and coping) variables to evaluate a brief cognitive-behavioral (CB) treatment for chronic temporomandibular disorder (TMD) pain. TMD clinic patients (N=158) were assigned randomly to four biweekly sessions of either CB pain management training (PMT) or an education/attention control condition [self-care management (SCM)] and were asked to complete electronic interviews three times daily for the 8-week treatment. We analyzed diary data from 126 participants who completed >50% of requested interviews for >6 weeks. Multilevel regression analyses indicated no statistically significant difference between the study groups in rate of within-subject change over time on the daily outcome measures, but consistently greater within-subject improvement in the PMT group on the daily process measures. Significantly (P<0.05) greater proportions of PMT than of SCM patients showed clinically important (>50%) improvement from weeks 1 to 8 in daily activity interference and jaw use limitations. This study is novel in its application of electronic diary methods for assessing outcome and process variables in a chronic pain treatment trial, and supports the feasibility and utility of such methods. The brief CB treatment was efficacious in decreasing catastrophizing and increasing perceived control over pain, and in improving activity interference and jaw use limitations for a subgroup of patients. Longer-term follow-ups are ongoing to determine if there is an impact on outcomes over time.
Orofacial pain
2003, Handbook of Pain Management: A Clinical Companion to Textbook of Pain
A review of complementary and alternative medicine use for treating chronic facial pain
2002, Journal of the American Dental Association
Citation Excerpt :
They found that biofeedback was associated with significantly greater reduction in pain compared with splint therapy or no therapy. Of the four comparative trials28,29,32,40 Crider and Glaros37 identified, three met our inclusion criteria. Dahlstrom and Carlsson28 compared the long-term treatment effects of EMG biofeedback training to effects of occlusal splint therapy in a sample of 30 female patients.
The authors compiled information on the prevalence of complementary and alternative medicine, or CAM, use, as well as on reports of randomized clinical trials of CAM modalities used to treat chronic facial pain.
The authors searched several databases for reports of clinical trials randomizing patients who had facial pain to a CAM intervention or to a control or comparison group. Search terms included “complementary,” “alternative,” “acupuncture,” “biofeedback,” “relaxation,” “herbal,” “meditation,” “massage,” “yoga,” “chiropractic,” “homeopathic” and “naturopathic.”
Three acupuncture trials, eight biofeedback trials and three relaxation trials met the authors’ inclusion criteria. Across studies, results suggested that acupuncture, biofeedback and relaxation were comparable to conservative treatment (for example, an intraoral appliance) and warranted further study. The authors did not locate any randomized clinical trials that tested the effects of homeopathy, naturopathy, chiropractic, massage, meditation, yoga or herbal remedies for chronic facial pain.
Significant gaps in the scientific knowledge base limit the accuracy with which dental professionals can guide their patients regarding CAM approaches used to treat chronic facial pain.
Pain site and impairment in individuals with amputation pain
2002, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
The end points for these measures were adapted from the pain intensity items of the Chronic Pain Grade.15 Numeric rating scales have shown significant correlations with other measures of pain intensity16-20 as well as sensitivity to treatments that impact pain intensity.21-24 To assess impairment associated with pain, participants were asked to complete a modified version of the Pain Interference Scale of the Brief Pain Inventory25 (BPI).
Marshall HM, Jensen MP, Ehde DM, Campbell KM. Pain site and impairment in individuals with amputation pain. Arch Phys Med Rehabil 2002;83:1116-9. Objective: To determine the association between pain site and pain interference with activities of daily living (ADLs) among persons with acquired amputation. Design: Survey. Setting: Community-based survey from clinical databases, flyer postings, and an advertisement in the inMotion magazine. Participants: Persons with lower-limb amputations (N=478). Interventions: Six or more months after lower-limb amputation, participants completed an amputation pain questionnaire that included several standardized pain measures. Main Outcome Measures: Numeric rating scale measures of average phantom limb, residual limb, and back pain and pain-related impairment as measured by a modified version of the Pain Interference Scale of the Brief Pain Inventory. Results: Phantom limb, residual limb, and back pain intensity ratings, as a group, accounted for 20% of the variance in pain interference. The pain intensity ratings associated with each individual pain site made a statistically significant contribution to the prediction of pain interference with ADLs even after controlling for the pain intensity of the other 2 sites. Conclusions: Pain in each of 3 sites (phantom limb, residual limb, back) appears to be important to pain-related impairment and function. Measurement of the intensity of pain at each site appears to be required for a thorough assessment of amputation pain–related impairment. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

View all citing articles on Scopus

^*: This research was partially supported by a grant from the Ontario Ministry of Health (1365-H08) to R. I. Brooke and P. G. Stenn and by a Medical Research Council General support grant to R. I. Brooke. A portion of this paper was presented at the Annual Meeting of the Eastern Psychological Association, Boston, MA, 1977.

View full text

Biofeedback and a cognitive behavioral approach to treatment of myofascial pain dysfunction syndrome*

Journal of the American Dental Association

Behavior Therapy

Psychosomatics

Journal of Experimental Social Psychology

Journal of Prosthetic Dentistry

Journal of the American Dental Association

Journal of the American Dental Association

Self-efficacy: Toward a unifying theory of behavioral change

Psychological Review

An electromyographic feedback technique for teaching voluntary relaxation of biofeedback training

Journal of Dental Research

Biofeedback in the treatment of long-term temporomandibular joint pain

Biofeedback and Self-regulation

Perceived control, self-observation and response to aversive stimulation

Journal of Personality and Social Psychology

Skills training as an approach to the treatment of heterosexual-social anxiety: A review

Psychological Bulletin

Guide to rational living