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

BACKGROUND Chronic temporomandibular disorders (TMD) pain is an undertreated condition in Sweden despite the fact that national guidelines includes effective treatment options. These guidelines recommend multimodal treatment with a behavioral approach. Internet-based intervention is an appealing modality for multimodal TMD treatment, enabling more patients to be reached and treated.

Objective To investigate the treatment effect of an internet-based multimodal pain program (iMPP) on chronic TMD pain. As the study progressed, it also became a measure to evaluate the feasibility of running a larger randomized controlled trial.

STUDY DESIGN An unblinded parallel-arm RCT pilot study with equal allocation was conducted. Participants were randomized to the iMPP or to an active control. They were recruited from a general dental care clinic (Fäladstorget) within the National Dental Care Skåne, Sweden. Examination and allocated treatment were free of charge for participants and no other financial compensation was given. This study is part of a large research project with the primary objective to study changes in the brain after treatment in patients with chronic TMD pain. Therefore, participants went through magnetic resonance imaging (MRI) of the brain pre- and post-treatment. The study was approved by the Ethics Review Board in Lund, Sweden (No. 2016/6). This study was not registered in a public trials registry due to its feasibility character.

PARTICIPANTS Participants had to fulfill the following criteria: (1) age between 18 and 75 years; (2) at least one of the TMD pain diagnoses myalgia, myofascial pain with referral, headache attributed to TMD or arthralgia according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) {Schiffman, 2014 #4}; (3) chronic TMD pain (≥3 months), experienced once a week or more often, with an intensity of ≥3 on an 0-10 numeric rating scale (NRS); (4) access to a computer with an internet connection and a mobile phone; (5) sufficient computer literacy and (6) mastery of the Swedish language. Exclusion criteria were: (1) chronic inflammatory systemic disease; (2) all psychiatric disorders except depression and anxiety (due to high comorbidity); (3) occlusal splint therapy in the past 12 months; (4) ongoing extensive dental treatment; and (5) conditions contradicting MRI examination.

Recruitment of participants started in April 2016 and ended in December 2017. Screening was paused during holiday periods (June-August) and during February-April in 2017 due to technical issues with the MRI machine.