TMJ Self-Management Programs

Self-management (SM) programs in temporomandibular disease (TMD) are a core component of pain management of TMD throughout its course and are often given to patients as a first essential step after diagnosis. Up until now, the problem has been that there has been no agreed-upon definition of self-management, nor a consistent standard for the components that constitute a SM program. Therefore, the goal of the process described in the article was to agree upon a definition of the term “self-management” and reach consensus on its components.

SM programs are defined as a group of procedures that have a logical basis for therapeutic action in relation to the respective diagnosis for which they are recommended. Simply put, procedures are recommended to the patient based on his/her diagnosis.

The procedures should be simple enough to allow patients to be easily taught how to do them and to be able to do them independently. The core program for TMD, as defined by the article, consists of the following components: education, exercise, self-massage, thermal therapy (hot, cold), dietary advice and nutrition, and identifying and avoiding behaviors that exacerbate pain. Each component has its own purpose, but, in general, the main goal of SM is to allow healing and prevent further injury to the musculoskeletal system.

Key to the success of a self-management program is the ability of the patient tounderstand and implement the recommended procedures consistently over a reasonable length of time. Success also requires that the patient and the health care provider stay in communication about the effects of the recommended SM procedures,so that adjustments can be made in the program as needed. Such active participation in the process by both patient and provider can be empowering, as it lets the patient know that he or she has the innate ability to heal and that there are specific ways that can help to manage pain.

The process (Delphi Process) described in this article has established an international consensus regarding the principal components and standardized definition of SM.However, significantly more research is required to further refine the cause-effect relationships of specific components, presumed causative or contributing factors,individual patient’s response to each component and the whole SM program. In other words, what works, for whom, under what conditions, and how, will drive the whole process, which will be monitored and adjusted, from first recommendations through application, toward the stated goal of return to normal function.

The definition and principal concepts of SM agreed upon during the Delphi Process should allow the evidence base to be expanded in a more homogeneous, comparable manner in order to advance the science behind SM of TMD.

For more specific information on the process and its specific findings and recommendations, consult the full article at: http://onlinelibrary.wiley.com/doi/10.1111/joor.12448/epdf.

Durham, J., Al-Baghdadi, M., Baad-Hansen, L., Breckons, M., Goulet, J. P., Lobbezoo,F., List, T., Michelotti, A., Nixdorf, D. R., Peck, C. C., Raphael, K., Schiffman, E., Steele, J.G., Story, W. and Ohrbach, R. (2016), Self-management programmes in temporomandibular disorders: results from an international Delphi process. J OralRehabil, 43: 929-936. doi:10.1111/joor.12448

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