Title	Hypnosis And TMD Pain Management
Clinical Question	In patients with Temporomandibular disease, is hypnosis effective in reducing TMD pain compared to no treatment?
Clinical Bottom Line	In patients with Temporomandibular disease, hypnosis is an effective way of reducing TMD pain compared to no treatment. (See Comments on the CAT below)
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 6393181 Stam/1984 61 patients suffering from Temporomandibular pain and dysfunction ramdomly chosen RCT Key results This study shows that hypnosis (a cognitive-behavioral approach) in treating patients with Temporomandibular pain is effective. The group reported experiencing less pain while they were managed in a cognitive behavioral manner.The P value reported for Pain experienced with using hypnosis as a treatment was less than 0.05. 19604319 Abramsen/2009 40 women with TMD for 11.9 years RCT Key results Hypnosis was used in the experimental group and compared with a control group for which only relaxation therapy was used. NRS pain scores were reduced significantly in the hypnosis group (4.5 to 2.9) p=0.001 compared with the control group (4.2 to 3.9) p=0.733. The number needed to treat was 4.0. The hypnosis group also improved significantly with use of coping strategy “reinterpreting pain sensations. P = 0.001.” Both groups improved significantly in number of painful muscle palpation sites and pain on palpation, number of awakenings due to pain, in somatization, obsessive compulsive symptoms and anxiety.
Evidence Search	hypnosis and temporomandibular dysfunction
Comments on The Evidence	The paper by Stam is a Randomized controlled study that had all groups starting similar at start. There was not an 80 percent completion rate. Not all groups were treated the same but there was adequate follow up with all groups. This is a single-blinded study with adequate compliance. Recall bias is unlikely and competing interest was not found to exist in this study. The paper by Abramsen incorporated 2 groups of randomly assigned 20 subjects each. 3 subjects dropped out of the control group, none from the experimental group. The follow up period was short. A no treatment control group was unfeasible due to ethical considerations.
Applicability	The subjects that were presented in this study are representative of real dental patients. Dentists can’t do hypnosis in their office unless they are certified to do it. they most likely will have to refer them out to have it done. Patient would not be harmed in any way from hypnosis.
Specialty	(General Dentistry) (Orthodontics) (Restorative Dentistry) (Behavioral Science)
Keywords	Hypnosis, Temporomandibular disorder, myofacial pain, Tempromandibular joint pain
ID#	861
Date of submission	04/01/2011
E-mail	ghahremanin@livemail.uthscsa.edu
Author	Nazanin Ghahremani
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Edward F. Wright, DDS, MS
Faculty mentor e-mail	WrightE2@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Ryushiro Sugita & Carson Phillips (San Antonio, Texas) on 10/09/2014 A PubMed search on hypnosis and TMD management was performed October 2014. A more recent publication was found: Ferrando 2012, PubMed: 22669067. This RCT on 72 individuals showed that similar result as those published in this CAT and this supports the evidence that hypnosis is an effective modality for TMD treatment.