***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : Cognitive-behavioral treatment has proven efficacy for chronic temporom and ibular disorder ( TMD ) . However , most patients receive dental treatment that may not address psychological comorbidities often present in TMD . The aim of the present study was to evaluate the efficacy of biofeedback-based cognitive-behavioral treatment ( BFB-CBT ) versus dental treatment with occlusal splint ( OS ) . Moreover , changes in nocturnal masseter muscle activity ( NMMA ) were investigated . Methods : Fifty-eight patients with chronic TMD were r and omly assigned to receive either 8 weekly sessions of BFB-CBT or 8 weeks of OS treatment . Diagnoses were established using Research Diagnostic Criteria for TMD . Pain intensity and disability were defined as primary outcomes . Secondary outcomes included emotional functioning , pain coping , somatoform symptoms , treatment satisfaction , and adverse events . NMMA was assessed during 3 nights pretreatment and posttreatment with portable devices . Follow-up assessment took place 6 months after the treatment . Results : Both treatments result ed in significant reductions in pain intensity and disability , with similar amounts of clinical ly meaningful improvement ( 45 % for BFB-CBT and 48 % for OS ) . Patients receiving BFB-CBT showed significantly larger improvements in pain coping skills . Satisfaction with treatment and ratings of improvement were higher for BFB-CBT . Effects were stable over 6 months , and tended to be larger in the BFB-CBT group for all outcomes . No significant changes were observed in NMMA . Discussion : The fact that BFB-CBT result ed in larger improvements in pain coping skills , and was well accepted by the patients , underlines the importance and feasibility of psychological treatments in the clinical management of TMD Psychological characteristics potentially may be a cause or consequence of temporom and ibular disorder ( TMD ) . We hypothesized that psychological characteristics associated with pain sensitivity would influence risk of first-onset TMD , but the effect could be attributed to variation in the gene encoding catechol-O-methyltransferase ( COMT ) . We undertook a prospect i ve cohort study of healthy female volunteers aged 18–34 yrs . At baseline , participants were genotyped , they completed psychological question naires , and underwent quantitative sensory testing to determine pain sensitivity . We followed 171 participants for up to three years , and 8.8 % of them were diagnosed with first-onset TMD .  Depression , perceived stress , and mood were associated with pain sensitivity and were predictive of 2- to 3-fold increases in risk of TMD ( P < 0.05 ) . However , the magnitude of increased TMD risk due to psychological factors remained unchanged after adjustment for the COMT haplotype . Psychological factors linked to pain sensitivity influenced TMD risk independently of the effects of the COMT haplotype on TMD risk Abstract Although cognitive – behavioral therapies ( CBT ) have been demonstrated to be effective for a variety of chronic pain problems , patients vary in their response and little is known about patient characteristics that predict or moderate treatment effects . Furthermore , although cognitive – behavioral theory posits that changes in patient beliefs and coping mediate the effects of CBT on patient outcomes , little research has systematic ally tested this . Therefore , we examined mediators , moderators , and predictors of treatment effects in a r and omized controlled trial of  CBT for chronic temporom and ibular disorder ( TMD ) pain . Pre‐ to post‐treatment changes in pain beliefs ( control over pain , disability , and pain signals harm ) , catastrophizing , and self‐efficacy for managing pain mediated the effects of CBT  on pain , activity interference , and jaw use limitations at one year . In individual mediator analyses , change in perceived pain control was the mediator that explained the greatest proportion of the total treatment effect on each outcome . Analyzing the mediators as a group , self‐efficacy had unique mediating effects beyond those of control and the other mediators . Patients who reported more pain sites , depressive symptoms , non‐specific physical problems , rumination , catastrophizing , and stress before treatment had higher activity interference at one year . The effects of CBT generally did not vary according to patient baseline characteristics , suggesting that all patients potentially may be helped by this therapy . The results provide further support for cognitive – behavioral models of chronic pain and point to the potential benefits of interventions to modify specific pain‐related beliefs in CBT and in other health care encounters ABSTRACT The purpose of this study was to determine whether cognitive – behavioral treatment ( CBT ) operates by effecting changes in cognitions , affects , and coping behaviors in the context of painful episodes . Patients were 54 men and women with temporom and ibular dysfunction‐related orofacial pain ( TMD ) enrolled in a study of brief ( 6 weeks ) st and ard conservative treatment ( STD ) or st and ard treatment plus CBT ( STD + CBT ) . Momentary affects , pain , and coping processes were recorded on a cell phone keypad four times per day for 7 days prior to treatment , and for 14 days after treatment had finished , in an experience sampling paradigm . Analyses indicated no treatment effects on general retrospective measures of pain , depression , or pain‐related interference with lifestyle at post‐treatment . However , mixed model analyses on momentary pain and coping recorded pre‐ and post‐treatment indicated that STD + CBT patients reported greater decreases in pain than did STD patients , significantly greater increases in the use of active cognitive and behavioral coping , and significantly decreased catastrophization . Analyses of experience sampling data indicated that post‐treatment momentary pain was negatively predicted by concurrent active coping , self‐efficacy , perceived control over pain , and positive‐high arousal affect . Concurrent catastrophization was strongly predictive of pain . Active behavioral coping and self‐efficacy reported at the prior time point ( about 3 h previously ) were also protective , while prior catastrophization and negative‐high arousal mood were predictive of momentary pain . The results suggest that CB treatment for TMD pain can help patients alter their coping behaviors , and that these changes translate into improved outcomes To assess the differential efficacy of two commonly used treatments for temporom and ibular disorders ( TMD ) , intraoral appliances ( IAs ) and biofeedback ( BF ) , separately and in combination , two studies were conducted . The first study directly compared IA treatment , a combination of biofeedback and stress management ( BF/SM ) , and a waiting list control group in a sample of 80 TMD patients . Both treatments were determined to be equally credible to patients , ruling out this potential threat to the validity of the results obtained . The results demonstrated that the IA treatment was more effective than the BF/SM treatment in reducing pain after treatment , but at a 6-month follow-up the IA group significantly relapsed , especially in depression , whereas the BF/SM maintained improvements on both pain and depression and continued to improve . The second study examined the combination of IA and BF/SM in a sample of 30 TMD patients . The results of this study demonstrated that the combined treatment approach was more effective than either of the single treatments alone , particularly in pain reduction , at the 6-month follow-up . These results support the importance of using both dental and psychologic treatments to successfully treat TMD patients if treatment gains are to be maintained AIMS To conduct a pilot trial to test the feasibility of a guided self-help intervention for chronic orofacial pain . METHODS A pilot r and omized controlled trial was conducted to compare the intervention with usual treatment . A total of 37 patients with chronic orofacial pain were r and omized into either the intervention group ( n = 19 ) or the usual treatment ( control ) group ( n = 18 ) . Vali date d outcome measures were used to measure the potential effectiveness of the intervention over a number of domains : physical and mental functioning ( Short Form 36 [ SF-36 ] ) ; anxiety and depression ( Hospital Anxiety and Depression Scale [ HADS ] ) ; pain intensity and interference with life ( Brief Pain Inventory [ BPI ] ) ; disability ( Manchester Orofacial Pain Disability Scale [ MOPDS ] ) ; and illness behavior ( Revised Illness Perceptions Question naire [ IPQr ] ) . Bootstrap confidence intervals were computed for the treatment effect ( ES ) posttreatment and at 3 months follow-up and adjusted for baseline values of the outcome measure by using analysis of covariance . RESULTS At posttreatment and the 3-month follow-up , 11 participants in the intervention group and 7 in the control group failed to complete outcome measures . The intervention was acceptable and could be feasibly delivered face to face or over the telephone . Although the pilot trial was not powered to draw conclusions about the effectiveness , it showed significant ( P < .05 ) effects of the intervention on physical and mental functioning and treatment control . CONCLUSION The self-help intervention was acceptable to patients and allowed them to better underst and and self-manage chronic orofacial pain . It showed potential effectiveness on outcome domains related to functioning and illness perception . Further research is needed to underst and the cost effectiveness of the intervention for chronic orofacial pain There are few robust , evidence -based data about what constitutes the diagnosis of atypical facial pain and how it is best treated . We therefore aim ed to find out the current opinion of those on specialist lists in the United Kingdom ( UK ) on whether they use the term atypical facial pain , how they reach their diagnosis , and what treatment they offer . We sent out question naires to 240 specialists r and omly selected from the UK lists of those most likely to deal with atypical facial pain ( oral and maxillofacial surgeons , oral medical specialists , ear nose and throat surgeons , anaesthetists , psychiatrists and neurologists ) . We divided the replies according to whether the specialists were medically or dentally based . Of the 209 valid question naires , 143 were returned ( a response rate of 68 % ) ; 127 of the 143 used the term atypical facial pain , the others used various other terms . The two groups used significantly different criteria , mainly to exclude other conditions to achieve a diagnosis . About half used haematological tests and most used radiographic investigations routinely , and there were no significant differences among the specialities . No unified pattern of referral between different units was found . Treatment was mainly by antidepressant and anticonvulsant drugs , and counselling OBJECTIVES ( i ) To examine the association between  self-reported mechanical factors  and  chronic oro-facial pain .  ( ii ) To test the hypothesis that this relationship could be explained by : ( a ) reporting of psychological factors , ( b ) common association of self-reported mechanical factors with other unexplained syndromes . METHODS A population based cross-sectional study of 4200 r and omly selected adults registered with a General Medical Practice in North West , Engl and . The study examined the association of  chronic oro-facial pain  with a variety of self-reported mechanical factors : teeth grinding , facial trauma , missing teeth and the feeling that the teeth did not fit together properly . Information was also collected on demographic factors , psychological factors and the reporting of other frequently unexplained syndromes . RESULTS An adjusted response rate of 72 % was achieved . Only two mechanical factors : teeth grinding ( odds ratio ( OR ) 2.0 , 95 % CI 1.3 - 3.0 ) and facial trauma ( OR 2.0 ; 95 % CI 1.3 - 2.9 ) were independently associated with chronic oro-facial pain after adjusting for psychological factors . However , these factors were also commonly associated with the reporting of other frequently unexplained syndromes : teeth grinding ( odds ratio ( OR ) 1.8 , 95 % CI 1.5 - 2.2 ) , facial trauma ( OR 2.1 ; 95 % CI 1.7 - 2.6 ) . CONCLUSIONS Self-reported mechanical factors associated with chronic oro-facial pain are confounded , in part , by psychological factors and are equally common across other frequently unexplained syndromes . They may represent another feature of somatisation . Therefore the use of extensive invasive therapy such as occlusal adjustments and surgery to change mechanical factors may not be justified in many cases Previous research has suggested that a habit reversal treatment might be used effectively in a home-based minimal therapist contact ( MTC ) protocol to facilitate flexibility and increase treatment completion rates . Recent review s of MTC interventions have found it to be generally efficacious , cost-effective , and generalizable . While MTC has been used for certain health-related disorders ( e.g. , headache ) , almost no research has evaluated the effectiveness of a MTC protocol with a population suffering from temporom and ibular disorder ( TMD ) . The current study utilized an oral habit reversal treatment in a MTC format in an attempt to reduce attrition and increase treatment flexibility . Twenty females suffering from TMD were r and omly assigned to either a treatment ( n = 10 ) or a wait-list control ( n = 10 ) condition . Six individuals in each group used telephone contact while 4 used e-mail for weekly communication with the therapist . Results demonstrated that a habit reversal treatment in a MTC format led to statistically and clinical ly significant improvements in mean weekly pain ratings , number of pain-free days per week , and highest weekly pain ratings . Also , a significant reduction in maladaptive oral habits occurred from pre- to post-treatment and significant reductions in life stress and pain interference were observed . Results were maintained at follow-up . The implication s for the use of MTC for treatment of facial pain are discussed , as are the implication s of these findings for the role of oral habits in the etiology of TMD & NA ; Temporom and ibular disorders ( TMD ) are currently viewed as an interrelated set of clinical conditions presenting with signs and symptoms in masticatory and related muscles of the head and neck , and the soft tissue and bony components of the temporom and ibular joint . Epidemiologie and clinical studies of TMD confirm its status as a chronic pain problem . In this report we present results from a r and omized clinical trial which compared , at 3‐ and 12‐month 
    Output:
    
Self-management interventions are effective for patients with chronic orofacial pain .
Packages of physical and psychosocial self-regulation and education appear beneficial .
SIGNIFICANCE This systematic review provides clear evidence for effectiveness of combined biomedical and psychological interventions ( incorporating self-management approaches ) on long-term outcomes in the management of chronic orofacial ( principally TMD ) pain .