CLINICAL RESEARCH POSTER PRESENTATION ABSTRACTS
Please note: All posters will be displayed in
Salons 10-12.
FRIDAY, 5:45-6:30 PM
Litt MD, Kreutzer D, Shafer D.
Alterations of inflammatory cytokines in temporomandibular
dysfunction as a function of cognitive-behavioral treatment
University of Connecticut Health Center Litt@nso.uchc.edu
PURPOSE: To determine whether Cognitive-Behavioral
treatment for temporomandibular dysfunction (TMD) pain acts in part
by altering inflammatory function, as measured by levels of circulating
cytokines.
METHODS: Thirty men and women suffering from
jaw pain for at least 3 months and never treated were randomly assigned
to either a standard conservative care group (STD; n=15) or to standard
care plus cognitive-behavioral treatment (STD+CBT; n=15). Treatment
took place one hour per week for 6 weeks. STD consisted of placement
of a flat plane splint plus prescription of nonsteroidal anti-inflammatory
medication. The STD+CBT condition added relaxation training, stress
management, cognitive restructuring intended to promote self-efficacy,
and habit modification. Cytokine measures examined included IL-10, IL-6,
TNF_, IL-3, IL-2, and IL-10. Patients were followed at posttreatment
(6 weeks), 12 weeks, 18 weeks, and 24 weeks. Cytokine assays of patient
plasma were conducted using high sensitivity ELISAs. Detectable levels
were found for IL-10, IL-6, and TNF_ at baseline, and at all follow-ups
for 27 subjects.
RESULTS: Repeated measures ANOVA indicated a
significant Treatment X Time effect on reported pain over the follow-up
period showing ad advantage for STD+CBT over STD alone. Results of repeated
measures ANCOVA yielded significant Treatment X Time effects on IL-6
(p < .05) and on TNF_ (p < .05), such that these cytokine levels tended
to decrease over time in the STD+CBT patients, but did not decrease
in the STD patients. IL-10 levels tended to increase over time in both
groups. Separate linear mixed model analyses were conducted in which
pain was the repeated dependent variable, and each of the three cytokine
levels were independent variables. A significant Treatment X Time X
Cytokine level effect emerged for TNF_ (p < .05), and significant Time
X Cytokine effects emerged for both IL-6 and IL-10 (p < .05 for each
cytokine), indicating that reported pain was in part a function of inflammatory
and ant-inflammatory cytokine levels. These results are consistent with
a pattern of gradually decreasing pro-inflammatory action in IL-6 and
TNF_, and gradually increasing anti-inflammatory action from IL-10,
coinciding with pain levels over time, and varying by Treatment type.
CONCLUSIONS: Results are seen as supporting
the idea that Cognitive-Behavioral treatments may act in part by effecting
changes in cytokine networks and inflammation in chronic pain states.
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