This research study aims to evaluate the effectiveness of Pain Neuroscience Education (PNE) when it is added to a physiotherapy program for people experiencing chronic temporomandibular disorders (TMD). To see whether adding PNE to physiotherapy program would provides additional benefits in reducing pain intensity, improving psychological well-being, and enhancing functional outcomes. The findings are expected to provide new insights into more comprehensive and patient-centered treatment strategies for managing chronic TMD. Participants will be randomly assigned to one of two groups: Control Group: Physiotherapy only PNE Group: Physiotherapy plus Pain Neuroscience Education Both groups will receive their respective treatments for a set period of time.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
36
Physiotherapy treatment programs include therapeutic ultrasound, muscle relaxation techniques, range of motion exercises, and joint and soft tissue mobilization.
PNE sessions will be conducted in addition to physiotherapy programs for intervention groups. PNE sessions will occupy half of each session during the first two weeks. Physiotherapists trained in PNE will deliver sessions using a combination of metaphors, animated videos, and scientifically accurate descriptions. The same physiotherapist will lead both sessions with the same patient. Active learning techniques will include: Connecting new information with prior knowledge. Operationalizing key pain concepts into individual contexts. Facilitated problem-solving and critical reflection.
Istanbul Medipol University
Istanbul, Kavacik, Turkey (Türkiye)
RECRUITINGThe Craniofacial Pain and Disability Inventory (CF-PDI)
It consists of 21 items, with a score ranging from 0 to 63 points. Each question is scored on a 4-point ordinal scale, ranging from 0 to 3. A higher score reflects higher disability levels.
Time frame: Baseline, 1 month after start of treatment, Immediate post-treatment, 3 month follow up
Numeric Pain Rating Scale (NPRS)
It includes an 11-point numerical rating scale, ranging from 0, indicating (no pain), to 10, representing (the worst pain imaginable),.
Time frame: Baseline, 1 month after start of treatment, Immediate post-treatment, 3 month follow up
Pain Self-Efficacy Questionnaire (PSEQ)
It consists of 10 items scored on a 7-point ordinal scale (ranging from 0: "not at all confident" to 6: "completely confident").
Time frame: Baseline, 1 month after start of treatment, Immediate post-treatment, 3 month follow up
Pain Catastrophizing Scale (PCS)
It consists of 13 items for the assessment of catastrophizing thoughts. It is divided into three domains: helplessness, magnification, and rumination. Each item is scored on a 5-point ordinal scale. The PCS total score ranges from 0 to 52 points, higher values denote greater pain catastrophizing.
Time frame: Baseline,1 month after start of treatment, Immediate post-treatment, 3 month follow up
Hospital Anxiety and Depression Scale (HADS)
It comprises two subscales: HADS-Anxiety (HADS-A) and HADS-Depression (HADS-D), each consisting of seven items distributed throughout the questionnaire. Every item is rated on a 4-point Likert scale ranging from 0 to 3, reflecting the severity of symptoms. A score of 8 or above on either subscale is considered indicative of possible anxiety or depression.
Time frame: Baseline, 1 month after start of treatment, Immediate post-treatment, 3 month follow up
The Tampa Scale for Kinesiophobia specific to Temporomandibular Disorders (TSK-TMD)
It consists of 12 items. Each item is scored on a 4-point ordinal scale, ranging from "strongly disagree" (score = 1) to "strongly agree" (score = 4). Ratings are summed to yield a total score. Higher scores reflect a greater fear of movement (12-48 points).
Time frame: Baseline, 1 month after start of treatment, Immediate post-treatment, 3 month follow up
Revised Neurophysiology of Pain Questionnaire (rNPQ)
It includes 12 items, each requiring a true, false, or undecided response. Each correct answer receives one point, while incorrect or undecided answers receive zero. Total scores range from 0 to 12, with higher scores reflecting greater knowledge of pain-related physiological concepts.
Time frame: Baseline, 1 month after start of treatment, Immediate post-treatment, 3 month follow up
The Exercise Adherence Rating Scale (EARS)
The tool consists of six items rated on a five-point Likert scale, ranging from 0 (strongly agree) to 4 (totally disagree). Items with positively worded statements are reverse-scored to maintain consistency in interpretation. The total adherence score ranges from 0 to 24, with higher scores indicating greater adherence to the exercise regimen.
Time frame: Baseline, 1 month after start of treatment, Immediate post-treatment, 3 month follow up
Fear Avoidance Components Scale (FACS)
This self-administered questionnaire comprises 20 items rated on a 6-point Likert scale, ranging from 0 (completely disagree) to 6 (completely agree), yielding a maximum score of 100. Higher scores indicate stronger fear-avoidance beliefs.
Time frame: Baseline, 1 month after start of treatment, Immediate post-treatment, 3 month follow up
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