Journal of Oral Rehabilitation 1999 26; 428 – 435 Posture correction as part of behavioural therapy in treatment of myofascial pain with limited opening O. KOMIYAMA, M. KAWARA, M. ARAI, T. ASANO & K. KOBAYASHI Department of Complete Denture Prosthodontics, Nihon University School of Dentistry at Matsudo, Chiba, Japan ceived only cognitive behavioural intervention and SUMMARY In this study, we applied cognitive be- those who received it together with posture cor- havioural intervention to subjects who had pain- ful limited mouth opening, with or without rection in daily life compared to the non-interven- tion control group although there was little posture correction in daily life. The efficacy of non-intervention control was then compared with difference between the intervention groups. More- it in order to study the effectiveness of posture over, pain-free unassisted mouth opening was re- correction as part of a biobehavioural therapy. The stored earlier in the group which had added visual analogue scale (VAS) value of pain intensity posture correction. This suggests that posture cor- at maximum mouth opening and disturbance in rection in daily life has a positive effect in alleviat- ing myofascial pain with limited mouth opening. daily life sharply declined in the group which re- Introduction Signs and symptoms of temporomandibular disorders (TMD) have been called the ‘TMD triad’: joint/muscle pain, limited range of motion, and joint sounds. Treatment methods for TMD have been wide ranging and variable over the years because of the complexity of signs and symptoms. The aetiology of TMD has not been well-defined, and input from various disci- plines has resulted in a complex overview from prosthodontics, oral surgery, orthodontics, ortho- paedics, otorhinolaryngology, and psychiatry (De- Boever & Carlsson, 1994). In the 1990’s, the concepts emphasized conservative management on the grounds of treatment failures in the past decades and reconsideration of what constitutes TMD (Dworkin, 1994; Wright & Schiffman, 1995). At present, the major problem is considered to be pain (Fricton, 1991), with its elimination as the prime clinical focus in treatment (De Laat et al., 1993; Dao, Lund & Lavi- gne, 1994a). Moreover, how to handle these symp- toms by conservative methodology is another problem. Recently, Dworkin et al. (1994), have clinically ap- plied brief group cognitive behavioural treatment methods (CB) to TMD in its chronic form and they reported that the treatment was effective. In the past, CB treatment methods have been applied to the most common chronic pain conditions (Keel, 1982; Turk, Meichenbaum & Genest, 1983; Turner & Romano, 1990; Turner et al., 1990). These programmes typi- cally involve multiple components, including: (1) in- formation to increase knowledge and awareness of factors influencing chronic pain problems; (2) cogni- tive and behavioural therapies aimed at increasing physical and functional activities, and adaptive re- sponses to pain; and (3) skill training such as the use of relaxation, biofeedback, hypnosis and other self- control strategies to modify perception of pain and related bodily sensations (Fordyce, 1976; Keef & Gil, 1986). It is considered that these methods being most conservative, might indicate a direction in the treat- ment for TMD. Meanwhile, since the relationship between head posture and mandibular function (Mohl, 1976), and 428 © 1999 Blackwell Science Ltd