Living with chronic pain on a daily basis impacts not only the body but also the mind and emotions. This is the reality for thousands of people with temporomandibular disorder (TMD), a condition affecting the joint responsible for opening and closing the mouth, as well as the chewing muscles. For these individuals, constant jaw, temple, facial, or ear pain; difficulty chewing; and headaches can affect their daily routine and mental health.
A study conducted at the Ribeirão Preto School of Nursing at the University of São Paulo (EERP-USP) in Brazil and funded by FAPESP showed that regularly practicing mindfulness, a meditation technique involving focus and full attention, can help reduce pain sensitivity and improve emotional regulation in these individuals. The results were published in the Journal of Oral Rehabilitation.
The research was conducted at the Center for Mindfulness and Integrative Therapies at the University of São Paulo, which was established in 2016. The study was led by Edilaine Gherardi Donato , a nurse and full professor at EERP-USP, who coordinated the team. According to Gherardi-Donato, the study aimed to understand whether practicing mindfulness could alleviate chronic pain associated with TMD and improve multiple factors involved, including neurophysiological and psychological aspects such as stress, anxiety, and "pain catastrophizing." Pain catastrophizing occurs when a person focuses solely on their pain, amplifying their negative perception of it as if it were uncontrollable and unbearable.
"One of the human conditions that causes a lot of psychological suffering and undermines mental health is living with pain. Pain causes constant stress, both physically and mentally," the researcher explains. "When we promote mental health through care strategies that connect the body and mind, we prevent illness and promote quality of life for the population."
According to Gherardi-Donato, TMD is two to three times more prevalent in women than in men and can progress to chronic pain lasting three to six months, even at rest and after conservative treatment. TMD compromises function, impairs sleep and mood, and can cause hyperalgesia, an exaggerated response to painful stimuli.
In these situations, the body goes into a state of alert, the brain becomes sensitized, and the perception of pain increases, affecting not only the jaw region, but also other parts of the body. "These indicators show that pain is no longer just a joint problem, but has become a phenomenon of central nervous system modulation, requiring a multidimensional approach," the researcher says.
How the study was conducted
In the randomized clinical trial, the researcher and her team observed 53 women, aged 18 to 61, and diagnosed with chronic TMD. The women were recruited from the specialized service of the Ribeirão Preto School of Dentistry (FORP-USP), a project partner, as well as through advertising in health institutions and on social media.
Half of the women participated in an eight-week mindfulness program consisting of weekly two-hour face-to-face meetings and a four-hour outdoor session. Participants also received audio recordings of the mindfulness practices learned during the meetings and guidance on how to practice the techniques daily at home. The control group did not receive any intervention during the same period and was monitored to ensure that they did not start any other type of treatment.
"In our research, we only evaluated women because they're more affected by the problem and have hormonal variability that could influence the findings. We looked at cases of chronic painful TMD, that is, people who had been living with pain for an extended period and exhibited the typical signs of chronicity. These women are also more predisposed to feeling pain in different regions of the body due to the involvement of peripheral and central sensitization mechanisms because the nervous system is constantly on alert," the researcher explains.
The mindfulness program was adapted for Brazilian culture. It began with five-minute practices, which gradually increased to 30 minutes daily over the weeks. Activities included formal exercises such as focusing on breathing, body sensations, thoughts, and emotions; as well as different postures such as sitting, lying down, moving, and walking meditation. The program also included informal practices aimed at bringing awareness to routine tasks such as brushing teeth, eating, getting dressed, and washing dishes.
"You can't expect someone who has never practiced mindfulness to be able to meditate for half an hour right away. Progression is essential for a person to learn what it means to be present in their body and emotions without judgment. The practice should be comfortable, easy, simple, and natural," Gherardi-Donato explains.
After eight weeks, the women who participated in the program showed significant improvement in their pressure pain threshold. This means they could tolerate more stimuli before beginning to feel pain. There was also a reduction in painful points throughout the body, decreased stress, and less pain catastrophizing.
"These women reported decreased pain and were less sensitive to mild painful stimuli that were present before the intervention and were uncomfortable. There was a reduction in orofacial pain points and pressure pain in the facial and body regions," the researcher reports. "They also developed greater control of their attention, managing to put the pain into perspective. The pain was still present, but it no longer occupied 100% of their attention, making room for self-care and dealing more consciously with the negative emotions and thoughts that accompany and intensify it," she explains.
Another important finding of the study was the improvement in body awareness and emotional regulation. According to Gherardi-Donato, the practice helped participants cope with challenging sensations more effectively. "The mind of someone who experiences chronic pain tends to ruminate, feeding the fear that the pain will only get worse. This increases stress and the risk of anxiety and depression. With the practice of mindfulness, women begin to recognize pain as something impermanent that doesn't have to dominate their lives."
While the study did not reveal significant changes in anxiety or depression symptoms, Gherardi-Donato notes that the observed benefits in reducing stress and anxiety, improving pain perception, and strengthening cognitive and attentional abilities are significant.
Low cost and available in the public health system
The results reinforce the idea that integrative and complementary health practices such as mindfulness can be an important tool in managing chronic pain, especially complex conditions like TMD. Additionally, mindfulness is a low-cost practice that is easy to implement and incorporate into public health services.
"Mindfulness, as a type of meditation, has been included in the National Policy on Integrative and Complementary Practices of the SUS [acronym for 'Sistema Único de Saúde,' Brazil's national public health system] since 2017 [ Ordinance No. 849 ] This means that it can and should be offered as accessible care to the population, representing an expansion of the care model," she points out.
According to the researcher, mindfulness has an impact that goes beyond physical relief by promoting a change in attitude towards life. "The program restores essential cognitive and emotional skills and improves self-knowledge and self-care. People learn to sustain their attention for longer and access this state of presence in their daily activities as well. It isn't just about sitting and meditating, but about compassionately contemplating the broad range of our experiences, making more conscious choices, and living more consciously in our daily lives, moment by moment," she concludes.
About São Paulo Research Foundation (FAPESP)
The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at www.fapesp.br/en and visit FAPESP news agency at www.agencia.fapesp.br/en to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at http://agencia.fapesp.br/subscribe .
