Comparison of Psychological and Pharmacological Treatments for Pain Due to Temporomandibular Joint Disorder (TMD)

Inclusion: Age >= 18 and <= 65 Pain >= 3 months duration due to temporomandibular joint disorder Pain due to TMD is primary if other pain conditions present Exclusion: Continuous, chronic painful non-reducing disc displacement of TMJ and patient can't open mouth Unstable or acute severe pain from another pain condition Patient is pregnant Presence of a medical condition that contraindicates nortriptyline: angle-closure glaucoma,symptomatic orthosis EKG: first degree heart block or QTc > 450 msec Unstable angina or a history of a myocardial infarction within the past 3 months Current treatment with an antidepressant which cannot be withdrawn Current use of a medication that interacts with nortriptyline to raise blood levels, such as selective serotonin reuptake inhibitors (e.g.,paroxetine), systemic anti-fungal agents (fluconazole), antiarrhythmics (e.g., quinidine), antipsychotics (e.g., haloperidol), and antibiotics (e.g., erythromycin). Presence of dementia, psychosis or other disorder of cognition that impairs ability to participate in minimal contact intervention Beck Depression Inventory (BDI) score >= 35 OR BDI Item #9 (suicide item) is scored > 1 Patient has a terminal illness with a life expectancy of less than six months History of arthrotomy of temporomandibular joint History of allergic reaction to nortriptyline or benztropine History of a therapeutic trial with nortriptyline (dose >= 100 mg for at least 3 weeks)