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

Inclusion criteria

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history of a myocardial infarction within the past 3 months * Current treatment with an antidepressant which cannot be withdrawn * Current use of a medication that interacts with nortriptyline to raise blood levels, such as selective serotonin reuptake inhibitors (e.g.,paroxetine),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)