Psychosocial factors associated with pain outcomes in patients with painful temporomandibular disorders and headaches

The objective of this study was to assess the association between psychosocial factors (in terms of anxiety, somatization, depression, and optimism) and pain (in terms of headache pain intensity and pain-related disability), in patients with a painful temporomandibular disorder (TMD) and one of the following headache types: migraine, tension-type headache (TTH), or headache attributed to TMD, corrected for the influence of bruxism. A retrospective study was conducted at an orofacial pain and dysfunction (OPD) clinic. Inclusion criteria were painful TMD, with migraine, TTH, and/or headache attributed to TMD. Linear regressions were performed to assess the influence of psychosocial variables on pain intensity and on pain-related disability, stratified per headache type. The regression models were corrected for bruxism and the presence of multiple headache types. A total of 323 patients (61% female; mean age 42.9, SD 14.4 years) were included. Headache pain intensity only had significant associations in TMD-pain patients with headache attributed to TMD, and anxiety showed the strongest relation (β = 0.353) with pain intensity. Pain-related disability was most strongly associated with depression in TMD-pain patients with TTH (β = 0.444), and with somatization in patients with headache attributed to TMD (β = 0.399). In conclusion, the influence of psychosocial factors on headache pain intensity and pain-related disability depends on the headache type presenting.     

Relationship between self‐reported sleep bruxism and pain in patients with temporomandibular disorders

The aim of this study was to evaluate the association between self‐reported sleep bruxism and the age, gender, clinical subtypes of temporomandibular disorders (TMD), pain intensity and grade of chronic pain in patients previously diagnosed with TMD. Thousand two‐hundred and twenty patients of the Andalusian Health Service were examined using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire. The inclusion and exclusion criteria were those included in the RDC/TMD criteria. The bruxism diagnosis was drawn from the question, ‘Have you been told, or do you notice that you grind your teeth or clench your jaw while sleeping at night?’ in the anamnestic portion of the questionnaire. A bivariate analysis was conducted, comparing the presence of perceived parafunctional activity with age (over age 60 and under age 60), gender, different subtypes of TMD, pain intensity, grade of chronic pain and presence of self‐perceived locked joints. The overall prevalence of self‐reported sleep bruxism (SB) was 54·51%. A statistically significant association was found between the presence of SB and patients under age 60, women, greater pain intensity, greater pain interference with activities of daily living, and the axis‐I groups affected by both muscular and articular pathology. There is a statistically significant association between self‐reported sleep bruxism and women under age 60 who have painful symptoms of TMD. There is also a positive association between this parafunctional habit and the presence of chronic pain. However, more studies that cover larger samples and differentiate between sleep bruxism and awake bruxism are needed.     

颞下颌关节紊乱病患者疼痛的临床描述分析

目的通过研究颞下颌关节紊乱病（TMD）患者对疼痛的主观描述情况,分析TMD患者疼痛的特点。方法选择以口颌面部疼痛为主诉的TMD患者90例为研究对象,检测患者疼痛的强度和相关功能丧失的程度,记录患者自述的疼痛规律和描述疼痛的词汇。结果90例患者主要为轻到中等强度的疼痛,男女之间以及急、慢性期之间疼痛强度的差异无统计学意义（P>0.05）。TMD疼痛对咀嚼功能的影响最大,其次是对心情状况有比较大的影响。急、慢性期患者下颌静止时疼痛出现率无统计学差异（P>0.05）。急性期患者常用酸痛、隐痛、刺痛和抽着痛来描述疼痛,慢性期患者常用的词汇是钝痛、木痛和胀痛。结论急、慢性期TMD导致的疼痛强度均较低,主要影响患者的咀嚼功能和心理状态。急、慢性TMD疼痛的描述词汇有所不同。     

压力痛阈测试在颞下颌关节病中的应用

压力痛阈测试(pressure pain threshold,PPT)作为定量感觉测试的一项指标已经被用于颞下颌关节病的临床研究,其在揭示疾病疼痛的发生机制、预测疾病发展过程、判断不同治疗的临床效果差异等方面有巨大作用。本文就PPT在颞下颌关节病中的研究进展及其局限性作一综述。     

Validation of the Pain Resilience Scale in Chinese‐speaking patients with temporomandibular disorders pain

To validate the Pain Resilience Scale (PRS) for use in Chinese patients with temporomandibular disorders (TMD) pain. According to international guidelines, the original PRS was first translated and cross‐culturally adapted to formulate the Chinese version of PRS (PRS‐C). A total of 152 patients with TMD pain were recruited to complete series of questionnaires. Reliability of the PRS‐C was investigated using internal consistency and test‐retest reliability. Validity of the PRS‐C was calculated using cross‐cultural validity and convergent validity. Cross‐cultural validity was evaluated by examining the confirmatory factor analysis (CFA). And convergent validity was examined through correlating the PRS‐C scores with scores of 2 commonly used pain‐related measures (the Connor‐Davidson Resilience Scale [CD‐RISC] and the Tampa Scale for Kinesiophobia for Temporomandibular Disorders [TSK‐TMD]). The PRS‐C had a high internal consistency (Cronbach's alpha = 0.92) and good test‐retest reliability (intra‐class correlation coefficient [ICC] = 0.81). The CFA supported a 2‐factor model for the PRS‐C with acceptable fit to the data. The fit indices were chi‐square/DF = 2.21, GFI = 0.91, TLI = 0.97, CFI = 0.98 and RMSEA = 0.08. As regards convergent validity, the PRS‐C evidenced moderate‐to‐good relationships with the CD‐RISC and the TSK‐TMD. The PRS‐C shows good psychometric properties and could be considered as a reliable and valid measure to evaluate pain‐related resilience in patients with TMD pain.     

咬合板对颞下颌关节紊乱病相关颌面部疼痛的影响

颞下颌关节紊乱病（temporomandibular disorders, TMD）是口颌面部慢性痛的主要来源,严重干扰日常活动。咬合板是颞下颌关节紊乱病的最常用的治疗方法之一,但其疗效尚未完全明了。学者们多年来致力于对咬合板的作用机制、疗效的研究,但至今尚未得出统一的结果。该文将对咬合板的作用机制、咬合板的分类、TMD相关疼痛的种类与咬合板的选择、TMD的其他保守治疗与咬合板的关系四个方面对于咬合板治疗颞下颌关节紊乱病相关颌面部疼痛的疗效进行进行综述。     

Magnetic resonance imaging findings of osteoarthrosis and effusion in patients with unilateral temporomandibular joint pain

The purpose of this study was to investigate the relationship between the presence of temporomandibular joint (TMJ) pain and the magnetic resonance (MR) imaging findings of osteoarthrosis (OA), and effusion. The study comprised 112 consecutive TMJ pain patients. Criteria for including a patient were report of unilateral pain near the TMJ, with the presence of unilateral TMJ pain during palpation, function, and/or unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ OA, and/or effusion. Comparison of the TMJ side-related data showed a significant relationship between the clinical finding of TMJ pain and the MR imaging diagnoses of TMJ OA (P=0.000), and TMJ effusion (P=0.000). Further, there was a significant relationship between the MR imaging diagnosis of TMJ OA and TMJ effusion (P=0.000). Use of the Kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of TMJ OA (K=0.22), TMJ effusion (K=0.29), and TMJ 'OA and effusion' (K=0.30). The study's findings suggest that while clinical pain is correlated to TMJ-related MR imaging findings, clinical pain in and of itself, is not reliable for predicting the presence of TMJ OA and/or effusion. Validation of MR imaging diagnoses would involve the investigation of cross-sectional and longitudinal evidence to assess decisive differences in terms of prognosis and/or treatment outcome.     

Associations of pain intensity and pain‐related disability with psychological and socio‐demographic factors in patients with temporomandibular disorders: a cross‐sectional study at a specialised dental clinic

The study assessed whether psychological and socio‐demographic factors, including somatisation, depression, stress, anxiety, daytime sleepiness, optimism, gender and age, are associated with pain intensity and pain‐related disability in patients with temporomandibular disorders (TMDs). In total, 320 TMD patients were involved in the study. The psychological status of each patient was assessed with questionnaires, including the Symptom Checklist‐90 (SCL‐90), Epworth Sleeping Scale (ESS), stress questionnaire and Life Orientation Test‐Revised (LOT‐R). TMD pain, including pain intensity and pain‐related disability, was assessed with characteristic pain intensity (CPI) and disability points scales. The associations of psychological and socio‐demographic factors with pain intensity and pain‐related disability were assessed through logistic regression analyses. Higher pain intensity was significantly associated with more severe anxiety (P = 0·004), more severe somatisation (P < 0·001), more severe depression (P < 0·001), more severe stress (P = 0·001) and lower optimism (P = 0·025) in univariate regression analyses. However, multiple regression analysis showed that only somatisation was significantly associated with pain intensity (P < 0·001). Higher pain‐related disability was significantly associated with more severe anxiety (P < 0·001), more severe somatisation (P < 0·001), more severe depression (P < 0·001), more severe stress (P < 0·001) and lower optimism (P = 0·003) in univariate regression analyses. However, multiple regression analysis showed that only depression was significantly associated with pain‐related disability (P = 0·003). Among the psychological and socio‐demographic factors in this study, somatisation was the best predictor of pain intensity, while depression was the best predictor of pain‐related disability.     

Correlation of somatization,depression, and chronic pain with clinical findings of the temporomandibular disorders in asymptomatic women

ABSTRACT

Objective: The aim of this study was to correlate degree of depression, somatization, and chronic pain in asymptomatic women with clinical findings, using Research Diagnostic Criteria/Temporomandibular disorders (RDC/TMD).

Methods: A total of 200 female participants, ages 18–65, filled out a standard RDC/TMD axis II form for the assessment of chronic pain, disability, depression, and non-specific physical symptoms and underwent clinical examination of the temporomandibular joint. Correlation of clinical findings (axis I) and axis II assessment was performed using Spearman’s correlation test, with significance set at p < 0.05.

Results: There was a significant correlation between depression scores (p < 0.04), chronic pain (p < 0.001), and non-specific physical symptoms without questions about pain (p = 0.008).

Discussion: The highest scores on the Graded Chronic Pain Scale were observed in patients with arthralgia, while patients with myofascial pain scored higher on depression and somatization tests.     

The relationship between neck pain and cervical alignment in patients with temporomandibular disorders

ABSTRACT

Objective: To elucidate the impact of neck pain on cervical alignment in patients with TMDs.

Method: Patients diagnosed with TMDs between November 2013 and November 2015 were included. All subjects underwent lateral cervical X-ray evaluation and completed the RDC/TMD Axis II Biobehavioral Questionnaire for TMDs. Patients with neck pain also completed the Neck Pain & Disability Scale (NPDS). Cervical lordosis angle was measured according to C2-C7 Cobb’s method.

Results: The mean cervical lordosis angle of the whole group (n = 60) revealed hypolordosis (10.9 ± 12.7°). Cervical lordosis angle did not differ between patients with (n = 28) and without (n = 32) neck pain (12.2 ± 12.8° versus 9.8 ± 12.7°, respectively; p = 0.46). TMD-related variables were not correlated with cervical alignment but were moderately correlated with NPDS score, with the exception of TMD-associated disability.

Conclusion: Patients with TMDs have hypolordotic cervical malalignment (tendency toward kyphosis) regardless of neck pain.     

Depressive symptoms in Asian TMD patients and their association with non-specific physical symptoms reporting

BACKGROUND: The expression of depression in Asian temporomandibular disorder (TMD) patients may differ from that of their Caucasian counterparts. This study examined the prevalence of depressive symptoms and their association with non-specific physical symptoms (NPSs) reporting in Asian patients. METHODS: Two hundred and fifty-five Asian TMD patients (68 males; 187 females) with a mean age of 33.0 years were selected for this study. Research diagnostic criteria (RDC)/TMD history questionnaire was input directly into computers by patients using the NUS TMDv.1.1 software. Symptom Checklist 90 (SCL-90) depression and NPS scales were generated online and automatically archived for statistical analysis. Data were subjected to ANOVA/Scheffe's test and Pearson's correlation at significance level 0.05 and 0.01, respectively. RESULTS: 43.1 and 50.6% of the patients scored moderate-to-severe on the depression and NPS scales, respectively. The percentage of patients with diffuse physical symptoms remained high (45.5%), even after pain items were excluded from the computation. NPS scores ranged from 0.34 to 1.64, while depression scores ranged from 0.27 to 1.21. A significant and positive correlation (r = 0.74) was observed between depression and NPS scores. CONCLUSIONS: The prevalence of depressive symptoms and NPSs was lower in Asian TMD patients. Psychological distress experienced by female Asian TMD patients was comparable to their male counterparts. Results also suggest that depressive symptomatology is associated with the reporting of multiple NPSs.     

Endurance to physical strain in patients with temporomandibular disorders: a case-control study

Abstract

Objective. The hypothesis tested was whether patients with temporomandibular disorders (TMD) have an impaired endurance to motor tasks, under physical strain. Material and methods. The study population included 81 cases with TMD and 75 controls. After giving their informed consent, the participants filled out a questionnaire and performed five endurance trials. Each trial was measured in seconds from start to termination. The tests included: (a) holding the arm in a straight out position with a 2 kg weight in the hand, (b) lifting and lowering the arm with a 2 kg weight in the hand, (c) opening and closing the mandible repeatedly against a resistance of 1.6 kg during the jaw-opening phase, (d) protruding and retracting the mandible repeatedly against a resistance of 1.6 kg during the protruding phase and (e) unilateral chewing of three pieces of chewing gum. Analysis of differences between cases and controls for endurance were evaluated with Mann-Whitney U-test. A p-value < 0.05 was considered statistically significant. Results. The cases had statistically significantly (p < 0.0001) lower endurance time than controls for all tests. Conclusions. Patients with TMD compared to those without signs and symptoms of TMD have an impaired capacity to endure motor tasks that involve physical demand of the jaw muscles and shoulder girdle muscles.     

Determination of a pressure pain threshold cut‐off value for the diagnosis of temporomandibular joint arthralgia

Temporomandibular joint (TMJ) disorders are divided by the American Academy of Orofacial Pain into five categories. The most common ones are joint pain, as arthralgia and joint disorders, as disc displacements. An important clinical presentation of arthralgia is the painful tenderness to manual palpation or decreased pressure pain threshold (PPT). The authors conducted a study to determine the appropriate PPT value to discriminate asymptomatic TMJ individuals from those with moderate to severe arthralgia. Forty‐nine individuals was evaluated and divided into groups: TMJ arthralgia, asymptomatic disc displacement and control group. Magnetic resonance images were obtained for all the groups, and algometry was performed on the TMJ lateral pole. Patients with arthralgia filled out a visual analogue scale (VAS). anova test with 1% of significance analysed the data. Specificity, sensitivity and ROC curve were also determined. Arthralgia group had significant lower PPT (mean of 1·07 kgf cm^?2) than the others. Asymptomatic disc displacement group (mean of 1·64 kgf cm^?2) has shown significant lower PPT than the control (mean of 2·35 kgf cm^?2). 89·66% of specificity and 70% of sensitivity were obtained when 1·36 kgf cm^?2 was applied to the TMJ (ROC area = 0·90). This value was considered to be the most appropriate to detected moderate to severe TMJ arthralgia. Indeed, the presence of disc displacement seems to significantly decrease PPT levels in asymptomatic subjects. The PPT value of 1·36 kgf cm^?2 can be used in the calibration procedures of the professionals involved with temporomandibular disorders and orofacial pain.     

Risk factors for temporomandibular joint pain in patients with disc displacement without reduction - a magnetic resonance imaging study

The purpose of this study was to evaluate whether the magnetic resonance (MR) imaging variables of temporomandibular joint (TMJ) internal derangement, osteoarthrosis and/or effusion may predict the presence of pain in patients with a clinical disorder of an internal derangement type (ID)-III. The relationship between TMJ ID-III pain and TMJ internal derangement, osteoarthrosis and effusion was analysed in MR images of 84 TMJs in 42 patients with a clinical unilateral diagnosis of TMJ ID-III pain. Criteria for including a TMJ ID-III pain patient were report of orofacial pain referred to the TMJ, with the presence of unilateral TMJ pain during palpation, function and/or unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement, osteoarthrosis and effusion. Using chi-square analysis for pair-wise comparison, the data showed a significant relationship between the MR imaging findings of TMJ ID-III pain and those of internal derangement (P=0.01) and effusion (P=0.00). Of the MR imaging variables considered simultaneously in the multiple logistic regression analysis, osteoarthrosis (P=0.82) and effusion (P=0.08) dropped out as non-significant in the diagnostic TMJ pain group when compared with the TMJ non-pain group. The odds ratio that a TMJ with an internal derangement type of disk displacement without reduction might belong to the pain group was strong (2.7:1) and highly significant (P=0.00). Significant increases in risk of TMJ pain occurred with 'disk displacement without reduction in combination with osteoarthrosis' (5.2:1) (P=0.00) and/or 'disk displacement without reduction in combination with osteoarthrosis and effusion' (6.6:1) (P=0.00). The results suggest that TMJ pain is related to internal derangement, osteoarthrosis and effusion. However, the data re-emphasize the aspect that these MR imaging variables may not be regarded as the unique and dominant factors in defining TMJ pain instances.     

The gap between dental education and clinical treatment in temporomandibular disorders and orofacial pain

Implementation of research findings in patient care ideally will follow in a continuous cycle, and clinical questions from practitioners should stimulate research. Even in the most optimal situations, there will be a gap between the steady flow of new findings from research and their eventual implementation in clinical practice. In the clinical practice of temporomandibular disorders and orofacial pain (TMD/OFP) simple cases outnumber the more complex cases by far. Therefore, research implications for the general dental practitioner, whose patients are rarely represented in research populations, may differ from what is published and taught. Treatment options like counselling, occlusal treatments (reversible as a rule and irreversible by exception) and physiotherapy can be very successful in the hands of the general dental practitioner. European dental schools should define additional amendments to the recently proposed profile and competencies for the European dentist, in order to focus on the relevant and current knowledge on temporomandibular disorders and orofacial pain. These amendments should address the adequate diagnosis and management of non-complex TMD cases and the need to refer to a TMD/OFP specialist in complex cases. Professional organizations such as the European Academy of Craniomandibular disorders can endorse better TMD/OFP education and training.     

Associations among temporomandibular disorders,chronic neck pain and neck pain disability in computer office workers: a pilot study

Neck pain is the most common musculoskeletal complaint among computer office workers. There are several reports about the coexistence of neck pain and temporomandibular disorders (TMD). However, there are no studies investigating this association in the context of work involving computers. The purpose of this study was to verify the association between TMD and neck pain in computer office workers. Fifty‐two female computer workers who were divided into two groups: (i) those with self‐reported chronic neck pain and disability (WNP) (n = 26) and (ii) those without self‐reported neck pain (WONP) (n = 26), and a control group (CG) consisting of 26 women who did not work with computers participated in this study. Clinical assessments were performed to establish a diagnosis of TMD, and craniocervical mechanical pain was assessed using manual palpation and pressure pain threshold (PPT). The results of this study showed that the WNP group had a higher percentage of participants with TMD than the WONP group (42·30% vs. 23·07%, χ² = 5·70, P = 0·02). PPTs in all cervical sites were significantly lower in the groups WNP and WONP compared to the CG. Regression analysis revealed TMD, neck pain and work‐related factors to be good predictors of disability (R² = 0·93, P < 0·001). These results highlighted the importance of considering the work conditions of patients with TMD, as neck disability in computer workers is explained by the association among neck pain, TMD and unfavourable workplace conditions. Consequently, this study attempted to emphasise the importance of considering work activity for minimising neck pain‐related disability.