Association between Stigma and Pain in Patients with Temporomandibular Disorders

Abstract

Objective. This study aims to explore the association between stigma and pain in patients with temporomandibular disorders (TMDs). Methods. Two hundred and twenty-five patients with TMDs were recruited, and they completed the questionnaires including the Visual Analogue Scale of Pain (VAS), Generalized Anxiety Disorder 7-Item (GAD-7), the Patient Health Questionnaire 9-item (PHQ-9), Jaw Functional Limitation Scale 8-item (JFLS-8), the Stigma Scale for Chronic Illness 8-item (SSCI-8), and other demographic and disease-related information. The total score of SSCI-8 indicated overall stigma, which could be classified into 2 subdomains, felt stigma and enacted stigma, according to their representative items, respectively. Then, the patients were divided into 2 groups in each subdomain of stigma according to their scores: stigma group (score ≥ 1) and no stigma group (score = 0). Results. Patients with overall stigma and enacted stigma presented significantly higher scores in VAS, GAD-7, PHQ-9, and JFLS-8 than those without overall stigma and those without enacted stigma, respectively. Significant differences between patients with and without felt stigma were only observed in GAD-7, PHQ-9, and JFLS-8. Patients with overall stigma and enacted stigma mainly suffered from pain-related TMDs (PTs) and combined TMDs (CTs). Overall stigma and enacted stigma rather than felt stigma were significantly associated with both PTs and CTs. Stigma, including overall stigma, enacted stigma, and felt stigma, was more associated with anxiety and depression and less related to jaw functional limitation of the patients with TMDs. Conclusion. Stigma, specifically enacted stigma, was correlated to pain in patients with TMDs. Stigma was more related to psychological problems than jaw functional limitation.

Temporomandibular disorder patients with excessive daytime sleepiness present greater pain intensity and reduced jaw function

“…Adjustment for several confounding factors was conducted in this study, but residual confounding effects still remains possible. Multiple psychological factors such as stress and stigma are suggested associated with patients' sleep status and TMD symptoms 34–36 . Some studies indicated that various lifestyle habits, health condition, and mental states such as psychotropic medication use, caffeine intake, use of electronic devices, cognitive factors, etc.…”

“…Multiple psychological factors such as stress and stigma are suggested associated with patients' sleep status and TMD symptoms. [34][35][36] Some studies indicated that various lifestyle habits, health condition, and mental states such as psychotropic medication use, caffeine intake, use of electronic devices, cognitive factors, etc. might act as mediating factors or confounding factors in the relationship between sleep disorders and the development of TMD.…”

Low income is associated with impaired jaw function via anxiety and depression in patients with temporomandibular disorders

“…2,3 The main clinical symptoms include orofacial pain, joint noise and impaired jaw function. 4,5 The aetiology of TMD has long been controversial. 6,7 In recent years, the biopsychosocial medicine perspective has gradually gained widespread recognition, and the onset and development of TMD are considered to be the result of a combination of genetic, environmental, psychological and social factors, etc.…”

“…Epidemiological studies indicate that TMD affects about 5%–12% of the total population, with an annual incidence of 3.9% 2,3 . The main clinical symptoms include orofacial pain, joint noise and impaired jaw function 4,5 …”

Age and Gender, but Not Pain are Associated with Pressure Pain Thresholds in Patients with Temporomandibular Disorders: A Cross-Sectional Study

“…[11][12][13] The influence of various symptoms of TMD has been widely investigated and proven to be associated with psychological disorders, systemic disorders and overlapping pain conditions. 7,8,[11][12][13][14][15] As one of the most common symptoms of TMD, pain in the maxillofacial region, especially chronic pain persisting for a long time, was associated with negative emotions of the patients such as depression, stress, anxiety, and stigma as well as increased pain sensitivity. 7,14,15 The increased pain sensitivity caused by TMD has been related to the genetic factors and psychological disorders mentioned above and may be the result of an abnormal response of the central nervous system to nociceptive information induced by physical or emotional stress.…”