Catastrophizing Has a Better Prediction for TMD Than Other Psychometric and Experimental Pain Variables

Abstract

Temporomandibular disorders (TMDs) are characterized by moderate to severe pain in the masticatory muscles and/or the temporomandibular joint (TMJ). The present study is a part of a multidisciplinary project, initiated by the Norwegian Ministry of Health. The main purpose of this study is to compare a cohort of TMD patients to healthy individuals regarding experimental pain, the degree of disability caused by living with pain and psychometric variables, and to investigate which of these variables is the best predictor for TMD patients. We hypothesised that TMD patients have more disability when living with pain and lower pain thresholds than healthy controls, and those psychometric variables are stronger predictors than pain thresholds provoked by experimental pain. Sixty TMD patients were matched by sex and age to sixty healthy individuals without TMD symptoms or other musculoskeletal symptoms in the head and neck region. All subjects completed a questionnaire that included psychometric characteristics, that is, a one- and two-item version of the Pain Catastrophizing Scale, the Hospital Anxiety and Depression Scale (HADS), and the Roland Morris Scale (RMS), which measures disability when living with pain. They also underwent a clinical examination including the measurement of pain thresholds with electrical and pressure stimuli. The TMD patients had lower pain thresholds for experimental electrical and pressure stimuli compared with the controls ( P < 0.05 and <0.001, respectively). They also scored higher than healthy individuals with disability living with pain ( P < 0.001 ), anxiety ( P < 0.001 ), depression ( P < 0.001 ), and catastrophizing ( P < 0.001 ). The results for anxiety, depression, and catastrophizing have been published earlier, and the reused data in this study are compared with RMS and pain thresholds. The conditional logistic regression model identified catastrophizing (OR = 2.42, CI 1.22–4.79) as a significant predictor of TMD patients. The results support this hypothesis and indicate that TMD patients have lower pain thresholds and more disability when living with pain compared to healthy individuals, where the strongest prediction for TMD was catastrophizing. Awareness of psychometric disabilities in TMD patients is of importance when considering the choice of treatment.

High Pain Intensity is a Risk Factor of Non-Resolving TMD: A Three-Year Follow-Up of a Patient Group in a Norwegian Interdisciplinary Evaluation Program

“…A description of the interdisciplinary work up and a characterization of the patient group with severe TMD has previously been published. 11,12,16,30,31 Three-Year Follow Up Three years after the interdisciplinary evaluation, the patients received a comprehensive questionnaire by mail, similar to the questionnaire that they had filled in at the first evaluation with the addition of questions regarding their satisfaction with the follow-up by their GMP. Further, there were questions regarding the progression of their TMD symptoms (on a five-point scale, from much improved to much worse) and general health symptoms (on a three-point scale, from improved to worse), what kind of treatments they had received and the outcome of the treatments.…”

“…Chronic stress in patients with TMD has been considered an important characteristic of TMD, as previously shown by high CSQ and HADS scores. 11,12,39 Psychosocial factors, including stress, have also been considered as a major risk factor in TMD, 1,10,40 in the development of chronic pain. 41 Elevated CSQ may indicate poorer prognosis for pain relief in chronic pain in general.…”

“…1,10 Our group have previously reported increased saliva levels of stress hormones together with increased psychometric scoring, decreased pain thresholds and catastrophizing as predictors for TMD. 11,12 Several systematic reviews of TMD highlight the lack of evidence on how to base management decisions. [13][14][15] In 2013, the Norwegian Ministry of Health established a national interdisciplinary evaluation program for TMD patients at Haukeland University Hospital (HUH) in Bergen, Norway.…”

Disturbed sleep may be a core risk factor for jaw functional limitation in patients with painful temporomandibular disorders

“…Axis II core assessment aspects of both RDC/TMD and DC/TMD are psychological distress (eg depression and anxiety), somatisation and pain‐related disability. In addition to psychological distress and somatic symptoms, recent OPPERA studies and numerous studies identified pain catastrophising and maladaptive cognitive error of pain perception, as potent psychometric factors for TMD pain and disability 2,7 8 …”

“…In addition to psychological distress and somatic symptoms, recent OPPERA studies and numerous studies identified pain catastrophising and maladaptive cognitive error of pain perception, as potent psychometric factors for TMD pain and disability. 2,7 Kinesiophobia, another important psychometric dimension for assessing fear of movement, is a strong predictor of disability in patients with musculoskeletal disorders, including TMD. 8 In addition to pain, jaw functional limitation, included in Axis II of RDC/TMD and DC/TMD, is another major negative impact of TMD.…”