Psychological Factors Associated With Development of TMD: The OPPERA Prospective Cohort Study

Abstract

Case-control studies have consistently associated psychological factors with chronic pain in general and with temporomandibular disorders (TMD) specifically. However, only a handful of prospective studies has explored whether pre-existing psychological characteristics represent risk factors for first-onset TMD. The current findings derive from the prospective cohort study of the Orofacial Pain Prospective Evaluation and Risk Assessment (OPPERA) cooperative agreement. For this study, 3,263 TMD-free participants completed a battery of psychological instruments assessing general psychological adjustment and personality, affective distress, psychosocial stress, somatic symptoms, and pain coping and catastrophizing. Study participants were then followed prospectively for an average of 2.8 years to ascertain cases of first-onset of TMD, and 2,737 provided follow-up data and were considered in the analyses of TMD onset. In bivariate and demographically-adjusted analyses, several psychological variables predicted increased risk of first-onset TMD, including reported somatic symptoms, psychosocial stress, and affective distress. Principal component analysis of 26 psychological scores was used to identify latent constructs, revealing four components: stress and negative affectivity, global psychological and somatic symptoms, passive pain coping, and active pain coping. In multivariable analyses, global psychological and somatic symptoms emerged as the most robust risk factor for incident TMD. These findings provide evidence that measures of psychological functioning can predict first-onset of TMD. Future analyses in the OPPERA cohort will determine whether these psychological factors interact with other variables to increase risk for TMD onset and persistence.

Genetics of chronic post-surgical pain: a crucial step toward personal pain medicine

“…The current model of the susceptibility for developing TMD includes anatomical, neuromuscular, and psychological factors that operate in parallel, reflecting the concerted effects of genetic and non-genetic etiological factors. [35][36][37][38] The OPPERA project began by recruiting 3,300 healthy women who were followed up for five years with the expectation that about 10% would develop TMD over the course of the study. By having participants respond to psychological questionnaires, questionnaires that describe various aspects of TMD pain, and a number of psychophysical and cardiovascular assays, this project identified non-genetic risk factors for TMD.…”

COMT Diplotype Amplifies Effect of Stress on Risk of Temporomandibular Pain

“…Cross-sectional research over ensuing decades provided empirical support for this theoretical model, demonstrating a strong association between psychological factors and painful temporomandibular disorders (TMDs). More recent prospective studies confirmed the temporal sequence of this relationship, showing that increases in several dimensions of psychological distress predicted greater risk of TMD development (Slade et al 2007;Aggarwal et al 2010;Kindler et al 2012;Fillingim et al 2013;Sipila et al 2013).…”

Chronicity factors of temporomandibular disorders: a critical review of the literature

“…36 Other study showed that measures of catastrophizing and active pain coping, which are well-established constructs associated with chronic pain, were not significant predictors of the onset of TMD, but they could play a role in the perpetuation of TMD symptoms. 37 Taken together, physiological distress, sleep problems, upregulation of the serotonergic pathway, and gene polymorphisms could act as chronicity factors for TMD and pain amplification because they also act as pain-perpetuating factors. These literature findings are in line with the multifactorial etiology of chronic facial pain, and shift the perspective away from a local etiology towards a more central etiology, with dysregulations in the stress and pain-modulating systems.…”