Biopsychosocial Factors May Help With Coping in Chronic Temporomandibular Disorder
Every 3 months after enrollment, participants initially without a history of temporomandibular disorder were asked to fill out health questionnaires to assess emergence of the condition.
Several biopsychosocial factors as well as temporomandibular disorder (TMD)-related symptoms were found to improve over time in individuals with chronic but not newly occurring TMD, according to a long-term study published in Pain.
Data from 1088 patients with chronic TMD and 3258 individuals with no TMD history (all participants age 18-44 years) from the Orofacial Pain: Prospective Evaluation and Risk Assessment study, which was designed to identify risk factors for development of TMD, were analyzed. Every 3 months after enrollment, participants initially without a history of TMD were asked to fill out health questionnaires to assess emergence of TMD.
The TMD-free participants were divided into those who remained free from TMD and those in whom the condition developed during the initial observation period.
Investigators evaluated changes in psychosocial characteristics, cardiovascular indicators of autonomic function, pain sensitivity, and clinical jaw function in participants who had persisting or remitting chronic TMD at baseline (n=189) and participants who initially were TMD free (n=505). TMD developed in 83 of those who were initially TMD-free during a median 7.6-year follow-up.
In participants with chronic TMD, there was a significant decrease in mean characteristic pain intensity from baseline to follow-up (55.1 vs 45.2, respectively; P <.001). In participants initially free of TMD but in whom the condition later developed, TMD-related symptoms, pain sensitivity, and psychological function were found to be worse.
In addition, patients with baseline chronic TMD experienced improvements in TMD symptoms and in jaw function, increased positive affect, and reduced somatic symptoms. Clinical and psychosocial variables were found to be associated with TMD status to a greater extent than pain sensitivity and autonomic measures.
A limitation of the study is the lack of information regarding treatment-seeking in people in whom TMD developed.
“[T]hese findings demonstrate substantial temporal variability in TMD and its biopsychosocial accompaniments,” noted the investigators.
Fillingim RB, Slade GD, Greenspan JD, et al. Long-term changes in biopsychosocial characteristics related to temporomandibular disorder: findings from the OPPERA study [published online July 19, 2018]. Pain. doi: 10.1097/j.pain.0000000000001348