Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Relationship Between Psychological Factors and Pain Intensity in Temporomandibular Disorders with or without Central Sensitization: A Cross-Sectional Observational Study Using Multiple Regression Analysis

  • Received : 2023.08.18
  • Accepted : 2023.09.09
  • Published : 2023.09.30
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Abstract

Purpose: To quantify the relationship between perceived pain intensity and psychological variables in a sample of participants with temporomandibular disorder, with or without central sensitization (CS). Methods: A cross-sectional study with nonprobability convenience sampling was conducted from January 1, 2022, to June 30, 2023. Pain intensity (Numeric Pain Rating Scale), anxiety (State-Trait Anxiety Questionnaire, STAI), catastrophizing (Pain Catastrophizing Scale, PCS), perceived stress (Perceived Stress Scale, PSS), and sleep quality (Pittsburgh Sleep Quality Index, PSQI) were assessed. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Co.), which included descriptive and normality analyses and the calculation of strength of multiple correlational regression. Results: A total of 52 (n=34 female 65.4%; n=18 male 34.6%) subjects with diagnosis of temporomandibular disorders (TMD) were finally included. A total of 26 participants (n=26, 50.0%) were cases suffered from CS (TMD-CS mean=46.62±11.24) while the remaining participants (n=26, 50.0%) were the controls (TMD-nCS mean=26.77, standard deviation [SD]=8.42). The pain intensity was moderate in both groups TMDCS (mean=7.62, SD=0.83) and TMD-nCS (mean=7.05, SD=0.86), anxiety (TMD-CS STAI mean=53.27, SD=11.54; TMD-nCS STAI mean=49, SD=11.55), catastrophizing (TMD-CS PCS mean=46.27, SD=9.75; TMD-nCS PCS mean=26.69, SD=4.97), perceived stress (TMDCS PSS mean=30.35, SD=4.91; TMD-nCS PSS mean=26.12, SD=6.60) and sleep quality (TMD-CS PSQI mean=15.81, SD=3.65; TMD-nCS PSQI mean=12.77, SD=2.76) levels were measured in both groups. In TMD-CS and TMD-nCS, higher anxiety levels were moderately and significantly associated with greater pain intensity β=0.4467 (t=2.477, p=0.021) and β=0.5087 (t=2.672, p=0.014). Nevertheless, catastrophizing, perceived stress and sleep quality were not associated to pain intensity in neither of group. Conclusions: In both TMD-CS and TMD-nCS patients, elevated anxiety levels were moderately and significantly associated with increased pain intensity. However, heightened levels of pain catastrophizing, perceived stress, and poor sleep quality were not significantly associated with increased pain intensity in either of the two analyzed groups.

Keywords

References

  1. Velly AM, Anderson GC, Look JO, et al. Management of painful temporomandibular disorders: Methods and overview of The National Dental Practice-Based Research Network prospective cohort study. J Am Dent Assoc 2022;153:144-157. https://doi.org/10.1016/j.adaj.2021.07.027
  2. Oral K, Bal Kucuk B, Ebeoglu B, Dincer S. Etiology of temporomandibular disorder pain. Agri 2009;21:89-94.
  3. Greene CS. The etiology of temporomandibular disorders: implications for treatment. J Orofac Pain 2001;15:93-105.
  4. Murphy MK, MacBarb RF, Wong ME, Athanasiou KA. Temporomandibular disorders: a review of etiology, clinical management, and tissue engineering strategies. Int J Oral Maxillofac Implants 2013;28:e393-e414. https://doi.org/10.11607/jomi.te20
  5. Wilkie G, Al-Ani Z. Temporomandibular joint anatomy, function and clinical relevance. Br Dent J 2022;233:539-546. https://doi.org/10.1038/s41415-022-5082-0
  6. Minervini G, D'Amico C, Cicciu M, Fiorillo L. Temporomandibular joint disk displacement: etiology, diagnosis, imaging, and therapeutic approaches. J Craniofac Surg 2023;34:1115-1121. https://doi.org/10.1097/SCS.0000000000009103
  7. Chan NHY, Ip CK, Li DTS, Leung YY. Diagnosis and treatment of Myogenous Temporomandibular disorders: a clinical update. Diagnostics (Basel) 2022;12:2914.
  8. Chisnoiu AM, Picos AM, Popa S, et al. Factors involved in the etiology of temporomandibular disorders-a literature review. Clujul Med 2015;88:473-478. https://doi.org/10.15386/cjmed-485
  9. Selaimen CM, Jeronymo JC, Brilhante DP, Lima EM, Grossi PK, Grossi ML. Occlusal risk factors for temporomandibular disorders. Angle Orthod 2007;77:471-477. https://doi.org/10.2319/0003-3219(2007)077[0471:ORFFTD]2.0.CO;2
  10. Shroff B. Malocclusion as a cause for temporomandibular disorders and orthodontics as a treatment. Oral Maxillofac Surg Clin North Am 2018;30:299-302. https://doi.org/10.1016/j.coms.2018.04.006
  11. Aboalnaga AA, Amer NM, Elnahas MO, et al. Malocclusion and temporomandibular disorders: verification of the controversy. J Oral Facial Pain Headache 2019;33:440-450. https://doi.org/10.11607/ofph.2260
  12. Zuniga-Herrera ID, Aguilar-Perez FJ, Escoffie-Ramirez M, Herrera-Atoche JR. Malocclusion complexity in patients with disc displacement disorders: a case-control study. Healthcare (Basel) 2023;11:2202.
  13. Melou C, Leroux L, Bonnesoeur M, Le Padellec C, Bertaud V, Chauvel-Lebret D. Relationship between natural or iatrogenic malocclusions and temporomandibular disorders: a case control study. Cranio 2021:1-9.
  14. Ohlmann B, Waldecker M, Leckel M, et al. Correlations between sleep bruxism and temporomandibular disorders. J Clin Med 2020;9:611.
  15. Pozzato I, Tran Y, Gopinath B, Thuraisingham RA, Cameron ID, Craig A. The role of stress reactivity and pre-injury psychosocial vulnerability to psychological and physical health immediately after traumatic injury. Psychoneuroendocrinology 2021;127:105190.
  16. Miettinen O, Lahti S, Sipila K. Psychosocial aspects of temporomandibular disorders and oral health-related quality-of-life. Acta Odontol Scand 2012;70:331-336. https://doi.org/10.3109/00016357.2011.654241
  17. Jung W, Lee KE, Suh BJ. Influence of psychological factors on the prognosis of temporomandibular disorders pain. J Dent Sci 2021;16:349-355. https://doi.org/10.1016/j.jds.2020.02.007
  18. Anker EA, Sande T, Arefjord K, Hystad SW, Rosen A. The association between pain-related factors and psychological distress in patients with temporomandibular disorder. Psychol Health Med 2023;28:1049-1056. https://doi.org/10.1080/13548506.2022.2121969
  19. Latremoliere A, Woolf CJ. Synaptic plasticity and central sensitization: author reply. J Pain 2010;11:801-803. https://doi.org/10.1016/j.jpain.2010.06.006
  20. Cathenaut L, Schlichter R, Hugel S. Short-term plasticity in the spinal nociceptive system. Pain 2023. doi: 10.1097/j.pain.0000000000002999. [Epub ahead of print]
  21. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain 2011;152(3 Suppl):S2-S15. https://doi.org/10.1016/j.pain.2010.09.030
  22. Bell T, Trost Z, Buelow MT, et al. Meta-analysis of cognitive performance in fibromyalgia. J Clin Exp Neuropsychol 2018;40:698-714. https://doi.org/10.1080/13803395.2017.1422699
  23. van den Broeke EN. Central sensitization and pain hypersensitivity: some critical considerations. F1000Res 2018;7:1325.
  24. Meeus M, Nijs J. Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clin Rheumatol 2007;26:465-473. https://doi.org/10.1007/s10067-006-0433-9
  25. Eller-Smith OC, Nicol AL, Christianson JA. Potential mechanisms underlying centralized pain and emerging therapeutic interventions. Front Cell Neurosci 2018;12:35.
  26. Monaco A, Cattaneo R, Marci MC, Pietropaoli D, Ortu E. Central sensitization-based classification for temporomandibular disorders: a pathogenetic hypothesis. Pain Res Manag 2017;2017:5957076.
  27. Ferrillo M, Giudice A, Marotta N, et al. Pain management and rehabilitation for central sensitization in temporomandibular disorders: a comprehensive review. Int J Mol Sci 2022;23:12164.
  28. Campi LB, Jordani PC, Tenan HL, Camparis CM, Goncalves DAG. Painful temporomandibular disorders and central sensitization: implications for management-a pilot study. Int J Oral Maxillofac Surg 2017;46:104-110. https://doi.org/10.1016/j.ijom.2016.07.005
  29. Chaves TC, Dach F, Florencio LL, et al. Concomitant migraine and temporomandibular disorders are associated with higher heat pain hyperalgesia and cephalic cutaneous allodynia. Clin J Pain 2016;32:882-888. https://doi.org/10.1097/AJP.0000000000000369
  30. Bevilaqua-Grossi D, Lipton RB, Napchan U, Grosberg B, Ashina S, Bigal ME. Temporomandibular disorders and cutaneous allodynia are associated in individuals with migraine. Cephalalgia 2010;30:425-432. https://doi.org/10.1111/j.1468-2982.2009.01928.x
  31. Cayrol T, van den Broeke EN, Gerard E, et al. Chronic temporomandibular disorders are associated with higher propensity to develop central sensitization: a case-control study. Pain 2023;164:e251-e258. https://doi.org/10.1097/j.pain.0000000000002803
  32. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008;61:344-349.
  33. Cuesta-Vargas AI, Roldan-Jimenez C, Neblett R, Gatchel RJ. Cross-cultural adaptation and validity of the Spanish central sensitization inventory. Springerplus 2016;5:1837.
  34. McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med 1988;18:1007-1019. https://doi.org/10.1017/S0033291700009934
  35. Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res (Hoboken) 2011;63 Suppl 11:S467-S472. https://doi.org/10.1002/acr.20561
  36. Olmedilla-Zafra A, Ortega-Toro E, Abenza-Cano L. Validacion de la escala de catastrofismo ante el dolor (Pain Catastrophizing Scale) en deportistas espanoles. CPD 2013;13:83-94. https://doi.org/10.4321/S1578-84232013000100009
  37. Remor E. Psychometric properties of a European Spanish version of the Perceived Stress Scale (PSS). Span J Psychol 2006;9:86-93. https://doi.org/10.1017/S1138741600006004
  38. Buysse DJ, Reynolds CF, Monk TH, Berman SR , Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213. https://doi.org/10.1016/0165-1781(89)90047-4
  39. Staniszewski K, Lygre H, Bifulco E, et al. Temporomandibular disorders related to stress and HPA-Axis regulation. Pain Res Manag 2018;2018:7020751.
  40. Lambert CA, Sanders A, Wilder RS, et al. Chronic HPA axis response to stress in temporomandibular disorder. J Dent Hyg 2013;87:73-81.
  41. Korszun A, Papadopoulos E, Demitrack M, Engleberg C, Crofford L. The relationship between temporomandibular disorders and stress-associated syndromes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:416-420. https://doi.org/10.1016/S1079-2104(98)90366-3
  42. Fillingim RB, Ohrbach R, Greenspan JD, et al. Potential psychosocial risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case-control study. J Pain 2011;12(11 Suppl):T46-T60. https://doi.org/10.1016/j.jpain.2011.08.007
  43. Aranha RLB, Martins RC, de Aguilar DR, et al. Association between stress at work and temporomandibular disorders: a systematic review. Biomed Res Int 2021;2021:2055513.
  44. Dreweck FDS, Soares S, Duarte J, Conti PCR, De Luca Canto G, Porporatti AL. Association between painful temporomandibular disorders and sleep quality: a systematic review. J Oral Rehabil 2020;47:1041-1051. https://doi.org/10.1111/joor.12993
  45. Benassi GF, Mariotto LGS, Botelho AL, Da Costa Valente ML, Dos Reis AC. Relationship between temporomandibular dysfunctions, sleep disorders, and anxiety among dentistry students. Cranio 2022;40:258-261. https://doi.org/10.1080/08869634.2019.1708609
  46. Poppe C, Crombez G, Devulder J, Hanoulle I, Vogelaers D, Petrovic M. Personality traits in chronic pain patients are associated with low acceptance and catastrophizing about pain. Acta Clin Belg 2011;66:209-215.
  47. Pallegama RW, Ariyasinghe S, Perera ED, Treede RD. Influence of catastrophizing and personality traits on recalled ratings of acute pain experience in healthy young adults. Pain Med 2017;18:49-60. https://doi.org/10.1093/pm/pnw123