Distribution of depression, somatization and pain-related impairment in patients with chronic temporomandibular disorders

Abstract

Objectivethe aim of this study was to describe the frequency of psychosocial diagnoses in a large sample of patients attending a tertiary clinic for treatment of temporomandibular disorders (TMD).Material and Methodssix hundred and ninety-one patients who sought treatment for pain-related TMD were selected. Chronic pain-related disability (Graded Chronic Pain Scale, GCPS), depression [Symptoms Checklist-90 (SCL-90) scale for depression, DEP] and somatization levels (SCL-90 scale for non-specific physical symptoms, SOM) were evaluated through the Research Diagnostic Criteria for TMD (RDC/TMD) Axis II psychosocial assessment; TMD diagnoses were based on the Axis I criteria.Resultsthe majority of patients presented a low disability or no disability at all, with only a small portion of individuals showing a severely limiting, high disability pain-related impairment (4.3%). On the other hand, abnormal scores of depression and somatization were high, with almost half of the individuals having moderate-to-severe levels of depression and three-fourths presenting moderate-to-severe levels of somatization. The prevalence of high pain-related disability (GCPS grades III or IV), severe/moderate depression and somatization was 14.3%, 44% and 74.1% respectively. Gender differences in scores of SCL-DEP (p=0.031) and SCL-SOM (p=0.001) scales were signficant, with females presenting the highest percentage of abnormal values.Conclusionpatients with TMD frequently present an emotional profile with low disability, high intensity pain-related impairment, and high to moderate levels of somatization and depression. Therefore, given the importance of psychosocial issues at the prognostic level, it is recommended that clinical trials on TMD treatment include an evaluation of patients’ psychosocial profiles.

Pain Predictors in a Population of Temporomandibular Disorders Patients

“…Moreover, this investigation is the one of the first to assess risk factors in a population of TMD patients based on the presence of pain and not its location, in accordance with what was suggested for the evaluation of psychological factors in a previous paper [26]. Many studies on TMD risk assessment in the patient population are based on the inclusion of just one group of patients with a specific TMD diagnosis or the inclusion of patients with TMDs in general, i.e., independent of the specific signs and symptoms of TMDs [27][28][29][30][31]. It is also worth mentioning that, in this study, Axis I and Axis II diagnoses were made by an examiner who was thoroughly trained in the RDC/TMD protocol [18].…”

Influence of psychological factors on the prognosis of temporomandibular disorders pain

“…Several previous studies have reported a correlation between SOM score and TMD-related pain. 25 , 26 , 27 The SOM subscale reflects distress from perceived physical dysfunction such as headache and complaints of various organ systems. 12 , 28 Regression analysis showed that with each one-point increase in SOM score, the probability of pain persisting increased by 1.05 times.…”

Effects of 8 weeks of masticatory muscles focused endurance exercises on women with oro‐facial pain and temporomandibular disorders: A placebo randomised controlled trial

“…A possible explanation is that the present exercise approach and assessments to TMD pain did not take into account for the psychosocial sphere, mainly due to excessive number of variables and time consumed to evaluate during the sessions. The psychosocial factors have relevant role in both classifying and treating TMD subjects . Subjects with emotional profile with low disability, high intensity pain‐related impairment, and high to moderate levels of somatisation and depression would be important split factors or a co‐variates to include in future assessments …”

“…The psychosocial factors have relevant role in both classifying and treating TMD subjects . Subjects with emotional profile with low disability, high intensity pain‐related impairment, and high to moderate levels of somatisation and depression would be important split factors or a co‐variates to include in future assessments …”

“…43 Subjects with emotional profile with low disability, high intensity pain-related impairment, and high to moderate levels of somatisation and depression would be important split factors or a co-variates to include in future assessments. 43 The higher time until fatigue in the intervention group compared with placebo was the main factor to change the muscle efficiency as the force remained the same between groups across time. The unchanged biting force was expected due to the characteristics of the exercise protocol.…”