Influence of culture on pain comorbidity in women with and without temporomandibular disorder‐pain

Abstract

Evidence on cultural differences in prevalence and impact of common chronic pain conditions, comparing individuals with temporomandibular disorders (TMD) versus individuals without TMD, is limited. The aim was to assess cross-cultural comorbid pain conditions in women with chronic TMD pain. Consecutive women patients (n = 122) with the index condition of chronic TMD pain diagnosed per the research diagnostic criteria for TMD and TMD-free controls (n = 121) matched for age were recruited in Saudi Arabia, Italy and Sweden. Self-report questionnaires assessed back, chest, stomach and head pain for prevalence, pain intensity and interference with daily activities. Logistic regression was used for binary variables, and ancova was used for parametric data analysis, adjusting for age and education. Back pain was the only comorbid condition with a different prevalence across cultures; Swedes reported a lower prevalence compared to Saudis (P < 0·01). Saudis reported higher prevalence of work reduced >50% due to back pain compared to Italians or Swedes (P < 0·01). Headache was the most common comorbid condition in all three cultures. The total number of comorbid conditions did not differ cross-culturally but were reported more by TMD-pain cases than TMD-free controls (P < 0·01). For both back and head pain, higher average pain intensities (P < 0·01) and interference with daily activities (P < 0·01) were reported by TMD-pain cases, compared to TMD-free controls. Among TMD-pain cases, Italians reported the highest pain-related disability (P < 0·01). Culture influences the associated comorbidity of common pain conditions. The cultural influence on pain expression is reflected in different patterns of physical representation.

Cross‐cultural differences in types and beliefs about treatment in women with temporomandibular disorder pain

“…Interestingly, Italians take antidepressants significantly more than the two other sites. A possible explanation could be that in the current study, Italians experienced greater interference of pain in their daily living according to the GCPS score (III‐IV) compared to Saudis and Swedes . However, it must be stressed that in the questionnaire, the patients were asked about treatment modalities for TMD, and while antidepressant use could have been for depression rather than TMD, it is also likely that the antidepressant use was for pain or for pain‐related mood changes, consistent with the self‐report by the participants.…”

“…Table lists demographic and pain characteristics for the patients from the three cultures and was presented in a previous study by the same authors . Italian patients were significantly older than Saudi ( P < 0.01) or Swedish patients ( P = 0.01).…”

“…This study was conducted in 2008 and is part of a larger project. Some of the data have been presented elsewhere where more information about the methods can be found …”

Anatomical selectivity in overlap of chronic facial and bodily pain

“…Moreover, studies consistently report that TMD symptoms exhibit significant statistical overlap with other chronic pain conditions, 25 suggesting the existence of common etiologic pathways. 1 Most studies of overlap with orofacial pain have focused on selected pain conditions, classified according to clinical criteria (eg, headaches, cervical spine dysfunction, and fibromyalgia 5 ), location of self-reported pain (eg, back, chest, stomach, and head 2 ), or the number of comorbid pain conditions. 11 Although there is a long tradition of depicting overlap between pain conditions qualitatively using Venn diagrams, 28 we know of few studies that have quantified the degree of overlap between TMD and pain at multiple locations throughout the body.…”

Does temporomandibular disorder correlate with menopausal symptoms?

“…Other studies, 7,8 however, have shown that socioeconomic level could affect TMD. The emotional characteristic of pain, which is strongly influenced by culture, may lead to behavioral modification or heightened awareness, which may increase the prevalence of comorbidities, as a consequence of exposure to the environment; pain processing (which differs among cultural groups), the manner in which pain is interpreted; 16 and adaptive capacity. 15 Sociodemographic factors are potential mitigators or exacerbators of menopausal symptoms 10 because they influence not only women's lifestyle but also their quality of life, and the same can be said about TMD-induced complaints.…”