Muscle tenderness in different types of facial pain and its relation to anxiety and depression: A cross-sectional study on 649 patients

Abstract

To evaluate in patients with different types of facial pain the association between muscle tenderness and a set of characteristics, 649 consecutive outpatients with facial myogenous pain (MP), TMJ disorder, neuropathic pain (NP) and facial pain disorder (FPD) (DSM-IV) were enrolled. For each patient a psychological assessment on the Axis 1 of the DSM-IV and standardized palpation of pericranial and cervical muscles were carried out. A pericranial muscle tenderness score (PTS), a cervical muscle tenderness score (CTS) and a cumulative tenderness score (CUM, range 0-6) were calculated. Univariate analyses (one-way analysis of variance or chi(2) test) indicated that both age- and sex-distribution, tenderness scores and prevalence of psychiatric disorders markedly differed between groups. The prevalence of depression was highest in FPD patients (44.9%). Both muscle tenderness scores (either PTS or CTS) and prevalence of anxiety were higher in patients with MP than in those with TMJ or NP. To assess associations between CUM score and patients' demographic and clinical characteristics an ordered logit model was fit and interactions between psychiatric disorders and diagnostic groups were tested. The analysis showed that, regardless of the diagnostic group, anxiety and depression independently increase the likelihood of having one point higher muscle tenderness score (OR=1.55, 95% CI: 1.13-2.12 and OR=1.56, 95% CI: 1.10-2.21, respectively). A careful screening for the presence of an underlying psychiatric disorder, either anxiety or depression, should be part of the clinical evaluation in patients suffering from facial pain.

Mental Status as a Common Factor for Masticatory Muscle Pain: A Systematic Review

“…In 70% of studies individuals were assessed based on RDC/TMD as a diagnostic criterion. Other diagnostic criteria were Graded Chronic Pain Scale (Park et al, 2010; Velly et al, 2011), Guideline of diagnosis of TMD by the American Academy of Orofacial Pain (Kindler et al, 2012; Boggero et al, 2016), Diagnostic Criteria for FM (Nilsen et al, 2008; Pfau et al, 2009; Velly et al, 2010; Alfvén, 2012; García-Moya et al, 2015), International Classification of Headache Disorders II (Mongini et al, 2007; de Tommaso et al, 2009), International Headache Society (Glaros et al, 2007), Diagnostic and Statistical Manual of Mental Disorders-IV (Mongini et al, 2007; Vidaković et al, 2016), Craniomandibular Index (Penna et al, 2009), and Craniomandibular Index/RDC (Velly et al, 2011). In three studies only healthy subjects were included and RDC/TMD were treated as excluding criteria (Slade et al, 2007; Komiyama et al, 2008; Manfredini et al, 2011).…”

Anxiety and depression in patients with chronic temporomandibular pain and in controls

“…Thus, after examining 649 patients with facial pain divided into four diagnostic subgroups, Mongini et al found that anxiety increases the likelihood of muscle tenderness and that patients with myogenous and facial pain had higher anxiety and muscle tenderness scores. 25 The absence of a pain-free control group is a shortcoming of their study. Use of the DSM-IV anxiety disorder criteria impedes comparison with our results, because the HADS does not enable definite diagnoses and gives a dimensional rather than categorical representation of mood.…”

“…The level of anxiety is found to correlate with pain diagnosis 23 and to be positively related to muscle tenderness in migraine patients 24 and patients with facial pain. 25 TMD patients who are more anxious seem to be at greater risk of developing chronic pain. 26 Although anxiety has been significantly correlated with TMD in many studies, 23,[27][28][29] several researchers have reported contradictory results.…”

GABA and glutamate levels in occlusal splint-wearing males with possible bruxism

“…The etiology of oral dysfunctions such as bruxism and TMD is multifactorial and psychological factors are considered a major component in the initiation and progression of these disorders (21), which suggests that GABA neuronal system may also be critical in the manifestation of bruxism. The increased incidence of anxiety and depression in these patients (26, 44-46) has led to a theory that psychological factors, such as anxiety, predispose patients to TMD/bruxism by increasing tooth grinding and clenching behaviors, which may produce masticatory muscle fatigue and soreness (25-27). We hypothesized that the stress-related behavioral disorder of bruxism and anxiety-related disorders share similar underlying mechanisms involving the inhibitory neurotransmitter GABA as well as the metabolites N-acetylaspartate (NAA), creatine, choline-containing compounds, myo-inositol, glutamate and glutamine (47).…”