Neurocognitive Functioning in Patients with Painful Temporomandibular Disorders

Abstract

Aim To investigate psychosocial factors in painful TMD (pTMD) which could have consequences for mastering chronic pain. Methods Our study included 22 patients (20 women, 2 men) with pTMD, refractory to conservative treatment, and 19 healthy controls. The control group was matched for gender, age, and educational level, and IQ tested on the Wechsler Abbreviated Scale of Intelligence. Neurocognitive function was tested with the Color-Word Interference Test (CWIT). Pain intensity was reported according to the General Pain Intensity Questionnaire (GPI), using the Numeric Rating Scale (NRS). Self-perceived cognitive difficulties were reported by the Perceived Deficits Questionnaire-Depression 5-item (PDQ-5). Two measures of rumination were included: the Rumination-Reflection Questionnaire (RRQ) and the Ruminative Response Scale (RRS). The Montgomery Åsberg Depression Rating Scale Self-report (MADRS-S) was used to measure depressive symptoms, and the Oral Health Impact Profile-TMD (OHIP-TMD) to measure QoL related to oral health. Results There were no statistical differences in age (median pTMD: 55 years, median control: 53 years), educational level, and IQ between pTMD and controls. Median pain intensity in pTMD was NRS 8 at maximum and the median pain duration was 18 years. There were no significant differences in CWIT between pTMD and controls. Self-perceived cognitive function (PDQ) was significantly poorer in pTMD. Rumination scores from both measures, and the depression score from MADRS, were significantly higher in pTMD. The OHIP-TMD score revealed a significantly poorer QoL in pTMD. Conclusion The group of pTMD patients have self-perceived cognitive difficulties that may make it more difficult to master chronic pain and common everyday tasks. They reported significantly more self-perceived cognitive difficulties, higher rumination, more depressive symptoms, and lower QoL compared to healthy controls, suggesting that these psychosocial factors could be targeted in treatment and interventions. However, the tested neurocognitive performance was equivalent to the control group.

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“…The DMN’s functional connectivity with the sgACC seems to be a neural substrate for depressive rumination, reflecting the integration of self-referential signals from the DMN and affective behavioral withdrawal signals from the sgACC ( Hamilton et al, 2015 ). Rumination is predictive of relapse to depression ( Ronold et al, 2020 ), exacerbation of pain ( Staniszewski et al, 2023 ), greater depressive symptom burden and impairment including cognitive and interpersonal difficulties, and might also predict anxiety, substance abuse, eating disorders and self-harm ( Nolen-Hoeksema et al, 2008 ). Furthermore, rather than leading to active problem solving, rumination involves a recurrent passive focus on problems and emotions related to them, often without leading to any action.…”

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“…And patients suffering from painful TMD surely experience heightened self-perceived cognitive impairments and depressive symptoms. 214 Furthermore, extensive alterations in brain structures have been observed in individuals afflicted with TMD pain, 215 including modifications in the trigemino-thalamo-cortical system, the lateral and medial pain systems, periaqueductal gray-raphe magnus pathway and the motor system. Nevertheless, the relation between these neuropeptides and psychological distress is more complicated than previously thought, and further research is required to understand the intricate interaction between TMD and psychological distress (Fig.…”