Smoking and Posttraumatic Stress Disorder Symptomatology in Orofacial Pain

Abstract

To explore the impact of interactions between smoking and symptoms of posttraumatic stress disorder (PTSD) on pain intensity, psychological distress, and pain-related functioning in patients with orofacial pain, a retrospective review was conducted of data obtained during evaluations of 610 new patients with a temporomandibular disorder who also reported a history of a traumatic event. Pain-related outcomes included measures of pain intensity, psychological distress, and pain-related functioning. Main effects of smoking status and PTSD symptom severity on pain-related outcomes were evaluated with linear regression analyses. Further analyses tested interactions between smoking status and PTSD symptom severity on pain-related outcomes. PTSD symptom severity and smoking predicted worse pain-related outcomes. Interaction analyses between PTSD symptom severity and smoking status revealed that smoking attenuated the impact of PTSD symptom severity on affective distress, although this effect was not found at high levels of PTSD symptom severity. No other significant interactions were found, but the present results identifying smoking as an ineffective coping mechanism and the likely role of inaccurate outcome expectancies support the importance of smoking cessation efforts in patients with orofacial pain. Smoking is a maladaptive mechanism for coping with pain that carries significant health-and pain-related risks while failing to fulfill smokers' expectations of affect regulation, particularly among persons with orofacial pain who also have high levels of PTSD symptom severity. Addressing smoking cessation is a critical component of comprehensive treatment. Further research is needed to develop more effective ways to help patients with pain and/or PTSD to replace smoking with more effective coping strategies.

Post-traumatic stress disorder and temporomandibular dysfunction: a review and clinical implications

“…The PTSD population studied consisted of war veterans with an average age of 42 years and with medical PTSD diagnosis. The positive association between PTSD symptoms and variables such as pain intensity, disability, psychological dysfunction, difficulties in coping with pain, interference with daily activities and sleep problems were found in three studies 6,17,18 . Finally, a cohort study reported that PTSD predicted the incidence of painful TMD in healthy populations with a risk ratio of 1.38 19 .…”

“…PTSD development after traumatic events is associated with increased risk of musculoskeletal pain and functional somatic syndromes (FSS) 33,34 . In addition, subjects with both conditions, TMD and PTSD, presented greater pain intensity, psychological dysfunction, interference with daily activities, sleep problems and pain coping difficulties when compared to subjects without PTSD 6,17,18 . These results may be reflective of changes in pain processing found in PTSD subjects.…”

“…After sorting the titles and abstracts, 12 articles were selected for a complete reading of the texts. From these, six meet the inclusion criteria [6][7][8][17][18][19] . One paper was excluded because it did not evaluate the relationship between TMD and PTSD 20 and five because they did not use diagnostic criteria validated for TMD, only evaluating signs and symptoms of dysfunction in the studied population [21][22][23][24][25] .…”

“…Weber et al 18 Cross-sectional 610 patients with TMD reporting traumatic life events 85% women PTSD predicts pain severity, psychological dysfunction, and interference in daily activities in TMD patients.…”

“…The sample of TMD patients was composed mostly of women, with an average age ranging from 37 to 47 years old. One paper evaluated only subjects with masticatory muscle myofascial pain 7 and three studies investigated populations with painful muscle and joint TMD 6,17,18 . In these papers 6,7,17,18 the participants were not formally diagnosed (medical diagnosis) with PTSD but had symptoms consistent with PTSD diagnosis identified by Post-Traumatic Stress Disorder Check List-Civilian (PCL-C) 26 , a structured questionnaire, developed according to the DSM, and validated to investigate the PTSD prevalence in epidemiological surveys.…”