The comparison between pains, difficulties in function, and associating factors of patients in subtypes of temporomandibular disorders

Abstract

The aim of this study was to compare the multidimensional properties among subtypes of painful temporomandibular disorders (TMD): myofascial pain (group I), disc displacement (group II), arthralgia (group IIIa) and osteoarthritis (group IIIb). A total of 511 patients answered a battery of questionnaires, which included questions relating to intensity and duration of pain, the Japanese version of the McGill Pain Questionnaire, limitation of daily functions, the Hospital Anxiety and Depression Scale, the Eysenck Personality Questionnaire short-form and 34 items of behavioural contributing factors. Group IIIb showed significantly the highest age in all subtypes. Those in group I had higher depression scores than those in group II (P = 0.005). Group IIIa had a lower women's ratio than in group II (P = 0.001) and the patients showed a shorter pain duration than those in groups I (P = 0.000) and II (P = 0.001). Group IIIa patients also showed lower visual analogue scale (VAS) ratings for pain descriptors 'heavy' (P = 0.002) and 'tiring' (P = 0.004) than those of group I, and 'dull' (P = 0.005), 'heavy' (P = 0.001) and 'tiring' (P = 0.005) than those of group II. Group IIIa showed lower ratios of contributing factors of 'an awareness of grinding/clenching during sleep' (P = 0.000) and 'an awareness of clenching sensation when waking up at night' (P = 0.002) than those of group I, and also showed a higher ratio of 'a liking for a hard food' (P = 0.000) and lower ratio of 'talking for a long time on the telephone' (P = 0.001) than those of group II. In conclusion, although several properties were different between subtypes, the majority of them were similar in the four subtypes of TMD.

Quality of life and general health in patients with temporomandibular disorders

“…Some studies [19][20][21] in the literature assessed depression, anxiety and pain in patients with TMD. Although these studies did not analyze general health indicators, a trend was observed that patients with muscle pain exhibited more psychological problems, poor quality of sleep and a greater number of stress agents.…”

The Evolution of TMD Diagnosis

“…The results from approximately 35 published OPPERA studies revolve around the simple phenotype identified by the TMD case definition, indicating that it may be a sufficient marker for underlying complexity as well as suggesting that other diagnostic resources should be allocated to more refined assessment of the appreciable variability reflected as individual differences in how TMDs are expressed. While the OPPERA studies have been limited to subjects 18 to 44 y old characterized on the basis of masticatory system pain, patient characteristics are largely similar across the major RDC/TMD subtypes (Kino et al 2005), and treatment models suggest that the same principles successful for managing pain conditions apply to TMJ impairments (Schiffman et al 2007). Consequently, the OPPERA evidence suggestive of a TMD pain phenotype identified by the core diagnostic variables contained within, for example, the DC/TMD may be generalizable to other types of TMDs but this awaits confirmation.…”

To Evaluate the Pharmacotherapeutic Efficacy of Tizanidine Hydrochloride and Gabapentin in Treating Myofascial Pain - In a Stepwise Treatment Approach

“…These pain scores are higher than those in the literature, usually reported as 3 to 5 on a visual analog scale. 11,12 Treatment of Myofascial pain syndrome is difficult because it may be initiated by peripheral and central mechanisms that appear to be inter-related as Central sensitization would lead to an increased excitability of spinal and supraspinal regions resulting from injury or inflammation-induced activation of peripheral nociceptors. 13 Tizanidine, an alpha-2 -adrenergic agonist, exerts effects in both the brain and spinal cord, with effects at the second order dorsal horn neurons and wide dynamic range neurons-the same location implicated in the central sensitization process.…”