Painful temporomandibular disorders cause pain and dysfunction of the masticatory muscles that control the jaw movement and joint. This group of conditions affect between 5 and 10% of the population worldwide.
Goal
The largest study about painful temporomandibular disorders (pTMDs) that assessed pain in the joint and around the temple, identified three categories of patients with similar symptoms. They include:
- adaptive (A); those with high pain tolerance and no psychological symptoms,
- pain sensitive (PS); those with high pain sensitivity and less psychological symptoms, and
- global symptoms (GS); those with high pain sensitivity and psychological symptoms.
Faez Saleh Al-Hamed, Aurelio Alonso, Daniela Vivaldi, Shad Smith and Prof Carolina Beraldo Meloto aimed to compare clinical and psychological properties among patients seeking care assigned to the different pain clusters. In other words, what are the clinical and psychological differences between these three groups of people?
Methodology
This study uses data from the medical records of patients attending Duke Innovative Pain Therapy Centre (NC, USA) between August 2017 and April 2021 who had pTMD diagnosis. Data included facial and pain-related measures, jaw profile, and psychological properties such as measures of stress, anxiety, depression, perceived self-efficacy to decrease pain and others. Patients were grouped based on a well-established algorithm (Rapid OPPERA Algorithm (ROPA)).
Main findings
131 patients [A: n=54 (41.2%); PS: n=49 (37.4%); GS: n=28 (21.4%)] were included in this study. PS cluster patients displayed greater number of pain in joint sites and masticatory and cervical muscles, which increased during touching. GS cluster patients showed higher scores of severe pain and stress as well as continuous pain. The results support the concept that, compared to individuals assigned to the A cluster that have high pain tolerance and no psychological symptoms, those assigned to the GS cluster display poorer clinical and psychological properties. The research team’s results showed that PS cluster as a group of individuals who do not show psychological symptoms despite being hypersensitive to pain.
Take home message
The differences that were found may signify that distinct mechanisms sustain pain in patients belonging to different clusters and ultimately, that personalized treatment strategies may be needed to better care for such patients. This study emphasizes the importance of examining patients with painful temporomandibular disorders in a holistic manner that includes assessing symptoms of psychological distress. Patients with greater psychological distress will likely benefit from multidisciplinary treatment strategies that may include psychological treatments.
