Is the experience of pain in patients with temporomandibular disorder associated with the presence of comorbidity?

Chronic temporomandibular disorder pain patients with a history of neuropathic pain treatment: a narrative research on their diagnosis and treatment history

The aims of this qualitative research were (1) to gain more insight in the diagnostic and treatment history of patients with chronic temporomandibular disorder (TMD) pain; (2) to get a deeper understanding of possible factors that are involved in the possible delay in setting a TMD-pain diagnosis and receiving appropriate treatment; and (3) to get a deeper understanding of the perspectives and experiences of chronic TMD-pain patients on the possible improvement of various aspects of their diagnostic and treatment journey.MethodsIn this narrative research, semi-structured interviews took place with patients who experienced chronic orofacial pain (OFP) for at least three years before getting diagnosed with, and treated for, TMD pain by an OFP specialist in an interprofessional setting.ResultsIn total, ten patients were interviewed in-depth. Patients experienced their chronic OFP in different ways, but all reported a significant impact of their pain on their quality of life. All patients visited numerous health care professionals before their TMD diagnosis was set. Among others, they underwent anti-neuropathic pain medication therapies and invasive surgeries, which did not significantly reduce their chronic OFP. The interprofessional TMD-pain treatment reduced the suffering of the chronic OFP substantially, also 6 months after the start of therapy, and improved the quality of life for all patients. In most of them, the OFP intensity was also decreased.ConclusionChronic TMD-pain patients with a history of neuropathic pain treatment may experience a long journey until receiving the appropriate diagnosis and treatment. This stresses the need to improve the implementation of chronic TMD-pain guidelines.

Affective relationships as predictors of TMD symptoms in young adults

Abstract Introduction Orofacial pain is a critical TMD symptom that can influence physical and social capacity. Objective To evaluate the association of temporomandibular disorders (TMD) symptoms with affective relationships and demographic variables in young adults. Material and method A cross-sectional study involving 395 young adults was developed. Diagnostic Criteria for TMD, anxiety, and depression were collected from questionnaires. The Dental Health Component of the Index of Orthodontic Treatment Need measures the orthodontic treatment need. Questionnaires also contained questions related to the previous orthodontic treatment. Logistic regression models were adjusted, estimating crude odds ratio with the 95% confidence intervals. The variables with p<0.20 in the analyses were assessed in a multiple logistic regression model, remaining with p≤0.10. Result There was no significant association of TMD symptoms with sex, age, medication use for pain, previous orthodontic treatment, orthodontic treatment need, anxiety, and depression (p>0.05). Individuals without an affective relationship are 1.78 (95%CI: 0.99-3.17) times more likely to report TMD symptoms. Conclusion Affective relationships showed an association with TMD symptoms in young adults.

The role of sleep dysfunction in temporomandibular onset and progression: A systematic review and meta-analyses

BACKGROUND

Painful temporomandibular (TM) disorders result in 4.3 billion dollars spent annually in the United States. The complex interplay of physiological processes in persistent pain and dysfunctional sleep has been established. Recently, dysfunctional sleep has been identified as a potential pathway to the onset of painful TM disorder.

OBJECTIVES

The aims were to (1) identify self-report outcome measures (SROMs) of sleep quality that are clinimetrically sound in patients with painful TM disorders and (2) determine whether sleep dysfunction has any diagnostic or prognostic value for this population.

METHODS

A systematic search following PRISMA guidelines was run in six databases: CINAHL, Dental, PsychALL, PubMed, Scopus and Web of Science. Any study involving minors was excluded. Risks of biases were examined in all studies. Diagnostic pooled findings were reported.

RESULTS

Of the identified articles (n = 681), 18 were included in this systematic review (n = 1 clinimetric studies, n = 11 diagnostic studies, n = 6 prognostic studies). Nine different assessment tools were used; only the Pittsburg Sleep Quality Index (PSQI) has been validated in patients with painful TM disorders. Overall, sleep dysfunction was diagnostic for painful TM disorders. The pooled relative risk of sleep dysfunction was 1.71 (95% CI 1.30. 2.26). When PSQI scores were greater than 5/21, the unadjusted hazard ratio for development of painful TM disorders was reported to be 2.1.

CONCLUSION

At present, the only SROM that has diagnostic and prognostic value in evaluating and managing patients with painful TM disorders is the PSQI.