Long-term changes in biopsychosocial characteristics related to temporomandibular disorder: findings from the OPPERA study

Abstract

Painful temporomandibular disorders (TMDs) are both consequence and cause of change in multiple clinical, psychosocial, and biological factors. Although longitudinal studies have identified antecedent biopsychosocial factors that increase risk of the TMD onset and persistence, little is known about long-term change in those factors after TMD develops or remits. During a 7.6-year median follow-up period, we measured change in psychosocial characteristics, pain sensitivity, cardiovascular indicators of autonomic function, and clinical jaw function among 189 participants whose baseline chronic TMD status either persisted or remitted and 505 initially TMD-free participants, 83 of whom developed TMD. Among initially TMD-free participants who developed TMD, symptoms and pain sensitivity increased, whereas psychological function worsened. By contrast, participants with chronic TMD at baseline tended to show improved TMD symptoms, improved jaw function, reduced somatic symptoms, and increased positive affect. In general, clinical and psychosocial variables more frequently changed in parallel with TMD status compared with pain sensitivity and autonomic measures. These findings demonstrate a complex pattern of considerable changes in biopsychosocial function associated with changes in TMD status. In particular, several biopsychosocial parameters improved among participants with chronic TMD despite pain persisting for years, suggesting considerable potential for ongoing coping and adaptation in response to persistent pain.

Figures

Figure 1

Flow Diagram of Participant Matriculation through the Protocol.

Figure 2

Selected Clinical and Health Measures for Each Group at Baseline and Follow-Up. Three measures are presented for illustrative purposes to show observed patterns of change over time across groups. a) Number of body sites painful to palpation during examination; b) Pain-free jaw opening measured during examination, in which higher scores show greater range of motion; c) Jaw Function Limitation Scale chewing subscale score, when higher scores indicate greater functional limitations. Open diamonds (⋄) reflect Baseline values and closed circles (●) reflect Follow-Up values. No statistical inference testing was performed on these data, as our statistical approach modeled the change scores as presented in Tables 2, 3 and 4.

Figure 3

Selected Psychosocial Measures for Each Group at Baseline and Follow-Up. Two measures are presented for illustrative purposes to show observed patterns of change over time across groups. a) Pennebaker Inventory of Limbic Languidness (PILL) scores, in which higher scores indicate greater endorsement of somatic symptoms; b) Perceived Stress Scale (PSS) scores, where higher scores indicate greater perceived stress. Open diamonds (⋄) reflect Baseline values and closed circles (●) reflect Follow-Up values. No statistical inference testing was performed on these data, as our statistical approach modeled the change scores as presented in Tables 2, 3 and 4.

Figure 4

Selected Quantitative Sensory Testing Measures for Each Group at Baseline and Follow-Up. Two measures are presented for illustrative purposes to show observed patterns of change over time across groups. a) Pressure Pain Threshold at the temporalis muscle, a cranial site; b) Pressure Pain Threshold at the lateral epicondyle, a non-cranial site. For both measures, higher scores reflect greater pain thresholds, or lower sensitivity to pressure pain. Open diamonds (⋄) reflect Baseline values and closed circles (●) reflect Follow-Up values. No statistical inference testing was performed on these data, as our statistical approach modeled the change scores as presented in Tables 2, 3 and 4.