Abstract
Objectivethe aim of this study was to describe the frequency of psychosocial diagnoses in a large sample of patients attending a tertiary clinic for treatment of temporomandibular disorders (TMD).Material and Methodssix hundred and ninety-one patients who sought treatment for pain-related TMD were selected. Chronic pain-related disability (Graded Chronic Pain Scale, GCPS), depression [Symptoms Checklist-90 (SCL-90) scale for depression, DEP] and somatization levels (SCL-90 scale for non-specific physical symptoms, SOM) were evaluated through the Research Diagnostic Criteria for TMD (RDC/TMD) Axis II psychosocial assessment; TMD diagnoses were based on the Axis I criteria.Resultsthe majority of patients presented a low disability or no disability at all, with only a small portion of individuals showing a severely limiting, high disability pain-related impairment (4.3%). On the other hand, abnormal scores of depression and somatization were high, with almost half of the individuals having moderate-to-severe levels of depression and three-fourths presenting moderate-to-severe levels of somatization. The prevalence of high pain-related disability (GCPS grades III or IV), severe/moderate depression and somatization was 14.3%, 44% and 74.1% respectively. Gender differences in scores of SCL-DEP (p=0.031) and SCL-SOM (p=0.001) scales were signficant, with females presenting the highest percentage of abnormal values.Conclusionpatients with TMD frequently present an emotional profile with low disability, high intensity pain-related impairment, and high to moderate levels of somatization and depression. Therefore, given the importance of psychosocial issues at the prognostic level, it is recommended that clinical trials on TMD treatment include an evaluation of patients’ psychosocial profiles.
Highlights
IntroductionSeveral studies have reported that patients with chronic pain conditions show high psychosocial impairment compared with pain-free control groups. These psychosocial variables are associated with poorer pain-related adjustment among patients with chronic pain. Similar results have been reported for patients with painful temporomandibular disorders (TMD) (i.e., myofascial pain, arthralgia, arthritis), who showed higher psychosocial impairment than TMD-free individuals.4,5Based on such observations, theories on the etiology of TMDs and its implications for treatment have progressively embraced the importance of a comprehensive biological and psychosocial assessment and TMDs are viewed as a complex disorder resulting from an interplay of causes, including multiple genetic and environmental domains. Psychological impairment is associated with greater severity and persistence of TMD-related clinical symptoms, which affect approximately 10% of the population, with a higher prevalence in females.8The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II9 was designed for a thorough psychosocial assessment, allowing evaluation of the severity of chronic pain and the levels of depression and somatization in TMD patients
Objective: the aim of this study was to describe the frequency of psychosocial diagnoses in a large sample of patients attending a tertiary clinic for treatment of temporomandibular disorders (TMD)
Chronic pain-related disability (Graded Chronic Pain Scale, GCPS), depression [Symptoms Checklist-90 (SCL-90) scale for depression, DEP] and somatization levels (SCL-90 scale for non-specific physical symptoms, SOM) were evaluated through the Research Diagnostic Criteria for TMD (RDC/TMD) Axis II psychosocial assessment; TMD diagnoses were based on the Axis I criteria
Summary
Several studies have reported that patients with chronic pain conditions show high psychosocial impairment compared with pain-free control groups. These psychosocial variables are associated with poorer pain-related adjustment among patients with chronic pain. Similar results have been reported for patients with painful temporomandibular disorders (TMD) (i.e., myofascial pain, arthralgia, arthritis), who showed higher psychosocial impairment than TMD-free individuals.4,5Based on such observations, theories on the etiology of TMDs and its implications for treatment have progressively embraced the importance of a comprehensive biological and psychosocial assessment and TMDs are viewed as a complex disorder resulting from an interplay of causes, including multiple genetic and environmental domains. Psychological impairment is associated with greater severity and persistence of TMD-related clinical symptoms, which affect approximately 10% of the population, with a higher prevalence in females.8The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II9 was designed for a thorough psychosocial assessment, allowing evaluation of the severity of chronic pain and the levels of depression and somatization in TMD patients. Several studies have reported that patients with chronic pain conditions show high psychosocial impairment compared with pain-free control groups.. Similar results have been reported for patients with painful temporomandibular disorders (TMD) (i.e., myofascial pain, arthralgia, arthritis), who showed higher psychosocial impairment than TMD-free individuals.. Similar results have been reported for patients with painful temporomandibular disorders (TMD) (i.e., myofascial pain, arthralgia, arthritis), who showed higher psychosocial impairment than TMD-free individuals.4,5 Based on such observations, theories on the etiology of TMDs and its implications for treatment have progressively embraced the importance of a comprehensive biological and psychosocial assessment and TMDs are viewed as a complex disorder resulting from an interplay of causes, including multiple genetic and environmental domains.. The core features of the original Axis II that have been used for years to collect psychosocial data on TMD patients as part of the RDC/TMD guidelines are still useful tools to share epidemiological data among the different research groups, as well as to characterize behavioral features in clinical settings
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