Disturbed sleep may be a core risk factor for jaw functional limitation in patients with painful temporomandibular disorders.

Abstract

Pain related to temporomandibular disorder (TMD) usually affects jaw function. In patients with TMD, little is known about the biopsychosocial relevance to jaw functional limitations. This study explored the impact of biopsychosocial risk factors on jaw functional limitation in patients with painful TMD. A comprehensive set of patient-reported outcomes (PROs), consisting of pain severity (Brief Pain Inventory), psychological stress (Symptom Checklist-90-Revised), catastrophising thought (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia-TMD), sleep quality (Pittsburgh Sleep Quality Index) and jaw functional limitation (Jaw Functional Limitation Scale-20), were administered, and clinical examinations were performed in patients with TMD. This study included the data obtained from 131 patients with painful TMD. In the logistic regression analysis, biomedical factors (age, sex, pain duration and TMD phenotype) were not associated with jaw functional limitation. Correlations were higher in the order of sleep quality (ρ=0.946), pain severity (ρ=0.582), pain catastrophising (ρ=0.535), kinesiophobia (ρ=0.486) and emotional distress (ρ=0.268). Multiple regression analysis demonstrated three predictors, including pain severity (p=.001), kinesiophobia (p=.023) and sleep quality (p<.001) for jaw functional limitation. In the mediation analysis, the indirect effect of pain severity on the association between sleep and limitation was significant (p<.0001). Jaw functional limitation is associated with biopsychosocial factors. In particular, sleep may be a core risk factor for functional limitation in patients with painful TMD.