The role of pain-related catastrophizing in outcomes and recovery from minimally invasive and surgical procedures for treating temporomandibular disorders

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THE ROLE OF PAIN-RELATED CATASTROPHIZING IN OUTCOMES AND RECOVERY FROM MINIMALLY INVASIVE AND SURGICAL PROCEDURES FOR TREATING TEMPOROMANDIBULAR DISORDERS By Aaron Michael Martin, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2013. Major Director: Stephen M. Auerbach, Ph.D. Professor of Psychology Department of Psychology The current study examined the ability of pain-related catastrophizing to predict outcomes following non-surgical and surgical intervention for temporomandibular disorders (TMDs). The interpersonal context of pain-related catastrophizing, referred to as the communal coping model, was also examined to determine if patient perceptions of punishing and solicitous responses from significant others would moderate or mediate relations between pain catastrophizing and outcomes. The role of pain duration as a moderator of the relation between pain-related catastrophizing and perceived significant other responding was also examined. A total of 94 patients were identified for which 65 had follow-up outcomes that could be examined. Patient follow-up data were obtained at approximately two to three weeks, two to three months, and six months post-intervention. Results showed that pain-related catastrophizing was predictive of greater pain severity at all three follow-up time points after controlling for baseline levels of pain severity, depressive symptoms, sleep disturbance, and pain duration. Pain-related catastrophizing was predictive of poorer range of motion (ROM) at the initial follow-up after controlling for baseline levels of ROM, gender, and form of intervention. Pain-related catastrophizing was not associated with ROM at the second and third post-intervention follow-ups. There was no interaction between pain-related catastrophizing and perceptions of either solicitous or punishing responses in predicting post-intervention pain severity or ROM and any time point. Perceptions of significant other responses also did not mediate the relation between pain-related catastrophizing and post-intervention outcomes at any time point. Additionally, the interaction between pain duration and pain-related catastrophizing in the prediction of post-intervention pain severity or ROM was not significant at any follow-up time point. The findings indicate that painrelated catastrophizing is an important predictor of pain severity following non-surgical and surgical interventions for TMDs both initially and in the long-term. Pain-related catastrophizing is related to ROM outcomes only in the short term. Perceptions of punishing and solicitous responses from significant others do not appear to play a role in these associations. The results suggest that patients with high levels of pre-intervention catastrophizing may benefit from adjunctive cognitive-behavioral intervention to attenuate post-intervention pain severity.