IADR Abstract Archives
Widespread Palpation Tenderness and Temporomandibular Disorders: The OPPERA Study
Objectives: Temporomandibular disorders (TMD) represent a group of heterogeneous musculoskeletal pain conditions. Some patients' pain is limited to craniofacial structures, while others have evidence of additional bodily pain. The aim of this study was to compare TMD subgroups, classified according to the presence or absence of widespread palpation tenderness (WPT), in terms of self-reported and clinically assessed pain and jaw function measures.
Methods: Data were collected in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) case-control study of chronic TMD. WPT was determined by digital palpation examination at 18 predefined bodily sites. Of the n=1080 participants with examiner-verified TMD, n=569 were found additionally to report pain to digital palpation bilaterally and above and below the waist, i.e., at least present in diagonal locations (TMD+WPT); the remaining 463 TMD cases did not meet these criteria (TMD-WPT). There were also n=2700 TMD-free controls who had neither TMD nor WPT. The two groups of TMD cases were contrasted with controls on measures of clinical pain, jaw function, and parafunctional behaviors assessed using self-administered instruments and a clinical examination. The null hypothesis of no differences between the groups was tested using regression models.
Results: Both TMD+WPT and TMD-WPT cases reported greater global jaw functional limitation and greater endorsement of oral parafunctional behaviors than controls (p<0.0001). The TMD+WPT group reported significantly higher pain intensity and pain interference, a greater number of nonspecific orofacial symptoms, greater verbal and emotional communication limitations, and greater self-reported oral parafunctional behaviors than the TMD-WPT group (all p<0.01). Although the TMD groups did not differ on maximum unassisted and assisted mouth opening, significantly more participants in the TMD+WPT group reported pain associated with these jaw movements (p<0.005).
Conclusions: These results suggest that individuals with TMD+WPT have more pain and functional disturbance than those with TMD-WPT despite similar levels of impairment.
Methods: Data were collected in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) case-control study of chronic TMD. WPT was determined by digital palpation examination at 18 predefined bodily sites. Of the n=1080 participants with examiner-verified TMD, n=569 were found additionally to report pain to digital palpation bilaterally and above and below the waist, i.e., at least present in diagonal locations (TMD+WPT); the remaining 463 TMD cases did not meet these criteria (TMD-WPT). There were also n=2700 TMD-free controls who had neither TMD nor WPT. The two groups of TMD cases were contrasted with controls on measures of clinical pain, jaw function, and parafunctional behaviors assessed using self-administered instruments and a clinical examination. The null hypothesis of no differences between the groups was tested using regression models.
Results: Both TMD+WPT and TMD-WPT cases reported greater global jaw functional limitation and greater endorsement of oral parafunctional behaviors than controls (p<0.0001). The TMD+WPT group reported significantly higher pain intensity and pain interference, a greater number of nonspecific orofacial symptoms, greater verbal and emotional communication limitations, and greater self-reported oral parafunctional behaviors than the TMD-WPT group (all p<0.01). Although the TMD groups did not differ on maximum unassisted and assisted mouth opening, significantly more participants in the TMD+WPT group reported pain associated with these jaw movements (p<0.005).
Conclusions: These results suggest that individuals with TMD+WPT have more pain and functional disturbance than those with TMD-WPT despite similar levels of impairment.