Behavioral/Psychosocial Profiles of Patients with Myofascial Pain and TMJ Pathology

Objectives:The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) allow to distinguish muscle related diagnoses (myofacial pain) from TMJ pathology. Additionally, joint related diagnoses can assessed by imaging modalities. However, the association between different physical diagnoses (muscle or TMJ) and the psychosocial profile is still unknown. Therefore, the aim of this study was to evaluate psychosocial aspects of patients presenting either TMJ related diagnoses or myofascial pain or combinations of both. Methods: 100 patients were examined by calibrated examiners using the RDC/TMD. Joint-related diagnoses were assessed using magnetic resonance images (MRI). Additionally, a specific questionnaire was used to evaluate the frequency of previous consultations and treatment modalities. Thirty patients had to be excluded because they did not sign the informed consent, suffered from diseases impending MRI acquisition, or because of insufficient image quality. The remaining 70 patients were divided into three groups according to their physical diagnosis. Group I: Myofascial pain without TMJ pathology (n=20), group II: TMJ pathology without myofascial pain (n=22) and group III: combination of I and II (n=28). Differences in psychosocial characteristics between these groups were assessed by non-parametric statistics. Results: Compared to group II, Group I demanded significantly (Mann-Whitney U-test: p<0.05) more medical care (physicians, physiotherapist, splint therapy) and demonstrated significantly higher somatization scores and a higher limitation to do daily work. However, there were no significant differences in pain intensity, depression, duration of the pain and medication. Group III showed results comparable to Group II. Conclusion: Since the psychosocial profile of patients presenting myofacial pain differs significantly from patients with TMJ related diagnoses, specific interventions and pain management programs for both subgroups of TMD seem to be necessary.