The following article by Roger B. Fillingim, Gary D. Slade, Joel D. Greenspan, Ronald Dubner, William Maixner, Eric Bair, and Richard Ohrbach was published in the journal of Pain, November 2018. We are grateful to Dr. Fillingim for writing the following summary of this article for this issue of TMJ News Bites.
Temporomandibular disorder (TMD) is often a chronic condition; that is, it can last for years. In addition to jaw pain and related symptoms, people with TMD also frequently experience changes in other aspects of biological and psychological functioning. However, little research has examined people with TMD over a long period of time to see how their TMD status changes and whether this relates to changes in their other non-TMD symptoms.
Using data from the OPPERA Study, we examined people who had TMD either at baseline or at the time of follow-up, some 7 years later, compared to those who were TMD-free throughout. Perhaps not surprisingly, people who started out as TMD-free but developed TMD sometime during the follow-up showed an increase not only in jaw symptoms, but also in body tenderness, other physical symptoms, and general psychological distress. On the flip side, people whose TMD resolved over time showed improvements across these different measures. Interestingly, the people who had TMD at both time points also tended to show improvements across many of the physical and psychological measures, suggesting positive adaptation in this group.
These findings show that TMD status fluctuates over the course of several years, and these fluctuations are accompanied by changes in other characteristics, including both physical and psychological symptoms. Whether the changes in TMD caused the changes in other symptoms, or vice versa, could not be determined, and should be addressed in future studies.
Painful temporomandibular disorders (TMDs) are both consequence and cause of change in multiple clinical, psychosocial, and biological factors. Although longitudinal studies have identified antecedent biopsychosocial factors that increase the risk of TMD onset and persistence, little is known about long-term changes in those factors after TMD develops or remits. During a 7.6-year median follow-up period, we measured change in psychosocial characteristics, pain sensitivity, cardiovascular indicators of autonomic function, and clinical jaw function among 189 participants whose baseline chronic TMD status either persisted or remitted and 505 initially TMD-free participants, 83 of whom developed TMD. Among initially TMD-free participants who developed TMD, symptoms and pain sensitivity increased, whereas psychological function worsened. By contrast, participants with chronic TMD at baseline tended to show improved TMD symptoms, improved jaw function, reduced somatic symptoms, and increased positive affect. In general, clinical and psychosocial variables more frequently changed in parallel with TMD status compared with pain sensitivity and autonomic measures. These findings demonstrate a complex pattern of considerable changes in biopsychosocial function associated with changes in TMD status. In particular, several biopsychosocial parameters improved among participants with chronic TMD despite pain persisting for years, suggesting considerable potential for ongoing coping and adaptation in response to persistent pain.