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Long-term changes in biopsychosocial characteristics related to temporomandibular disorder

findings from the OPPERA study

Fillingim, Roger B.a,b,*; Slade, Gary D.c,d,e; Greenspan, Joel D.f,g; Dubner, Ronaldf; Maixner, Williamh; Bair, Ericc,i,j; Ohrbach, Richardk

doi: 10.1097/j.pain.0000000000001348
Research Paper
Global Year 2018

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 risk of the TMD onset and persistence, little is known about long-term change 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.

In this longitudinal study, changes in temporomandibular disorder status were associated with changes in biopsychosocial characteristics among participants with and without TMD at baseline.

aPain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States

bDepartment of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States

cCenter for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States

Departments of dDental Ecology and

eEpidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States

fDepartment of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States

gBrotman Facial Pain Clinic, University of Maryland School of Dentistry, Baltimore, MD, United States

hCenter for Translational Pain Medicine, Duke University, Durham, NC, United States

Departments of iBiostatistics and

jEndodontics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States

kDepartment of Oral Diagnostic Sciences, University at Buffalo, Buffalo, NY, United States

Corresponding author. Address: UF Pain Research and Intervention Center of Excellence, Clinical and Translational Research Building (CTRB), Room 3216, 2004 Mowry Rd, PO Box 100404, Gainesville, FL 32610-0404, United States. Tel.: (352) 273-5963. E-mail address: rfilling@ufl.edu (R.B. Fillingim).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received April 26, 2018

Received in revised form July 11, 2018

Accepted July 13, 2018

© 2018 International Association for the Study of Pain
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