Psychological factors associated with development of TMD: the OPPERA prospective cohort study
Open accessAbstract
Unlabelled Case-control studies have consistently associated psychological factors with chronic pain in general and with temporomandibular disorder (TMD) specifically. However, only a handful of prospective studies have explored whether preexisting psychological characteristics represent risk factors for first-onset TMD. The current findings derive from the prospective cohort study of the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) cooperative agreement. For this study, 3,263 TMD-free participants completed a battery of psychological instruments assessing general psychological adjustment and personality, affective distress, psychosocial stress, somatic symptoms, and pain coping and catastrophizing. Study participants were then followed prospectively for an average of 2.8 years to ascertain cases of first-onset of TMD, and 2,737 provided follow-up data and were considered in the analyses of TMD onset. In bivariate and demographically adjusted analyses, several psychological variables predicted increased risk of first-onset TMD, including reported somatic symptoms, psychosocial stress, and affective distress. Principal component analysis of 26 psychological scores was used to identify latent constructs, revealing 4 components: stress and negative affectivity, global psychological and somatic symptoms, passive pain coping, and active pain coping. In multivariable analyses, global psychological and somatic symptoms emerged as the most robust risk factor for incident TMD. These findings provide evidence that measures of psychological functioning can predict first onset of TMD. Future analyses in the OPPERA cohort will determine whether these psychological factors interact with other variables to increase risk for TMD onset and persistence.Perspective This article reports that several premorbid psychological variables predict first-onset TMD in the OPPERA study, a large prospective cohort study designed to discover causal determinants of TMD pain. Measures of somatic symptoms were most strongly associated with TMD onset, but perceived stress, previous life events, and negative affect also predicted TMD incidence.
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Psychosocial distress is a risk factor for onset of acute- and chronic TMD, and can be a cause and a consequence of TMD.
“Psychosocial distress is a risk factor for onset of acute- and chronic TMD, and can be a cause and a consequence of TMD (Fillingim et al., Citation2013, Citation2018).”
From The association between pain-related factors and psychological distress in patients with temporomandibular disorder. (2023) · cites this paper as Fillingim et al., 2013
The Discussion identifies psychological distress and related symptoms as premorbid risk factors for first-onset, typically acute TMD. It reports an association with existing chronic TMD, but does not establish risk for chronic TMD onset. It also says that changes in psychological functioning after TMD onset remain for future analysis, so it does not establish distress as a consequence of TMD. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSeveral studies found that patients with positive general social support but without solicitous responses to pain were less likely to develop persistent phantom limb pain after amputation and reported lower physical dysfunction.
“Several studies found that patients reporting positive general social support but lacking solicitous responses to pain were less likely to develop persistent phantom limb pain post-amputation and report lower levels of physical dysfunction 85, 107, 109.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [109]
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Alajbeg, I. Z., Vrbanović, E., Lapić, I., Alajbeg, I., & Vuletić, L. (2020) · Scientific Reports · doi:10.1038/s41598-020-67383-x · Cited by 36 · see citing works
- Authors
- Fillingim, R. B., Ohrbach, R., Greenspan, J. D., Knott, C., Diatchenko, L., Dubner, R., Bair, E., Baraian, C., Mack, N., Slade, G. D., & Maixner, W.
- Affiliations
- University of Florida Health (US)
- University at Buffalo, State University of New York (US)
- University of Maryland, Baltimore (US)
- Battelle (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Fillingim, Roger B.
- ORCID
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 14
- Issue
- 12
- Pages
- T75-T90
- ISSN
- 1526-5900 (ISSN-L)
- PMC
- PMC3855656
- OpenAlex
- W2001391699
- Cited by
- 528
- References
- 93
- Citations by year
- 2026: 45 · 2025: 62 · 2024: 65 · 2023: 52 · 2022: 69 · 2021: 48 · 2020: 42 · 2019: 30 · 2018: 41 · 2017: 21 · 2016: 22 · 2015: 14 · 2014: 7 · 2013: 5 · 2012: 1
- FWCI
- 26.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- National Institutes of Health
- University at Buffalo
- National Institute of Dental and Craniofacial Research (U01DE017018)
- Topics
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- temporomandibular disorders, psychological risk factors, somatic symptoms, psychosocial stress, emotional distress, negative affectivity, pain coping, pain catastrophizing, psychological adjustment, personality, orofacial pain
- MeSH terms
- Adolescent, Adult, Facial Pain, Female, Humans, Male, Prospective Studies, Surveys and Questionnaires, Risk Factors, Temporomandibular Joint Disorders
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