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Five-year outcomes in TMD: relationship of changes in pain to changes in physical and psychological variables
Abstract
Factors influencing natural history and clinical course of pain in temporomandibular disorders (TMD) are largely unknown. Physical, psychological and behavioral data from a population-based epidemiologic study of TMD were examined in 234 cases of persons reporting TMD pain. The cases were assigned to one of five pain pattern groups based on changes in average TMD pain from baseline to 5-year follow-up: (i) remitted (49% of the sample), (ii) high-improvement (14%), (iii) low-improvement (9%), (iv) same (13%), and (v) worse (16%). For each pain change group, an ANOVA-derived pattern analysis was performed to assess whether the pattern of change in each of seven physical and three psychological variables was congruent or dissimilar to the pattern of change in average pain intensity. For none of the physical or psychological variables was the change over time completely congruent with the changes in pain. Changes in ambient average TMD pain were most closely related to those clinical variables whose assessment is influenced by pain or other self-reported symptoms (e.g., number of muscle sites painful to examiner palpation), while the amount of pain change was less closely related to changes in clinical variables, such as joint sounds, where assessment is not dependent on subjective report. The three psychological variables, anxiety, depression, and somatization, displayed similar change patterns, but these patterns were distinctly different from those of the physical variables in…
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“Of the five most recently published guidelines, four do not report the methodology used for their development, and they provide lists of available conservative and invasive treatments for TMD without information on comparative effectiveness or certainty of evidence.”
From Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline (2023) · cites this paper as [21]
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Metadata
- Authors
- Ohrbach, R., & Dworkin, S. F.
- Affiliations
- University of Washington (US)
- Corresponding author
- Ohrbach, Richard
- ORCID
- Ohrbach, Richard
- Venue
- Pain
- Published
- 1998-01
- Volume
- 74
- Issue
- 2
- Pages
- 315-326
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W2047826445
- Cited by
- 203
- References
- 36
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 7 · 2023: 5 · 2022: 8 · 2021: 16 · 2020: 14 · 2019: 9 · 2018: 8 · 2017: 6 · 2016: 7 · 2015: 3 · 2014: 4 · 2013: 8 · 2012: 14
- FWCI
- 10.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (2t32de007227-06)
- National Institute of Dental and Craniofacial Research (T32DE07227, DE08773, P01DE008773)
- Topics
- Health Sciences › Dentistry › Oral Surgery › Temporomandibular Joint Disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- temporomandibular disorders, TMD pain, pain remission, pain improvement, natural history of pain, psychological distress, anxiety, depression, somatization, joint sounds, muscle palpation, clinical signs, five-year outcomes
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Depression, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Pain, Pain Measurement, Temporomandibular Joint Disorders, Treatment Outcome, Pain Management
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