The Journal of Pain
Volume 12, Issue 11, Supplement , Pages T75-T91, November 2011

Potential Autonomic Risk Factors for Chronic TMD: Descriptive Data and Empirically Identified Domains from the OPPERA Case-Control Study

  • William Maixner

      Affiliations

    • Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • Corresponding Author InformationAddress reprint requests to Dr. William Maixner, OPPERA Study, Center for Neurosensory Disorders, Rm 2111, Old Dental Building, University of North Carolina, Chapel Hill, NC 27599-7455.
    • ,
  • Joel D. Greenspan

      Affiliations

    • Department of Neural and Pain Sciences, and Brotman Facial Pain Center, University of Maryland Dental School, Baltimore, Maryland
    • ,
  • Ronald Dubner

      Affiliations

    • Department of Neural and Pain Sciences, and Brotman Facial Pain Center, University of Maryland Dental School, Baltimore, Maryland
    • ,
  • Eric Bair

      Affiliations

    • Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • Department of Biostatistics University, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • ,
  • Flora Mulkey

      Affiliations

    • Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • Department of Biostatistics University, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • ,
  • Vanessa Miller

      Affiliations

    • Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • ,
  • Charles Knott

      Affiliations

    • Battelle Memorial Institute, Durham, North Carolina
    • ,
  • Gary D. Slade

      Affiliations

    • Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • ,
  • Richard Ohrbach

      Affiliations

    • Department of Oral Diagnostic Services, State University at Buffalo, Buffalo, New York
    • ,
  • Luda Diatchenko

      Affiliations

    • Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • ,
  • Roger B. Fillingim

      Affiliations

    • Department of Community Dentistry & Behavioral Science, University of Florida, Gainesville, Florida

Abstract 

Several case-control studies have been conducted that examine the association between autonomic variables and persistent pain conditions; however, there is a surprising dearth of published studies in this area that have focused on temporomandibular disorders (TMD). The current study presents autonomic findings from the baseline case-control study of the OPPERA (Orofacial Pain: Prospective Evaluation and Risk Assessment) cooperative agreement. Measures of arterial blood pressure, heart rate, heart rate variability, and indirect measures of baroreflex sensitivity were assessed at rest and in response to a physical (orthostatic) and psychological (Stroop) stressors in 1,633 TMD-free controls and 185 TMD cases. In bivariate and demographically adjusted analyses, greater odds of TMD case status were associated with elevated heart rates, reduced heart rate variability, and reduced surrogate measures of baroreflex sensitivity across all experimental procedures. Principal component analysis was undertaken to identify latent constructs revealing 5 components. These findings provide evidence of associations between autonomic factors and TMD. Future prospective analyses in the OPPERA cohort will determine if the presence of these autonomic factors predicts increased risk for developing new onset TMD.

Perspective

This article reports autonomic findings from the OPPERA Study, a large prospective cohort study designed to discover causal determinants of TMD pain. Findings indicate statistically significant differences between TMD cases and controls across multiple autonomic constructs at rest and during both physical and psychologically challenging conditions. Future analyses will determine whether these autonomic factors increase risk for new onset TMD.

Key words: Temporomandibular disorders, heart rate variability, blood pressure, heart rate, baroreflex sensitivity, stroop, orthostatic

 

 Supported by NIH grant U01DE017018 and P01NS045685. This material was also supported with by the North Florida/South Georgia Veterans Health System, Gainesville, FL. The OPPERA program also acknowledges resources specifically provided for this project by the respective host universities: University at Buffalo, University of Florida, University of Maryland-Baltimore, and University of North Carolina-Chapel Hill.

 Roger Fillingim and Gary Slade are consultants and equity stock holders, and William Maixner and Dr. Luda Diatchenko are officers and equity stock holders in Algynomics, Inc., a company providing research services in personalized pain medication and diagnostics.

 Supplementary data accompanying this article are available online at jpain.org and sciencedirect.com.

PII: S1526-5900(11)00744-9

doi:10.1016/j.jpain.2011.09.002

The Journal of Pain
Volume 12, Issue 11, Supplement , Pages T75-T91, November 2011

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