Abstract
Multiple physiological and psychological regulatory domains may contribute to the
pathophysiology of pain in temporomandibular disorder (TMD) and other bodily pain
conditions. The purpose of this study was to evaluate the relationship between multisystem
dysregulation and the presence of TMD pain, as well as the presence of different numbers
of comorbid pain conditions in TMD. Secondary data analysis was conducted in 131 non-TMD
(without comorbid pain) controls, 14 TMD subjects without comorbid pain, 78 TMD subjects
with 1 comorbid pain, and 67 TMD subjects with multiple comorbid pain conditions who
participated in a TMD genetic study. Twenty markers from sensory, autonomic, inflammatory,
and psychological domains were evaluated. The results revealed that 1) overall dysregulation
in multiple system domains (OR [odds ratio] = 1.6, 95% confidence interval [CI] = 1.4–1.8),
particularly in the sensory (OR = 1.9, 95% CI = 1.3–2.9) and the psychological (OR = 2.1,
95% CI = 2.1–2.7) domains, were associated with increased likelihood of being a painful
TMD case; and 2) dysregulations in individual system domains were selectively associated
with the increased odds of being a TMD case with different levels of comorbid persistent
pain conditions. These outcomes indicate that heterogeneous multisystem dysregulations
may exist in painful TMD subgroups, and multidimensional physiological and psychological
assessments can provide important information regarding pathophysiology, diagnosis,
and management of pain in TMD patients.
Perspective
The concurrent assessment of multiple physiological and psychological systems is critical
to our understanding of the pathophysiological processes that contribute to painful
TMD and associated comorbid conditions, which will ultimately guide and inform appropriate
treatment strategies that address the multisystem dysregulation associated with complex
and common persistent pain conditions.
Key words
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Article info
Publication history
Published online: May 30, 2013
Accepted:
March 26,
2013
Received in revised form:
March 20,
2013
Received:
November 10,
2012
Footnotes
This study was supported by NIH/NIDCR grants DE016558, NS045685, PO1 NS045685-061 A, T32-DE017245, and UO1-DE017018.
Drs Maixner and Diatchenko are equity shareholders in and consultants to Algynomics. The rest of the authors disclose no conflict of interest.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.
