Pain-related Disability Among People with Chronic Orofacial Pain

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  • March 21, 2019
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  • Miller, Vanessa
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Pain-related Disability Among People with Chronic Orofacial Pain High pain-related disability diminishes quality of life and increases health care costs. This study evaluated characteristics discriminating between high and low pain-related and examined the relationship between factors associated with pain-related disability among people with chronic painful temporomandibular disorder (TMD). We conducted a cross-sectional analysis of a community-based sample of 1088 individuals with chronic TMD who completed standardized questionnaires assessing four domains: 1) sociodemographic, 2) psychological distress, 3) clinical pain, and 4) experimental pain. We used high pain-related disability, classified using the Graded Chronic Pain Scale, as the dependent variable in logistic regression modeling to evaluate contributions of variables from each domain. Cross-validated area under the ROC curve (AUC) quantified model discrimination. We re-validated this measure of pain-related disability and created measurement models of TMD clinical features, psychological distress, and experimental pain sensitivity. Latent variables were combined for a full structural equation model that was crafted with exploratory model changes. Participants were 18-44 years old (mean 29.2, SD + 7.8) with a mean duration of 6.9 (6.4) years of chronic TMD. A third of participants had high pain-related disability. An 18-variable model encompassing all four domains had good discrimination (AUC=0.79 95% CI 0.75,0.82), as did a simplified model (sociodemographic variables plus catastrophizing, jaw limitation, and number of painful body sites: AUC=0.79 95% CI 0.76,0.82). Duration of pain, gender, and experimental pain testing results were not predictive. Our structural equation model of pain-related disability, TMD features, and psychological distress was created and refined based on exploratory model revisions. Estimation of the final model indicated a good fit with the data. TMD clinical features and psychological distress predicted pain-related disability but experimental pain sensitivity did not. The final model explained 78% of the variance in pain-related disability. High-impact chronic pain is a common problem among people with painful TMD. Assessment of characteristics associated with high-impact pain can be easily performed to identify modifiable risk factors and reduce high-impact pain. TMD clinical features (specifically jaw limitation) and psychological distress (including negative affect, somatization, and catastrophizing) should be considered by clinicians and researchers addressing pain-related disability.
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  • In Copyright
Advisor
  • Slade, Gary
  • Poole, Charles
  • Chen, Ding-Gen
  • Barrett, Deborah
  • Golightly, Yvonne
Degree
  • Doctor of Public Health
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2018
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