Norwegian study finds high pain intensity is a risk factor of non-resolving TMD

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Norwegian study finds high pain intensity is a risk factor of non-resolving TMD


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A study that evaluated patients in Norway with long-term temporomandibular disorder found that patients who had higher levels of pain initially were at a heightened risk of non-resolving symptoms. (Image: Shutterstock/Marcin Balcerzak)

BERGEN, Norway: Existing research indicates that temporomandibular disorders (TMD) are the second most frequent source of disability and pain in the human body. A recent study evaluated the risk factors of non-resolving temporomandibular disorder  in patients with long-term refractory TMD three years after their enrolment in a national interdisciplinary evaluation programme at the Haukeland University Hospital in Bergen. The study found that those patients who reported higher levels of pain intensity were more likely to later report non-resolving TMD symptoms.

At the start of enrolment, the 60 TMD patients included in the study were examined by a medical radiologist, physiotherapist, clinical psychologist, dental specialist in orofacial pain, oral and maxillofacial surgeon and pain physician. The group had suffered from TMD pain for 13.4 years on average. After meeting with the specialists, the patients were given treatment suggestions to take to their general practitioners (GPs) for follow-up.

Initially and three years later, the patients completed a questionnaire covering not just TMD symptoms and pain but also physical functioning, adverse events such as trauma, and psychosocial factors.

Though the patients overall reported satisfaction with their initial multispecialist evaluation and suggestions for treatment, three years later only 21% of the patients reported satisfaction with the follow-up provided by their GPs. After three years, 33% of the patients reported worsened TMD symptoms, 26% improved symptoms and 41% unchanged symptoms. The researchers noted that those who experienced worsening symptoms had also previously reported a much higher minimum and maximum pain intensity at baseline. This group also initially reported a higher degree of suffering as a result of pain. Statistical analysis indicated that high maximum pain intensity at baseline was a significant predictor of worsened TMD symptoms at the three-year evaluation.

As Norway is facing a shortage of TMD specialists, particularly in rural locations, general medical and dental practitioners are often dealt the task of treating TMD, even though they may lack the expertise to do so. The researchers indicated that treatment of severe TMD would ideally involve a team of specialists from both medicine and dentistry and suggested that having to resort to general doctors and dentists for follow-up may have contributed to the improvement of just ten out of the 39 patients.

The authors suggested that treatment could be improved by follow-up by the interdisciplinary team with patients and GPs and by giving patients the opportunity for responsibility for their own recovery via a rehabilitation programme with feedback. They also recommended further research on management of stress in patients with chronic pain as a factor of treatment outcome.

The study, titled “High pain intensity is a risk factor of non-resolving TMD: A three-year follow-up of a patient group in a Norwegian interdisciplinary evaluation program”, was published online on 2 May 2022 in the Journal of Pain Research.

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