Characteristics associated with high-impact pain in people with TMD: a cross-sectional study.

High-impact (disabling) pain diminishes quality of life and increases health care costs. The purpose of this study was to identify variables that distinguish between high and low-impact pain among individuals with painful temporomandibular disorder (TMD). Community-dwelling adults (n=846) with chronic TMD completed standardized questionnaires assessing the following: 1) sociodemographic, 2) psychological distress, 3) clinical pain, and 4) experimental pain. We used high-impact pain, 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. One third of participants had high-impact pain. Sociodemographic variables weakly discriminated between low and high-impact pain (AUC=0.61, 95% CI 0.57, 0.65) with the exception of race. 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 associated. Characteristics that most effectively discriminated between people with low- and high-impact TMD pain included clinical pain features and ability to cope with pain.

PERSPECTIVE: This article presents the results of a multivariable model designed to discriminate between people with high or low-impact pain in a community-based sample of people with chronic painful TMD. The findings emphasize the importance of catastrophizing, jaw limitation, and painful body sites associated with pain-related impact.