Diurnal Variation in Pain Reports in Temporomandibular Disorder Patients and Control Subjects

Aims: To test the hypothesis that temporomandibular disorder (TMD) patients have characteristic diurnal patterns of pain that are associated with diurnal or nocturnal parafunctions. Methods: Experience sampling methods were used to obtain information on pain from subjects (n = 84) diagnosed, according to the Research Diagnostic Criteria for TMD, with myofascial pain, myofascial pain and arthralgia, disc displacement, and from non-TMD controls. Variations in pain as reported on the pager questionnaire form were modeled as linear, exponential, and quadratic effects. Results: Between 8.7% and 23.8% of TMD subjects with pain showed significant patterns to their daily pain reports, compared to 4.5% of non-TMD controls. Groups did not differ significantly in the proportions of those with increasing (59.5%) vs. decreasing (40.5%) pain levels. Self-reported clenching during the day and grinding at night were weakly associated with an increasing or decreasing pattern of pain during the day (P < .10). Pain levels during weekends were significantly lower for all groups. Conclusions: Strongly linear or curvilinear patterns of pain were not characteristic of this sample of subjects. More than half the subjects reported slightly increasing pain during the day, but the variability within groups was considerable. Increasing and decreasing patterns of pain were independent of self-reported daytime and nighttime clenching and grinding. Self-reported pain patterns may not be used to reliably infer the times when parafunctional activities occur. The presence of lower pain levels during the weekend probably reflects reduction in psychosocial stressors associated with the work week.

diurnal variation; experience sampling; modeling; pain; temporomandibular disorders

1. Ahlberg K, Ahlberg J, Kononen M, Alakuijala A, Partinen M, Savolainen A. Perceived orofacial pain and its associations with reported bruxism and insomnia symptoms in media personnel with or without irregular shift work. Acta Odontol Scand 2005;63:213–217.

2. Magnusson T, Egermark I, Carlsson GE. A prospective investigation over two decades on signs and symptoms of temporomandibular disorders and associated variables: A final summary. Acta Odontol Scand 2005;63:99–109.

3. Miyake R, Ohkubo R, Takehara J, Morita M. Oral parafunctions and association with symptoms of temporomandibular disorders in Japanese university students. J Oral Rehabil 2004;31:518–523.

4. Suvinen TI, Ahlberg J, Rantala M, et al. Perceived stress, pain and work performance among non-patient working personnel with clinical signs of temporomandibular or neck pain. J Oral Rehabil 2004;31:733–737.

5. Gendreau M, Hufford MR, Stone AA. Measuring clinical pain in chronic widespread pain: Selected methodological issues. Best Pract Res Clin Rheumatol 2003;17:575–592.

6. Kikuchi H, Yoshiuchi K, Miyasaka N, et al. Reliability of recalled self-report on headache intensity: Investigation using ecological momentary assessment technique. Cephalalgia 2006;26:1335–1343.

7. Robinson ME, Myers CD, Sadler IJ, Riley JL, Kvall SA, Geisser ME. Bias effects in three common self-report pain assessment measures. Clin J Pain 1997;13:74–81.

8. Shiffman S, Stone AA. Ecological momentary assessment in health psychology. Health Psychol 1998;17:3–5.

9. van Grootel RJ, van der Glas HW, Buchner R, de Leeuw JRJ, Passchier J. Patterns of pain variation related to myogenous temporomandibular disorders. Clin J Pain 2005;21:154–165.

10. Dworkin SF, LeResche L. Research Diagnostic Criteria for Temporomandibular Disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6:301–355.

11. Lausten LL, Glaros AG, Williams K. Inter-examiner reliability of physical assessment methods for assessing temporomandibular disorders. Gen Dent 2004;52:509–513.

12. Raphael KG, Marbach JJ. A year of chronic TMPDS: Evaluating patients’ pain patterns. J Am Dent Assoc 1992; 123:53–58.

13. Raphael KG, Marbach JJ. A year of chronic TMPDS: Relating patient symptoms and pain intensity. J Am Dent Assoc 1992;123:49–55.

14. Lobbezoo F, Lavigne GJ. Do bruxism and temporomandibular disorders have a cause-and-effect relationship? J Orofac Pain 1997;11:15–23.

15. Manfredini D, Cantini E, Romagnoli M, Bosco M. Prevalence of bruxism in patients with different research diagnostic criteria for temporomandibular disorders (RDC/TMD) diagnoses. Cranio 2003;21:279–285.

16. Glaros AG, Waghela R. Psychophysiological definitions of clenching. Cranio 2006;24:252–257.

17. Glaros AG, Williams K, Lausten L. Predicting facial pain: Role of parafunctions, emotions and stress. J Am Dent Assoc 2005;136:451–458.

18. Aaron LA, Turner JA, Mancl L, Brister H, Sawchuk CN. Electronic diary assessment of pain-related variables: Is reactivity a problem? J Pain 2005;6:107–115.