Temporomandibular Joint and Muscle Disorder-type Pain and Comorbid Pains in a National US Sample

Aims: To compare prevalences of self-reported comorbid headache, neck, back, and joint pains in respondents with temporomandibular joint and muscle disorder (TMJMD)-type pain in the 2000–2005 US National Health Interview Survey (NHIS), and to analyze these self-reported pains by gender and age for Non-Hispanic (NH) Whites (Caucasians), Hispanics, and NH Blacks (African Americans). Methods: Data from the 2000–2005 NHIS included information on gender, age, race, ethnicity, education, different common types of pain (specifically TMJMD-type, severe headache/migraine, neck, and low back pains), changes in health status, and health care utilization. Estimates and test statistics (ie, Pearson correlations, regressions, and logistic models) were conducted using SAS survey analysis and SUDAAN software that take into account the complex sample design. Results: A total of 189,977 people (52% female and 48% males, 73% NH Whites, 12% Hispanic, 11% NH Blacks, and 4% “Other”) were included. A total of 4.6% reported TMJMD-type pain, and only 0.77% overall reported it without any comorbid headache/mi-graine, neck, or low back pains; also 59% of the TMJMD-type pain (n = 8,964) reported ≥ two comorbid pains. Females reported more comorbid pain than males (odds ratio [OR] = 1.41, P < .001); Hispanic and NH Blacks reported more than NH Whites (OR = 1.56, P <.001; OR= 1.38, P <.001, respectively). In addition, 53% of those with TMJMD-type pain had severe headache/migraines, 54% had neck pain, 64% low back pain, and 62% joint pain. Differences in gender and race by age patterns were detected. For females, headache/migraine pain with TMJMD-type pain peaked around age 40 and decreased thereafter regardless of race/ethnicity. Neck pain continued to increase up to about age 60, with a higher prevalence for Hispanic women at younger ages, and more pronounced in males, being the highest in the non-Whites. Low back pain was higher in Black and Hispanic females across the age span, and higher among non-White males after age 60. Joint pain demonstrated similar patterns by race/ethnicity, with higher rates for Black females, and increased with age regardless of gender. Conclusion: TMJMD-type pain was most often associated with other common pains, and seldom existed alone. Two or more comorbid pains were common. Gender, race, and age patterns for pains with TMJMD-type pain resembled the specific underlying comor-bid pain.

age;back pain;chronic pain;headache/migraine;neck pain;prevalence;race/ethnicity;sample survey;self-report;temporomandibular joint and muscle disorders

1. Plesh O, Crawford PB, Gansky SA. Chronic pain in a biracial population of young women. Pain 2002;99:515–523.

2. Gansky SA, Plesh O. Widespread pain and fibromyalgia in a biracial cohort study of young women. J Rheumatol 2007;34:810–817.

3. Plesh O, Adams S, Gansky SA. Racial/ethnic and gender prevalences in reported common pains in a national sample. J Orofac Pain 2011;25:25–31.

4. National Center for Health Statistics. Data File Documentation, National Health Interview Survey, 2004. Hyattsville, MD: National Center for Health Statistics, 2005.

5. Isong U, Gansky SA, Plesh O. Temporomandibular joint and muscle disorder-type pain in US adults: The national interview survey. J Orofac Pain 2008;22:317–322.

6. Ciancaglini R, Randaelli G. The relationship between headache and symptoms of temporomandibular disorders in the general population. J Dent Res 2001;29:93–98.

7. Glaros AG, Urban D, Locke J. Headache and temporomandibular disorders: Evidence for diagnostic and behavioral overlap. Cephalgia 2007;27:542–547.

8. Rantala MA, Ahlberg J, Suvinen TI, Nissien M, Lindholm H. Temporomandibular joint related painless symptoms, orofacial pain, neck pain, headaches, and psychological factors among non-patients. Acta Odontol Scand 2003;61: 217–222.

9. Ballegaard V, Thede-Schmidt-Hansen P, Svensson P, Jensen R. Are headache and temporomandibular disorders related. A blind study. Chephalgia 2008;28:832–841.

10. Goncalves DAG, Bigal ME, Jales LCF, Speciali JG. Headache and symptoms of temporomandibular disorders: An epidemiological study. Headache 2009;50:10–15.

11. Scher AI, Midgette LA, Lipton RB. Risk factors for headache chronification. Headache 2008;48:16–25.

12. Wanman A. The relationship between muscle tenderness and craniomandibular disorders: A study of 35-year-olds from the general population. J Orofac Pain 1995;9: 235–243.

13. Clark GT, Green EM, Dornan MR, Flack VF. Craniocervical dysfunction levels in a patient sample from a temporomandibular joint clinic. J Am Dent Assoc 1987;115:251–256.

14. De Laat A, Meuleman H, Stevens A, Verbeke G. Correlation between cervical spine and temporomandibular disorders. Clin Oral Invest 1998;2:54–57.

15. Wiesinger B, Malker H, Englund E, Wanman A. Back pain in relation to musculoskeletal disorders in the jawface: A matched case-control study. Pain 2007;131: 311–319.

16. Wolfe F, Katz RS, Michaud K. Jaw pain: Its prevalence and meaning in patients with rheumatoid arthritis, osteoarthritis, and fibromyalgia. J Rheumatol 2005;32:2421–2428.

17. Aaron LA, Burke MM, Buckwald D. Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia and temporomandibular disorders. Arch Intern Med 2000;160:221–227.

18. Turp JC, Kowalski CJ, O’Leary N, Stohler CS. Pain maps from facial pain patients indicate a broad pain geography. J Dent Res 1998;77:1462–1472.

19. VonKorff M, Omel M, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain 1992:50:133–149.

20. Plesh O, Wolfe F, Lane N. The relationship between fibromyalgia and temporomandibular disorders: Prevalence and symptom severity. J Rheumatol 1996;23:1948–1952.

21. Meisler JG. Chronic pain conditions in women. J Women Health 1999;8:313–320.

22. White BA, Williams LA, Leben JR. Health care utilization and cost among health maintenance organization members with temporomandibular disorders. J Orofacial Pain 2001;15:158–169.

23. Stowell AW, Gatchel RJ, Wildenstein L. Cost-effectiveness of treatment for temporomandibular disorders. Biopsychosocial intervention versus treatment as usual. J Am Dent Assoc 2007;138:202–208.

24. Velly AM, Look JO, Schiffman E, et al. The effect of fibromyalgia and widespread pain on the clinically significant temporomandibular muscle and joint disorders: A prospective 18-month cohort study. J Pain 2010;11:1155–1164.

25. Parsons S, Breen A, Foster NE, et al. Prevalence and comparative troublesomeness by age of musculoskeletal pain in different body locations. Fam Pract 2007;24:308–316.

26. Johansson A, Unell L, Carlsson GE, Soderfeldt B, Halling A. Risk factors associated with symptoms of temporomandibular disorders in a population of 50 and 60-year-old subjects. J Oral Rehab 2006;33:473–481.

27. Nilsson IM, List T, Drangsholt M. The reliability and validity of self-reported temporomandibular disorder pain in adolescents. J Orofac Pain 2006;20:138 –144.

28. Pinelli C, de Castro Monteiro Loffredo L. Reproducibility and validity of self-perceived oral health conditions. Clin Oral Invest 2007;11:431–437.

29. Research Triangle Institute. SUDAN Manual Release 9.0. Research Triangle Park, NC: Research Triangle Institute, 2004.

30. Unruh AM. Gender variations in chronic pain experience. Pain 1996;65:123–167.

31. Berkley KJ. Sex differences in pain. Behav Brain Scien 1997;20:1–10.

32. Green CR, Baker TA, Smith EM, Sato Y. The effect of race in older adults presenting chronic pain management: A comparative study of black and white Americans. J Pain 2003;4:82–90.

33. Green CR, Anderson K, Baker T, et al. The unique burden of pain: Confronting racial and ethnic disparities in pain. Med Biol Res Nursing 2005;7:7–15.

34. Seeman TE, Singer BH, Rowe JB, McEwing B. Price of adaptation-allostatic load and its health consequences. MacArthur studies of successful aging. Arch Inter Med 1997;157:2259–2268.

35. McEwens BS, Kalia M. The role of corticosteroids and stress in chronic pain conditions. Metabolism 2010;59(suppl 1):S9–S15.

36. Headache Classification Subcommitteee of the International Headache Society. The international classification of headache disorders, ed 2. Cephalgia 2004;24(suppl 1):1–60.

37. Martin VT, Behbebani M. Ovarian hormones and migraine headache: Understanding mechanism and pathogenesis. Part I. Headache 2006;46:3–23.

38. Gupta S, Mehrotras S, Villalon CM, Saxena PR, Massen Van Den Brik A. Potential role of female sex hormones in the pathology of migraine. Pharmacol Therap 2007;113:32–40.

39. Sessle BJ. Acute and chronic craniofacial pain: Brainstem mechanisms of nociceptive transmission and neuroplasticity and their clinical correlates. Crit Rev Oral Biol Med 2000;11:57–91.

40. Morch CD, Hu JW, Arendt-Nielsen L, Sessle BJ. Convergence of cutaneous, musculoskeletal, dural and visceral afferents onto nociceptive neurons in the first cervical dorsal horn. Europ J Neurosci 2007;26:142–154.

41. Sessle BJ. Trigeminal central sensitization. Rev Analg 2005;8:85–102.

42. Bevilaqua-Grossi D, Lipton RB, Napchan U, Bigal ME. Temporomandibular disorders and cutaneous allodynia are associated in individuals with migraine. Cephalgia 2009;3:209–215.

43. Olesen J, Burstein R, Ashina M, Tfelt-Hansen P. Origin of pain in migraine: Evidence for peripheral sensitization. Lancet Neurol 2009;8:679–689.

44. Rollman GB, Shaheed J, Gillespie JM, Jones KS. Does past pain influence current pain: Biological and psychosocial models. Europ J Pain 2004, 8:427-433.

45. Van Korff M, Dunn KM. Chronic pain reconsidered. Pain 2009;138:267–276.

46. Hardt J, Jacobsen C, Goldberg J, Nickel R, Buchwald D. Prevalence of chronic pain in a representative sample in the United States. Pain Med 2008;9:803–812.

47. Perreault N, Brisson C, Dionne CE, Montreuil S, Punnett L. Agreement between a self-administered questionnaire on musculoskeletal disorders of the neck-shoulder region and a physical examination. BMC Musculoskelet Disord 2008;17:9–34.