Gender Modifies Effect of Perceived Stress on Orofacial Pain Symptoms: National Survey of Adult Oral Health

Aims: To determine in a representative sample of the Australian adult population the relationship between age, gender, and two components of perceived stress (distress and control) and to investigate whether the relationship of perceived stress and temporomandibular disorder (TMD)-related orofacial pain symptoms was modified by gender or age. Methods: Data were from the National Survey of Adult Oral Health conducted in Australia in 2004–2006 and were collected from 3,954 adults aged 18 to 91 years. TMD-related orofacial pain symptoms were evaluated using seven validated screening questions. Perceived stress was measured with the 14-item Perceived Stress Scale and was investigated to empirically test its two theoretical components (distress and sense of control), using principal components analysis. Results: Prevalence of TMD-related orofacial pain symptoms was 10.1% in the Australian adult population. Prevalence was higher in females than in males, inversely related to age, and positively related to distress and current cigarette smoking. Principal component analysis confirmed the theoretical presence of two factors labeled here as distress and control. An inverse relationship of age and distress was more pronounced in females than in males (P value for interaction = .005). In the adjusted binary logistic regression model, age, smoking, and distress remained positively associated with symptoms. A sense of control was protective against TMD-related orofacial pain symptoms, but only for males (P value for interaction = .040). Conclusion: The higher prevalence of TMD-related orofacial pain symptoms in females was better explained by their lower perception of control than from a greater perception of distress. J OROFAC PAIN 2011;25:317–326

effect modification;emotional stress;facial pain;population-based study;sex

1. Carlson CR, Reid KI, Curran SL, et al. Psychological and physiological parameters of masticatory muscle pain. Pain 1998; 76:297–307.

2. Jones GT, Power C, Macfarlane GJ. Adverse events in childhood and chronic widespread pain in adult life: Results from the 1958 British birth cohort study. Pain 2009;143:92–96.

3. McMillan AS, Wong MC, Zheng J, Luo Y, Lam CL. Widespread pain symptoms and psychological distress in southern Chinese with orofacial pain. J Oral Rehabil 2009:2–10.

4. Slade GD, Diatchenko L, Bhalang K, et al. Influence of psychological factors on risk of temporomandibular disorders. J Dent Res 2007;86:1120–1125.

5. Shinal RM, Fillingim RB. Overview of orofacial pain: Epidemiology and gender differences in orofacial pain. Dent Clin North Am 2007;51:1–18.

6. Dao TT, LeResche L. Gender differences in pain. J Orofac Pain 2000;14:169–195.

7. Riley JL III, Gilbert GH. Orofacial pain symptoms: An interaction between age and sex. Pain 2001;90:245–256.

8. Ribeiro-Dasilva MC, Peres Line SR, Leme Godoy dos Santos MC, et al. Estrogen receptor-alpha polymorphisms and predisposition to TMJ disorder. J Pain 2009;10:527–533.

9. Macfarlane TV, Blinkhorn AS, Davies RM, Kincey J, Worthington HV. Association between female hormonal factors and orofacial pain: Study in the community. Pain 2002;97: 5–10.

10. Warren MP, Fried JL. Temporomandibular disorders and hor-mones in women. Cells Tissues Organs 2001;169:187–192.

11. Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S (eds). The Social Psychology of Health. Newbury Park, CA: Sage, 1988: 251.

12. Lazarus RS. Psychological Stress and the Coping Process. New York: McGraw-Hill, 1966.

13. Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York: Springer, 1984.

14. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385–396.

15. Slade GD, Spencer AJ, Roberts-Thomson KF. Australia’s Dental Generations: The National Survey of Adult Oral Health 2004–06. Canberra: Australian Institute of Health and Wel-fare, 2007:1–274.

16. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between smoking and low back pain: A meta-analysis. Am J Med 2010;123:87.

17. Weingarten TN, Iverson BC, Shi Y, Schroeder DR, Warner DO, Reid KI. Impact of tobacco use on the symptoms of painful temporomandibular joint disorders. Pain 2009;147:67–71.

18. Riley JL III, Tomar SL, Gilbert GH. Smoking and smokeless tobacco: Increased risk for oral pain. J Pain 2004;5:218–225.

19. Locker D, Slade G. Association of symptoms and signs of TM disorders in an adult population. Community Dent Oral Epi-demiol 1989;17:150–153.

20. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992; 6:301–355.

21. Ramirez MT, Hernandez RL. Factor structure of the Perceived Stress Scale (PSS) in a sample from Mexico. Span J Psychol 2007;10:199–206.

22. Wongpakaran N, Wongpakaran T. The Thai version of the PSS-10: An Investigation of its psychometric properties. Biopsychosoc Med 2010;4:6.

23. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2008.

24. Sipila K, Ylostalo PV, Ek E, Raustia AM. Association of stress level with facial pain: The role of coping. Cranio 2008;26: 216–221.

25. Luo Y, McMillan AS, Wong MC, Zheng J, Lam CL. Orofacial pain conditions and impact on quality of life in community-dwelling elderly people in Hong Kong. J Orofac Pain 2007;21: 63–71.

26. Keogh E, Herdenfeldt M. Gender, coping and the perception of pain. Pain 2002;97:195–201.

27. Riley JL III, Gilbert GH, Heft MW. Orofacial pain symptom prevalence: Selective sex differences in the elderly? Pain 1998;76:97–104.

28. Locker D, Grushka M. Prevalence of oral and facial pain and discomfort: Preliminary results of a mail survey. Community Dent Oral Epidemiol 1987;15:169–172.

29. Macfarlane TV, Blinkhorn AS, Davies RM, Kincey J, Worthington HV. Oro-facial pain in the community: Prevalence and associated impact. Community Dent Oral Epidemiol 2002; 30:52–60.

30. Isong U, Gansky SA, Plesh O. Temporomandibular joint and muscle disorder-type pain in US adults: The National Health Interview Survey. J Orofac Pain 2008;22:317–322.

31. Hewitt PL, Flett GL, Mosher SW. The perceived stress scale: Factor structure and relation to depression symptoms in a psychiatric sample. J Psychopathol Behav Assess 1992;14:247–257.

32. Mimura C, Griffiths P. A Japanese version of the perceived stress scale: Cross-cultural translation and equivalence assessment. BMC Psychiatry 2008;8:85.

33. Sanders AE, Slade GD, Turrell G, Spencer AJ, Marcenes W. Does psychological stress mediate social deprivation in tooth loss? J Dent Res 2007;86:1166–1170.

34. Gruen RJ, Folkman S, Lazarus RS. Centrality and individual differences in the meaning of daily hassles. J Pers 1988; 56:743–762.

35. Brage S, Bjerkedal T. Musculoskeletal pain and smoking in Norway. J Epidemiol Community Health 1996;50:166–169.

36. Palmer KT, Syddall H, Cooper C, Coggon D. Smoking and musculoskeletal disorders: Findings from a British national survey. Ann Rheum Dis 2003;62:33–36.

37. Aggarwal VR, Macfarlane GJ, Farragher TM, McBeth J. Risk factors for onset of chronic oro-facial pain. Results of the North Cheshire oro-facial pain prospective population study. Pain 2010;149:354–359.

38. Golden-Kreutz DM, Browne MW, Frierson GM, Andersen BL. Assessing stress in cancer patients: A second-order factor analysis model for the Perceived Stress Scale. Assessment 2004; 11:216–223.

39. Sandgren AK, McCaul KD. Short-term effects of telephone therapy for breast cancer patients. Health Psychol 2003; 22:310–315.