Catastrophizing and Hypervigilance Influence Subjective Sleep Quality in Painful TMD Patients

Aims: To determine sleep quality and associated factors in a group of patients with painful TMDs. Methods: The medical records of 80 patients with arthralgia and/or myofascial pain were reviewed and compared to a healthy control group. Data about sex, age, subjective pain, physical activity, social activity, subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI]), pain vigilance (Pain Vigilance and Awareness Questionnaire [PVAQ]), and pain catastrophizing (Pain Catastrophizing Scale [PCS]) were collected. Relationships between PSQI, age, pain intensity, PVAQ, and PCS in the TMD group were also analyzed. Data from the control group were used to transform the PSQI results into T-scores, which were then used to divide the TMD group into two subgroups: normal and impaired sleep. Results: TMD patients presented a significantly higher (P < .001) PSQI score than the control group. Also, in the TMD group, there was a low to moderate correlation between PSQI and pain intensity and a significant correlation between PVAQ and PCS. The impaired sleep group presented a significantly higher (P < .001) PSQI T-score than the normal sleep group. Univariate analysis showed that subjective pain, social activity, and the PCS total and subscale scores differed significantly between the different PSQI T-score groups. The comparison between TMD pain patients and control subjects showed a significantly higher prevalence of T-score discordance in almost all PSQI components in TMD patients with impaired sleep. Conclusion: Subjective sleep quality in painful TMD patients could be associated with and influenced by psychosocial factors (catastrophizing and hypervigilance), social activity, and pain intensity.

catastrophization; hypervigilance; pain; sleep; temporomandibular disorders

1. Schütz TC, Andersen ML, Tufik S. The influence of orofacial pain on sleep pattern: A review of theory, animal models and future directions. Sleep Med 2009;10:822–828.

2. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: An update and a path forward. J Pain 2013;14:1539–1552.

3. Cole JC, Dubois D, Kosinski M. Use of patient-reported sleep measures in clinical trials of pain treatment: A literature review and synthesis of current sleep measures and a conceptual model of sleep disturbance in pain. Clin Ther 2007;29 suppl:2580–2588.

4. National Institutes of Health. National Institutes of Health state of the science conference statement on manifestations and management of chronic insomnia in adults. Sleep 2005;28:1049–1057.

5. Yatani H, Studts J, Cordova M, Carlson CR, Okeson JP. Comparison of sleep quality and clinical and psychologic characteristics in patients with temporomandibular disorders. J Orofac Pain 2002;16:221–228.

6. Riley 3rd JL, Benson MB, Gremillion HA, et al. Sleep disturbance in orofacial pain patients: Pain-related or emotional distress? Cranio 2001;19:106–113.

7. Dubrovsky B, Raphael KG, Lavigne GJ, et al. Polysomnographic investigation of sleep and respiratory parameters in women with temporomandibular pain disorders. J Clin Sleep Med 2014;10:195–201.

8. Quartana PJ, Wickwire EM, Klick B, Grace E, Smith MT. Naturalistic changes in insomnia symptoms and pain in temporomandibular joint disorder: A cross-lagged panel analysis. Pain 2010;149:325–331.

9. Schmitter M, Kares-Vrincianu A, Kares H, Bermejo JL, Schindler HJ. Sleep-associated aspects of myofascial pain in the orofacial area among temporomandibular disorder patients and controls. Sleep Med 2015;16:1056–1061.

10. Rener-Sitar K, John MT, Bandyopadhyay D, Howell MJ, Schiffman EL. Exploration of dimensionality and psychometric properties of the Pittsburgh Sleep Quality Index in cases with temporomandibular disorders. Health Qual Life Outcomes 2014;12:10.

11. Al-Jewair T, Shibeika D, Ohrbach R. Temporomandibular disorders and their association with sleep disorders in adults: A systematic review. J Oral Facial Pain Headache 2021;35:41–53.

12. Sanders AE, Essick GK, Fillingim R, et al. Sleep apnea symptoms and risk of temporomandibular disorder: OPPERA cohort. J Dent Res 2013;92:70S–77S.

13. Yap AU, Tan KB, Chua EK, Tan HH. Depression and somatization in patients with temporomandibular disorders. J Prosthet Dent 2002;88:479–484.

14. Canales GT, Guarda-Nardini L, Rizzatti-Barbosa CM, Conti PCR, Manfredini D. Distribution of depression, somatization and pain-related impairment in patients with chronic temporo-mandibular disorders. J Appl Oral Sci 2019:27:e20180210.

15. De La Torre Canales G, Câmara-Souza MB, Muñoz Lora VRM, et al. Prevalence of psychosocial impairment in temporoman-dibular disorder patients: A systematic review. J Oral Rehabil 2018;45:881–889.

16. Häggman-Henrikson B, Bechara C, Pishdari B, Visscher CM, Ekberg E. Impact of catastrophizing in patients with temporo-mandibular disorders—A systematic review. J Oral Facial Pain Headache 2020;34:379–397.

17. Häggman-Henrikson B, Jawad N, Acuña XM, Visscher CM, Schiffman E, List T. Fear of movement and catastrophizing in participants with temporomandibular disorders. J Oral Facial Pain Headache 2022;36:59–66.

18. Reiter S, Eli I, Mahameed M, et al. Pain catastrophizing and pain persistence in temporomandibular disorder patients. J Oral Facial Pain Headache 2018;32:309–320.

19. Oliveira LK, Almeida Gde A, Lelis ÉR, Tavares M, Fernandes Neto AJ. Temporomandibular disorder and anxiety, quality of sleep, and quality of life in nursing professionals. Braz Oral Res 2015;29:1–7.

20. Lei J, Fu J, Yap AU, Fu KY. Temporomandibular disorders symptoms in Asian adolescents and their association with sleep quality and psychological distress. Cranio 2016;34:242–249.

21. Buenaver LF, Quartana PJ, Grace EG, et al. Evidence for indirect effects of pain catastrophizing on clinical pain among myo-fascial temporomandibular disorder participants: The mediating role of sleep disturbance. Pain 2012;153:1159–1166.

22. Lerman SF, Campbell CM, Buenaver LF, et al. Exploring the role of negative cognitions in the relationship between ethnicity, sleep, and pain in women with temporomandibular joint disorder. J Pain 2018;19:1342–1351.

23. Cioffi I, Perrotta S, Ammendola L, et al. Social impairment of individuals suffering from different types of chronic orofacial pain. Prog Orthod 2014;15:27.

24. Cho HJ, Kim SJ, Park SE, Park JW. Physical activity level and temporomandibular disorders in South Koreans. Community Dent Oral Epidemiol 2020;48:225–231.

25. Sullivan Bisson AN, Robinson SA, Lachman ME. Walk to a better night of sleep: Testing the relationship between physical activity and sleep. Sleep Health 2019;5:487–494.

26. von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Int J Surg 2014;12:1495–1499.

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

28. Furquim BD, Flamengui LM, Repeke CE, Cavalla F, Garlet GP, Conti PC. Influence of TNF-α-308 G/A gene polymorphism on temporomandibular disorder. Am J Orthod Dentofacial Orthop 2016;149:692–698.

29. Bertolazi AN, Fagondes SC, Hoff LS, et al. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med 2011;12:70–75.

30. Breivik EK, Björnsson GA, Skovlund E. A comparison of pain rating scales by sampling from clinical trial data. Clin J Pain 2000;16:22–28.

31. Roelofs J, Peters ML, McCracken L, Vlaeyen JW. The pain vigilance and awareness questionnaire (PVAQ): Further psychometric evaluation in fibromyalgia and other chronic pain syndromes. Pain 2003;101:299–306.

32. McWilliams LA, Asmundson GJ. Assessing individual differences in attention to pain: Psychometric properties of the Pain Vigilance and Awareness Questionnaire modified for a non-clinical pain sample. Personality and Individual Differences 2001;31:239–246.

33. Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychol Assess 1995;7:524–532.

34. Craner JR, Gilliam WP, Sperry JA. Rumination, magnification, and helplessness: How do different aspects of pain catastro-phizing relate to pain severity and functioning? Clin J Pain 2016;32:1028–1035.

35. Osman A, Barrios FX, Gutierrez PM, Kopper BA, Merrifield T, Grittmann L. The Pain Catastrophizing Scale: Further psychometric evaluation with adult samples. J Behav Med 2000;23:351–365.

36. Kothari SF, Baad-Hansen L, Svensson P. Psychosocial profiles of temporomandibular disorder pain patients: Proposal of a new approach to present complex data. J Oral Facial Pain Headache 2017; 31:199–209.

37. Rener-Sitar K, John MT, Pusalavidyasagar SS, Bandyopadhyay D, Schiffman EL. Sleep quality in temporomandibular disorder cases. Sleep Med 2016;25:105–112.

38. Lindroth JE, Schmidt JE, Carlson CR. A comparison between masticatory muscle pain patients and intracapsular pain patients on behavioral and psychosocial domains. J Orofac Pain 2002;16:277–283.

39. Morin CM, Gibson D, Wade J. Self-reported sleep and mood disturbance in chronic pain patients. Clin J Pain 1998;14:311–314.

40. Dubrovsky B, Janal MN, Lavigne GJ, et al. Depressive symptoms account for differences between self-reported versus polysomnographic assessment of sleep quality in women with myofascial TMD. J Oral Rehabil 2017;44:925–933.

41. Porto F, de Leeuw R, Evans DR, et al. Differences in psychosocial functioning and sleep quality between idiopathic continuous orofacial neuropathic pain patients and chronic masticatory muscle pain patients. J Orofac Pain 2011;25:117–124.

42. Buenaver LF, Quartana PJ, Grace EG, et al. Evidence for indirect effects of pain catastrophizing on clinical pain among myo-fascial temporomandibular disorder participants: The mediating role of sleep disturbance. Pain 2012;153:1159–1166.

43. Smith MT, Perlis ML, Carmody TP, Smith MS, Giles DE. Presleep cognitions in patients with insomnia secondary to chronic pain. J Behav Med 2001;24:93–114.

44. Vitiello MV, Rybarczyk B, Von Korff M, Stepanski EJ. Cognitive behavioral therapy for insomnia improves sleep and decreases pain in older adults with comorbid insomnia and osteoarthritis. J Clin Sleep Med 2009;5:355–362.

45. Hollins M, Harper D, Gallagher S, et al. Perceived intensity and unpleasantness of cutaneous and auditory stimuli: An evaluation of the generalized hypervigilance hypothesis. Pain 2009;141:215–221.

46. Romeijn N, Raymann RJ, Møst E, et al. Sleep, vigilance, and thermosensitivity. Pflugers Arch 2012;463:169–176.

47. Markiewicz MR, Ohrbach R, McCall Jr WD. Oral behaviors checklist: Reliability of performance in targeted waking-state behaviors. J Orofac Pain 2006;20:306–316.

48. Beattie L, Kyle SD, Espie CA, Biello SM. Social interactions, emotion and sleep: A systematic review and research agenda. Sleep Med Rev 2015;24:83–100.

49. Sluka KA, O’Donnell JM, Danielson J, Rasmussen LA. Regular physical activity prevents development of chronic pain and activation of central neurons. J Appl Physiol (1985) 2013;114:725–733.

50. Gordon R, Bloxham S. A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain. Healthcare (Basel) 2016;4:22

51. Kayo AH, Peccin MS, Sanches CM, Trevisani VF. Effectiveness of physical activity in reducing pain in patients with fibromy-algia: A blinded randomized clinical trial. Rheumatol Int 2012;32:2285–2292.

52. Pagel JF, Parnes BL. Medications for the treatment of sleep disorders: An overview. Prim Care Companion J Clin Psychiatry 2001;3:118–125.

53. Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 2021;17:263–298.

54. Wideman TH, Sullivan MJ. Reducing catastrophic thinking associated with pain. Pain Manag 2011;1:249–256.

55. Jerath R, Crawford MW, Barnes VA, Harden K. Self-regulation of breathing as a primary treatment for anxiety. Appl Psychophysiol Biofeedback 2015;40:107–115.