Association of Pain Widespreadness in Pain Drawings With Psychological Burden Among Tertiary Care Patients With Temporomandibular Disorders
Arvid Iljin, Kirsi Sipilä, Tuija Suvinen, Tuija Teerijoki-Oksa, Ville Vuollo, Ritva NäpänkangasObjective
The aim was to assess the association between pain widespreadness and psychological burden among tertiary care temporomandibular disorders (TMDs) pain patients by utilizing pain drawings (PDs) of the diagnostic criteria for TMD (DC/TMD)‐FIN both visually and quantitatively.
Methods
A total of 197 TMD pain patients were divided into PD profile subgroups (PD‐1 = head/face pain; PD‐2 = head and neck/shoulder regional pain; PD‐3 = widespread pain). In quantitative analysis of PDs, PD score was calculated, considering the pain widespreadness. Subscales and median sum scores of generalized anxiety disorder‐7 (GAD‐7) and patient health questionnaires (PHQ‐9 and PHQ‐15) were calculated. Differences in subscales and median sum scores of GAD‐7, PHQ‐9, and PHQ‐15 between PD profile subgroups were evaluated with independent samples Kruskal–Wallis and chi‐square tests. Linear regression models for PD sum score included sum scores of GAD‐7, PHQ‐9, and PHQ‐15, sociodemographic variables, pain duration, and study site. When using PD profile subgroup as outcome ordinal logistic regression models were used.
Results
Visualized via PDs, mean sum scores of GAD‐7, PHQ‐9, and PHQ‐15 increased significantly from PD‐1 to PD‐3 profile subgroup. Based on quantitative analysis, mean PD sum scores were highest among patients with severe anxiety, depression, and highest somatic symptom levels. PD sum scores tended to increase with anxiety and depression severity, but statistically significant subgroup differences were observed only for PHQ‐15. In the multivariate models, sum scores of GAD‐7, PHQ‐9, and PHQ‐15 were significantly associated with higher PD scores and higher PD profile subgroup.
Conclusion
Utilizing PD as an assessment tool both visually and quantitatively, patients with widespread pain profiles demonstrated higher levels of anxiety, depression, and somatic symptoms. Widespread pain may refer to higher psychosocial burden in TMD pain patients.