Biopsychosocial differences between high-risk and low-risk patients with acute TMD-related pain

Background. The aim of this study was to use a biopsychosocial perspective to characterize patients who were identified as being at high risk, or HR, of progressing from acute to chronic jaw-related pain. Methods. The authors classified 74 subjects as being at HR or low risk, or LR, according to the predictive algorithm. They used a variety of functional and biopsychosocial measures to evaluate subjects. Results. The HR group had significantly higher levels of self-reported pain as measured by the Characteristic Pain Inventory and significantly higher levels of depression as measured by the Beck Depression Inventory-II. They were 11 times more likely to have a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or DSM-IV, Axis I clinical diagnosis, and more than three times as likely to have a DSM-IV Axis II personality disorder. Logistic regression analyses identified variables that differentiated, with 77 percent accuracy, the HR and LR patients. Conclusions. Overall, the HR subjects had more psychopathology than did the LR subjects, used poorer coping styles and had greater self-reported pain. Six psychosocial factors alone enabled the authors to correctly classify 77 percent of the subjects as being in the HR group. Clinical Implications. Future research, in conjunction with the above findings, may enable the authors to determine, with greater certainty, if patients who are more anxious are at greater risk of developing chronic pain. If so, this provides further evidence of the need for early detection of patients at risk of developing chronic pain and the need to refer them for adjunctive care, such as cognitive-behavioral intervention.