Ralph I. Brooke

The cortisol response to psychological stress in temporomandibular dysfunction

Abstract The salivary cortisol response to psychological stress and its relationship to psychological variables was examined in 36 female temporomandibular dysfunction (TMD) sufferers and 39 female control participants. Saliva samples were taken at baseline, after completion of a modified version of the Trier Social Stress Test, and after rest. Participants also completed a battery of measures, including Visual Analog Scales for measuring pain intensity and disability and a number of established psychological scales. The TMD group showed a significantly higher cortisol response to experimental stress than the control group. Closer examination of the data revealed that the TMD group was heterogeneous and composed of a group that hypersecreted cortisol in response to stress (Hi‐SC TMD group) and another group whose cortisol response was not significantly different from the control group (Lo‐SC TMD group). The Lo‐SC TMD group showed significant negative relationships between cortisol response and self‐reported symptoms of both anxiety and depression, plus significantly more use of the Praying or Hoping coping strategy on the Coping Strategies Questionnaire. A dual relationship between TMD symptoms and the stress response is proposed. First, a biological predisposition to TMD is suggested by the stress response in the Hi‐SC TMD group. Second, both psychological and biological variables appear to be important factors in those TMD patients who respond to stress with low cortisol secretion.

Biofeedback and a cognitive behavioral approach to treatment of myofascial pain dysfunction syndrome

Thirteen subjects suffering from long-standing myofascial pain dysfunction syndrome (MPDS) were selected from a large group of myofascial pain patients attending a pain clinic. MPDS subjective and objective measures were recorded prior to and following a treatment program. This program included relaxation training, sensory awareness training, and coping skills training. In addition, half the subjects were given masseter muscle EMG biofeedback during relaxation training, while, for the others, masseter muscle tension was recorded, but not fed back. All subjects manifested reductions both in masseter muscle tension and in subjective measures of pain. Although the subjects receiving biofeedback experienced less subjective pain, there were no noticeable differences on EMG measures.

Atypical odontalgia: A report of twenty-two cases

The findings in twenty-two cases of a condition that causes pain in the teeth and gingivae are presented. Two cases are described in detail. The importance of recognizing the problem and avoiding unnecessary dental treatment is stressed. The most effective treatment appears to be reassurance and the use of antidepressant drugs.

Psychosocial correlates of temporomandibular joint pain and dysfunction

&NA; This study examines psychological differences between temporomandibular joint pain and dysfunction (TMJPD) patients, pain controls and healthy controls. Two hundred and two patients were classified, according to the diagnostic criteria of Eversole and Machado, as either myogenic facial pain (n = 42), internal derangement type I (n = 69), internal derangement type II (n = 85), or internal derangement type III (n = 6). Patients completed the Basic Personality Inventory, the Illness Behavior Questionnaire, the Multidimensional Health Locus of Control, the Perceived Stress Scale and the Ways of Coping Checklist. Subjects also answered questions pertaining to TMJPD symptomatology, including chronicity and severity. After conservative treatment with simple jaw exercise and ultrasound, patients were contacted again at 5 months to complete follow‐up questionnaires similar to those previously completed. Comparison groups were comprised of 79 patients attending outpatient physiotherapy clinics for pain‐related injuries not involving the temporomandibular joint and 71 pain‐free, healthy students. Data were analyzed using multivariate statistics. The results indicate a significant relationship between pain intensity (and to some extent chronicity) and diverse measures of personality among the pain controls but not among the TMJPD patients. This calls into question the validity of assuming individual pain disorders are subsets of a larger, homogeneous pain disorder population. TMJPD patients and pain controls score higher on hypochondriasis and anxiety than the pain‐free controls but these elevations are not clinically significant. The elevations decrease to normal levels in response to a positive treatment outcome. There were no differences between the TMJPD patients and the pain controls on any of the measures. These results suggest that TMJPD patients do not appear to be significantly different from other pain patients or healthy controls in personality type, response to illness, attitudes towards health care, or ways of coping with stress.

The diagnosis and conservative treatment of myofascial pain dysfunction syndrome

The findings in 194 cases of myofascial pain dysfunction syndrome are summarized and the differential diagnosis of the condition is discussed. Conservative methods of treatment were used in all cases, and follow-up revealed complete or almost complete recovery in 75 per cent of the patients; this percentage was increased still further when relaxation and coping skills training were used. Those patients who had been involved in accidents with direct or indirect trauma to one or both joints showed a significantly higher proportion of nonresponse to therapy.

Screening for psychiatric illness in patients with oral dysesthesia by means of the General Health Questionnaire-twenty-eight item version (GHQ-28) and the Irritability, Depression and Anxiety Scale (IDA)

Thirty-one consecutive subjects suffering from oral dysesthesia and without detectable organic disease were seen in a university outpatient dental clinic. They were assessed with a screening test for psychiatric illness, the General Health Questionnaire, 28-item version (GHQ-28). Twelve subjects also completed the Irritability, Depression and Anxiety Scale (IDA). At the 4/5 cutoff on the GHQ, 51.9% of the patients showed evidence of psychiatric illness. The IDA appeared to be more sensitive than the GHQ-28 in terms of detecting psychiatric illness, especially depression, and 75% of the 12 subjects who completed both scales were found to be depressed on the IDA. These results were compared to results obtained by another cross-sectional study of different types of pain clinics in which the same scales were used to screen for psychiatric illness. The subjects with oral dysesthesia as measured by the IDA appeared to have psychiatric illness more often than the other subjects with chronic pain, except those attending a psychiatric clinic. The GHQ-28 results on the other hand showed less psychiatric illness in the latter group. Our findings indicate that psychiatric illness, especially depression, may play an important role in this disorder and that the IDA may be more sensitive than the GHQ for detecting depression.

Atypical odontalgia. Update and comment on long-term follow-up

The purpose of the present study is to update the reader on atypical odontalgia and to present some preliminary data on the long-term follow-up of a subsample (n = 28) of these patients. Data based on 120 patients tend to support earlier findings that indicate that primarily women (81%) between the ages of 23 and 60 have this condition. Pain is generally localized in the teeth but may involve several areas of the oral cavity. On the basis of this larger sample size, the relationship between atypical odontalgia and migraine does not appear to be as strong as initially reported. Psychologic disturbance also may play a less significant role than initially thought. Follow-up data on 28 patients suggest that many patients will continue to experience episodes of pain. Antidepressant medication still appears to be the treatment of choice for this condition.

Postinjury myofascial pain dysfunction syndrome: Its etiology and prognosis**

Clinical data are producted which appear to show that the response to therapy of myofascial pain dysfunction syndrome (MPDS) is much less favorable when the patient has been involved in a road traffic or similar accident which precipiated the condition. Reasons for this difference and the differences between postinjury MPDS and nonpostinjury MPDS patients may be a consequence of litigation and, in addition, may be due to the personality of the patient. Evidence to support this hypothesis is seen when the condition is compared with such disorders as low back pain. Further research is needed to explore the etiology and treatment implications of these differences.

The relationship between cognitive appraisal, affect, and catastrophizing in patients with chronic pain

A study was conducted to clarify the nature of catastrophizing, a construct that is frequently referred to in the chronic pain literature. Information regarding 3 affective experience and 3 affect regulation dimensions was gathered from a heterogeneous sample of 104 chronic pain patients by using a semistructured clinical interview and the Affect Regulation and Experience Q-Sort (AREQ). Self-report questionnaires included visual analog pain scales, the Coping Strategies Questionnaire (CSQ), Multidimensional Pain Inventory (MPI), McGill Pain Questionnaire (MPQ), and Center for Epidemiological Studies Depression scale (CES-D). Hierarchical multiple regression was used to demonstrate the relative contributions of affective and cognitive appraisal components of catastrophizing. Thirty-one percent of the variance in CSQ-Catastrophizing scores was explained by a combination of cognitive appraisal variables (perceived ability to control pain; MPI Life Control) and AREQ scores, even after adjusting for pain severity and chronicity, age, and sex of participants. Results of the study strongly suggest that, rather than thinking of catastrophizing primarily as a cognitive coping construct, it should be described as an elaborate construct made up of both cognitive appraisal and affective components. Implications for tailoring interventions to match individual styles of affect regulation are discussed.

Is the temporo-mandibular pain and dysfunction syndrome a disorder of the mind?

Abstract It was assumed that patients with temporo‐mandibular pain and dysfunction syndrome (TMPDS) would represent a population whose pain resulted from their emotional state. It was anticipated in the light of existing reports in the literature that they would score like patients with anxiety neurosis or other psychiatric illness on the General Health Questionnaire (GHQ) and the Crown‐Crisp Experiential Index (CCEI: a measure of anxiety and other emotional characteristics). It was also anticipated that patients with facial pain associated with lesions would show evidence of similar emotional disturbance secondary to their pain. It was postulated, however, that the TMPDS patients would be separated from the others by a scale which measured their attitudes to parents and childhood experience, namely, the Parental Bonding Instrument (PBI). The actual comparison of TMPDS patients and patients with facial pain and lesions or pathophysiological disorders showed little evidence of neuroticism in either group; nor were the parental bonding attitudes found to be abnormal. It is questioned whether TMPDS is primarily psychological in origin.