| Study Shows Link Between Traumatic Stress and TMJ Pain |
ROSEMONT, Ill., Dec. 15 /PRNewswire/ -- A study published in the January 2005 issue of the Journal of Oral and Maxillofacial Surgery shows a strong link between major traumatic stress and chronic facial pain, notably disorders of the temporomandibular joint (TMJ), the joint that connects the lower jaw to the temporal bone at the side of the face and a source of distress for an estimated 10 million Americans.
The findings could help redirect the treatment of TMJ disorders (TMJD) to include a stronger emphasis on psychotherapy for stress-related anxiety and depression as well as treatment for stress-induced hormonal imbalances, reports Reny de Leeuw, DDS, PhD, principal author of the study and assistant professor in the Orofacial Pain Center at the University of Kentucky in Lexington.
Although TMJD have a variety of causes, many people with TMJD clench or grind their teeth at night, which can tire the jaw muscles and lead to pain.
Researchers administered a battery of psychological questionnaires, including a 15-item checklist of significant traumatic stressors, to 1,221 TMJD patients treated at the Orofacial Pain Center between 1997 and 2002. Patients were separated into two groups: those who reported one or more traumatic stressors (TS) and those who did not (NTS).
Nearly half (607, or 49.7%) of the TMJD patients (90 males, 517 females) reported one or more major traumatic stressors. The stressors most often reported were the death or injury of a family member (47%), a severe auto accident (29%), a sudden or serious injury (25%), observing someone be hurt or killed (23%) and a violent attack (19%).
Of the patients reporting a stressor, 57% indicated the date of the most significant traumatic event. Of this group, significantly more patients reported that the stressor occurred before the onset of pain compared to after the onset of pain (60% and 40%, respectively).
Fifty percent of TS patients reported one major traumatic stressor, 26% reported two, 11% reported three and 13% reported four or more (as many as nine).
"The prevalence of major traumatic life events in orofacial pain patients is high, and the experience of such stressors may be an important contributing factor in the etiology of chronic facial pain," Dr. Leeuw concludes.
"Although the influence of psychological factors on orofacial pain has long been recognized, few studies have focused on the prevalence of major traumatic stressors in TMJD patients and their impact on the patient's well- being and treatment outcome," he says. "The present study looked specifically at the incidence of traumatic life events among TMJD patients, as well as the incidence of long-term difficulties in coping with these traumas."
The fact that traumatic stress preceded rather than followed the onset of pain in significantly more TS patients fits with the current theory of a stress hormone disturbance as a key factor in the onset of facial pain, Dr. Leeuw says.
"However, chronic distress from traumatic events probably exacerbates an existing tendency toward hormonal dysregulation rather than causes it," he says.
"If hormonal dysregulation and psychological distress are indeed major players in chronic painful conditions, then it seems only logical that therapy should be oriented toward the resolution of these factors," Dr. Leeuw says.
The American Association of Oral and Maxillofacial Surgeons (AAOMS), the professional organization representing more than 7,000 oral and maxillofacial surgeons in the United States, supports its members' ability to practice their specialty through education, research, and advocacy. AAOMS members comply with rigorous continuing education requirements and submit to periodic office examinations, ensuring the public that all office procedures and personnel meet stringent national standards.
Quelle: American Association of Oral and Maxillofacial Surgeons