Patterns of pain variation related to myogenous temporomandibular disorders

Objectives: Myogenous temporomandibular disorders are characterized by jaw muscle pain. The aims were: 1) to characterize this pain generally in terms of intensity, frequency, duration, and behavior across a period of 2 weeks; 2) to identify main intraday pain patterns and to examine whether subgroups of patients in this respect differed in clinical, demographic, pain and sleep variables, psychosocial factors, and use of medication; and 3) to investigate some possible interday trends of pain intensity at a group level. Method: One hundred thirty-three patients with myogenous temporomandibular disorders completed a 2-week diary, rating pain intensity (100 mm Visual Analog Scale [VAS]). duration. behavior (verbal 6-point scale), and medication use on 4 times of the day. Furthermore, questionnaires were completed to score pain period before seeking treatment, spread of pain, and demographic, psychosocial, and sleep variables. Results: In the diary, pain intensity, frequency, daily pain duration, and the score of pain behavior were on average 29.1 mm, 69% of the scoring times, 5.5 hours, and 1.8 points (approaching pain present. but I can ignore it at times), respectively. Pain intensity was. oil average, maximal late in the day (before dinner or bedtime) for the majority of patients (79%) and early in the day (before breakfast or lunchtime) for the minority (21%). The larger subgroup had a significantly higher daily pain intensity, more frequently a widespread pain and problems with falling asleep at bedtime, agreed more about the role of a physician as an external health locus of control, and had a more distancing coping style. Both subgroups were similar for other variables, most notably in the level of state anxiety and depressive mood, and in a sparse use (7.8% of all possible times) of over-the-counter medication. Daily mean VAS scores, averaged across patients, were approximately constant for the various diary days. Both the daily mean and maximal VAS score were not related to a specific day of the week. Conclusions: Two main daily pain patterns occur in patients with myogenous temporomandibular disorders (79%: maximal pain late in the day; 21% early in the day), which might be related to differences in processes that influence pain sensitivity and patterns of jaw muscle activation. The interday similarities in pain level suggest that a sustained influence of counseling after the intake or an influence of a common behavioral pattern with a cycle duration of a week are not involved.