Comorbidity and Temporomandibular disorders (TMD)

Objectives: To compare TMD patients, with and without depression, in relation to reported sleep alteration (prevention and disturbance) and other recurrent chronic pains (headache, neckache, backache and abdominal pain)

Method: New referrals, to a hospital TMD clinic, with a diagnosis of TMD pain, were categorised into dichotomous groups, depressed and non-depressed, using the Beck Depression Index (Beck et al, 1978).Non-depressed (0-9), Depressed (above 10).

The presence or absence of sleep alteration and other recurrent chronic pains was scored at baseline and compared using nonparametric statistical analysis.

Results: 237 TMD patients, mean age 32.7 years (range 16-55 years), mean duration of pain 3.3 years (range 0.25-32),77% female, 23% male, were categorised into two groups 153 non depressed , 84 depressed. A significant difference in reported sleep prevention and disturbance was found amongst patients suffering from depression (p<0.001). This finding concurs with the concept of altered sleep patterns and depression (Yatani et al, 2002, Lam, 2006).

Non depressed (n=153)Depressed (n=84)

Prevention 54 (35%) 55 (66%) P<0.001

Disturbance 57 (37%) 56 (67%) P<0.001

Chronic pain comorbidity was also found to be increased amongst those presenting with TMD and depression; headache (p=0.021), neckache (p=0.007), backache (p=0.049) and abdominal pain (p=0.011).

Chronic pains Nondepressed(n=153)Depressed (n=84)

Headache 86 (56.2%) 60 (71.4%) P=0.021

Neckache 65 (42.5%) 51 (60.7%) P=0.007

Backache 67 (43.8%) 48 (57.1%) P=0.049

Abdominal pain 36 (23.5%) 33 (39.3%) P=0.011

Previous research suggests patients with TMD and multiple co-morbid pain conditions are more psychologically distressed with a greater risk of developing long-term TMD pain and disability,( John et al, 2003).

Conclusion: Early recognition of comorbid depression, other chronic pain conditions and sleep disturbance in TMD patients is of importance in relation to providing the most effective pain management, tailored to the individual patient.