Relationship of Daily Stress and Temporomandibular Pain

Objectives: Temporomandibular muscle and joint disorders (TMJD) are commonly considered to be related to stress. However, few studies have investigated the relationship between TMJD-related facial pain and stress on a daily basis. This study assessed the association of facial (TMJD) pain levels with 1) perceived stress; and 2) reported stressful events using daily diary methods. Methods: Subjects were 34 women meeting Research Diagnostic Criteria for both myofascial pain and arthralgia. All were 18-40 years old and had regular menstrual cycles. Participants completed and mailed in diaries daily over two menstrual cycles. Diaries included VAS (0-100) ratings of average and worst facial pain, somatic symptoms (somatization scale of the SCL-90), the brief Perceived Stress Scale (PSS; range=0-16) and a checklist of daily stressors (Kessler et al., 1988), including items on demands (overload) and interpersonal stressors (arguments). Results: Average diary completion rate exceeded 99%. The between-subjects correlation between PSS and average facial pain was r=0.24; the correlation between PSS and worst facial pain was r=0.19; and the correlation of PSS x somatic symptoms was r=0.47. In within-subjects analysis, the correlation of PSS x same day average facial pain was r=0.19; for PSS x same day worst facial pain, r=0.21; and for PSS x same day somatic symptoms r=0.24. Perceived stress and pain report were higher on days with vs. without overload (e.g., median PSS=5.0 vs. 3.6; median worst facial pain=30.5 vs. 20.6) and on days with vs. without arguments (e.g., median PSS = 5.1 vs. 3.3; median worst facial pain = 27.1 vs. 21.3). Conclusion: Our findings indicate a consistent positive association of both perceived stress and daily stressors with reported pain level. Future research is needed to determine whether additional factors (e.g., hormonal changes) may affect both stress and pain on a daily basis. Supported by NIH/NIDCR Grant No. R01DE016212.