title: Temporomandibular disorder subtypes according to self-reported physical and psychosocial variables in female patients: a re-evaluation.
abstract: Several studies support the relevance of psychological and psychosocial factors in the assessment and management of chronic musculoskeletal pain disorders, including temporomandibular pain disorders (TMDs). The aim of this study was to re-evaluate subtyping approach used in an earlier study (TI Suvinen, KR Hanes, JA Gerschman, PC Reade. J Orofac Pain 1997;11:200) and to compare perceived physical symptoms, psychological, coping and psychosocial variables between subtypes of patients who seek treatment for their temporomandibular pain and dysfunction. A total of 41 consecutive female patients were assessed multiaxially for physical symptoms, coping style and effectiveness and illness behaviour by a previously validated Temporomandibular Pain Dysfunction Questionnaire (TI Suvinen, KR Hanes, JA Gerschman, PC Reade. J Orofac Pain 1997;11:200). Additional measures of psychosocial variables included the global scores of the Beck Depression and Anxiety Inventory and Part I of the Multidimensional Pain Inventory. Subtypes were generated using an iterative partitioning method, k-means cluster analysis. Three clusters were identified and termed as Simple (22%), Intermediate (41%) and Complex (37%) temporomandibular disorders subtypes. Significant differences (P < 0.05) were found between clusters in psychological (coping style and effectiveness, disease conviction and affective disturbance) and in psychosocial variables (daily interference and social, work and family satisfaction), but not between physical variables. The results support previous studies that have shown differences in psychosocial variables in the presentation and subtyping of TMDs and the biopsychosocial orientation in assessment. The findings need to be reverified in a larger sample along specific physical diagnoses, but it is tentatively proposed how the three subtypes could be used in the classification of temporomandibular pain patients to guide management, based on the constellation of predominant psychological and psychosocial illness impact variables.
authors.affiliation: Institute of Dentistry, University of Helsinki, Helsinki, Finland. tuijasuvi@hotmail.com
authors.forename: T I
authors.initials: TI
authors.lastname: Suvinen
authors.forename: P C
authors.initials: PC
authors.lastname: Reade
authors.forename: K R
authors.initials: KR
authors.lastname: Hanes
authors.forename: M
authors.initials: M
authors.lastname: Könönen
authors.forename: P
authors.initials: P
authors.lastname: Kemppainen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety; D016009:Chi-Square Distribution; D016000:Cluster Analysis; D003863:Depression; D005260:Female; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement; D011788:Quality of Life; D018709:Statistics, Nonparametric; D013705:Temporomandibular Joint Disorders / Q000145:classification* / Q000523:psychology