title: Preclinical episodes of orofacial pain symptoms and their association with health care behaviors in the OPPERA prospective cohort study.
abstract: The course of preclinical pain symptoms sheds light on the etiology and prognosis of chronic pain. We aimed to quantify rates of developing initial and recurrent symptoms of painful temporomandibular disorder (TMD) and to evaluate associations with health behaviors. In the OPPERA prospective cohort study, 2,719 individuals aged 18 to 44years with lifetime absence of TMD when enrolled completed 25,103 quarterly (3-monthly) questionnaires during a median 2.3-year follow-up period. Questionnaires documented TMD symptom episodes, headache, other body pain, health care attendance, and analgesic use, and. Kaplan-Meier methods for clustered data estimated symptom-free survival time. Multivariable models assessed demographic variation in TMD symptom rates and evaluated associations with health care and analgesic use. One-third of the study subjects developed TMD symptoms and for a quarter of symptomatic episodes, pain intensity was severe. Initial TMD symptoms developed at an annual rate of 18.8 episodes per 100 persons. The annual rate more than doubled for first-recurrence and doubled again for second or subsequent recurrence such that, 1year after first recurrence, 71% of study subjects experienced a second recurrence. The overall rate increased with age and was greater in African Americans and lower in Asians relative to those of white race/ethnicity. The probability of TMD symptoms was strongly associated with concurrent episodes of headache and body pain and with past episodes of TMD symptoms. Episodes of TMD symptoms, headache, and body pain were associated with increases of ∼10% in probability of analgesic use and health care attendance. Yet, even when TMD, headache, and body pain occurred concurrently, 27% of study subjects neither attended health care nor used analgesics.
authors.affiliation: Regional Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Battelle Memorial Institute, Durham, North Carolina, USA Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA Brotman Facial Pain Center, University of Maryland-Baltimore, Baltimore, Maryland, USA Department of Neural and Pain Sciences, University of Maryland-Baltimore, Baltimore, Maryland, USA Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA.
authors.forename: Gary D
authors.initials: GD
authors.lastname: Slade
authors.forename: Anne E
authors.initials: AE
authors.lastname: Sanders
authors.forename: Eric
authors.initials: E
authors.lastname: Bair
authors.forename: Naomi
authors.initials: N
authors.lastname: Brownstein
authors.forename: Dawn
authors.initials: D
authors.lastname: Dampier
authors.forename: Charles
authors.initials: C
authors.lastname: Knott
authors.forename: Roger
authors.initials: R
authors.lastname: Fillingim
authors.forename: William O
authors.initials: WO
authors.lastname: Maixner
authors.forename: Shad
authors.initials: S
authors.lastname: Smith
authors.forename: Joel
authors.initials: J
authors.lastname: Greenspan
authors.forename: Ron
authors.initials: R
authors.lastname: Dubner
authors.forename: Richard
authors.initials: R
authors.lastname: Ohrbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003625:Data Collection; D005006:Ethnicity; D005157:Facial Pain / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006261:Headache / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013705:Temporomandibular Joint Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D014481:United States / Q000453:epidemiology; D055815:Young Adult