title: Subtyping patients with temporomandibular disorders in a primary health care setting on the basis of the research diagnostic criteria for temporomandibular disorders axis II pain-related disability: a step toward tailored treatment planning?
abstract: OBJECTIVE
  To use the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II and additional pain-related and psychosocial variables to identify subtypes of TMD patients in a primary health care setting based on pain-related disability.
  
  
  METHODS
  Consecutive TMD pain patients (n = 399) seeking treatment in a primary care setting completed a multidimensional pain questionnaire. Subtyping was based on the Graded Chronic Pain Scale (GCPS), and the patients were divided into a no-disability group (0 disability points), lowdisability group (1-2 disability points), and high-disability group (3-6 disability points). Psychosocial variables included RDC/TMD Axis II variables, anxiety, tension and stress, worry, catastrophizing, coping ability, general health, and other pain problems. Subtype differences were analyzed with t test, Wilcoxon rank-sum test, ANOVA, or Kruskal-Wallis test. A further analysis with multivariable logistic model was applied. All P values from pairwise comparisons were Bonferroni adjusted.
  
  
  RESULTS
  Most (61%) of the patients belonged to the no-disability group, 27% to the low-disability group, and 12% to the high-disability group. When subtypes were compared, patients in the no-disability group appeared psychosocially well-functioning, with fewer symptoms related to psychosocial distress, better ability to control pain, and fewer jaw functional limitations and other pain problems. Patients in the high-disability group reported the highest levels of symptoms of depression and somatization, sleep dysfunction, worry, and catastrophizing thoughts. The low-disability patients formed an intermediate group between the no-disability and high-disability groups.
  
  
  CONCLUSIONS
  The results suggest that GCPS-related disability scoring can be used as a simple screening instrument in primary care settings to identify individuals with different, clinically relevant psychosocial subtypes.
authors.forename: Ulla
authors.initials: U
authors.lastname: Kotiranta
authors.forename: Tuija
authors.initials: T
authors.lastname: Suvinen
authors.forename: Tommi
authors.initials: T
authors.lastname: Kauko
authors.forename: Yrsa
authors.initials: Y
authors.lastname: Le Bell
authors.forename: Pentti
authors.initials: P
authors.lastname: Kemppainen
authors.forename: Jorma
authors.initials: J
authors.lastname: Suni
authors.forename: Heli
authors.initials: H
authors.lastname: Forssell
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D058443:Catastrophization / Q000523:psychology; D059350:Chronic Pain / Q000145:classification / Q000523:psychology; D003863:Depression / Q000523:psychology; D006233:Persons with Disabilities / Q000145:classification* / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010347:Patient Care Planning; D011320:Primary Health Care; D016059:Range of Motion, Articular / Q000502:physiology; D012893:Sleep Wake Disorders / Q000523:psychology; D013001:Somatoform Disorders / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology; D013705:Temporomandibular Joint Disorders / Q000145:classification* / Q000175:diagnosis / Q000523:psychology; D055815:Young Adult