Chronic Temporomandibular Disorders: disability, pain intensity and fear of movement.
BACKGROUND
The objective was to compare and correlate disability, pain intensity, the impact of headache on daily life and the fear of movement between subgroups of patients with chronic temporomandibular disorder (TMD).


METHODS
A cross-sectional study was conducted in patients diagnosed with chronic painful TMD. Patients were divided into: 1) joint pain (JP); 2) muscle pain (MP); and 3) mixed pain. The following measures were included: Craniomandibular pain and disability (Craniofacial pain and disability inventory), neck disability (Neck Dsiability Index), pain intensity (Visual Analogue Scale), impact of headache (Headache Impact Test 6) and kinesiophobia (Tampa Scale of Kinesiophobia-11).


RESULTS
A total of 154 patients were recruited. The mixed pain group showed significant differences compared with the JP group or MP group in neck disability (p < 0.001, d = 1.99; and p < 0.001, d = 1.17), craniomandibular pain and disability (p < 0.001, d = 1.34; and p < 0.001, d = 0.9, respectively), and impact of headache (p < 0.001, d = 1.91; and p < 0.001, d = 0.91, respectively). In addition, significant differences were observed between JP group and MP group for impact of headache (p < 0.001, d = 1.08). Neck disability was a significant covariate (37 % of variance) of craniomandibular pain and disability for the MP group (β = 0.62; p < 0.001). In the mixed chronic pain group, neck disability (β = 0.40; p < 0.001) and kinesiophobia (β = 0.30; p = 0.03) were significant covariate (33 % of variance) of craniomandibular pain and disability.


CONCLUSIONS
Mixed chronic pain patients show greater craniomandibular and neck disability than patients diagnosed with chronic JP or MP. Neck disability predicted the variance of craniofacial pain and disability for patients with MP. Neck disability and kinesiophobia predicted the variance of craniofacial pain and disability for those with chronic mixed pain.
Hospital La Paz Institute for Health Research, Madrid, Spain. fongilmar@gmail.com.|Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios, Universidad Autónoma de Madrid, Calle La Salle, 10, 28036, Madrid, Spain. fongilmar@gmail.com.
Alfonso
A
Gil-Martínez
Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios, Universidad Autónoma de Madrid, Calle La Salle, 10, 28036, Madrid, Spain.
Mónica
M
Grande-Alonso
Hospital La Paz Institute for Health Research, Madrid, Spain.|Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios, Universidad Autónoma de Madrid, Calle La Salle, 10, 28036, Madrid, Spain.
Ibai
I
López-de-Uralde-Villanueva
Multidisciplinary Group on Pain Research and Management, Excellence Research Program URJC-Santander, Universidad Rey Juan Carlos, Alcorcón, Spain.|Departamento de medicina y cirugía, psicología, medicina preventiva y salud pública e inmunología microbiología médica, Universidad Rey Juan Carlos, Avda. Atenas s/n, 28922, Alcorcón, Spain.
Almudena
A
López-López
Hospital La Paz Institute for Health Research, Madrid, Spain.|Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios, Universidad Autónoma de Madrid, Calle La Salle, 10, 28036, Madrid, Spain.|Multidisciplinary Group on Pain Research and Management, Excellence Research Program URJC-Santander, Universidad Rey Juan Carlos, Alcorcón, Spain.|Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avda. Atenas s/n, 28922, Alcorcón, Spain.
Josué
J
Fernández-Carnero
Hospital La Paz Institute for Health Research, Madrid, Spain.|Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios, Universidad Autónoma de Madrid, Calle La Salle, 10, 28036, Madrid, Spain.
Roy
R
La Touche
D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D005157:Facial Pain / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D005239:Fear / Q000523:psychology*; D005260:Female; D006261:Headache / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D063806:Myalgia / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D019547:Neck Pain / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement; D013705:Temporomandibular Joint Disorders / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000150:complications / Q000503:physiopathology / Q000523:psychology
Chronic pain; Craniofacial disability; Headache; Neck disability; Temporomandibular disorders