Dataset Information

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.

SUBMITTER: Slade GD

PROVIDER: S-EPMC3652580 | biostudies-literature | 2013 May

REPOSITORIES: biostudies-literature

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Preclinical episodes of orofacial pain symptoms and their association with health care behaviors in the OPPERA prospective cohort study.

Slade Gary D GD Sanders Anne E AE Bair Eric E Brownstein Naomi N Dampier Dawn D Knott Charles C Fillingim Roger R Maixner William O WO Smith Shad S Greenspan Joel J Dubner Ron R Ohrbach Richard R

Pain 20130213 5

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 d ...[more]

PMID: 23531476

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Project description:<p>The OPPERA project has two sub-studies investigating effects of genetic, physiological, psychological and clinical factors on the risk of developing painful temporomandibular disorder (TMD).</p> <ol> <li>OPPERA I baseline case-control study of chronic TMJD (dbGaP study accession <a href="./study.cgi?study_id=phs000762">phs000762</a>). This sub-study uses a case-control study design to investigate characteristics associated with chronic TMD. The parent OPPERA phenotype file contains an indicator variable (<a href="javascript:getPage(this, 'variable.cgi', 222740);return true;" onclick="javascript:getPage(this, 'variable.cgi', 222740);return true;" oncontextmenu="javascript:getPage(this, 'variable.cgi', 222740);return true;">PHASE1CASECONTROL</a>) identifying participants in this sub-study. Data users should use the relevant case-classification variable (<a href="javascript:getPage(this, 'variable.cgi', 222742);return true;" onclick="javascript:getPage(this, 'variable.cgi', 222742);return true;" oncontextmenu="javascript:getPage(this, 'variable.cgi', 222742);return true;">CHRNONICTMDCASE</a>) and apply statistical methods appropriate for case-control studies when analyzing TMJD in this sub-study.</li> <li>OPPERA I prospective cohort for first onset of TMJD (dbGaP study accession <a href="./study.cgi?study_id=phs000850">phs000850</a>). This sub-study uses a prospective cohort study design to investigate characteristics that predict risk of developing first-onset TMD. The parent OPPERA phenotype file contains an indicator variable (<a href="javascript:getPage(this, 'variable.cgi', 222743);return true;" onclick="javascript:getPage(this, 'variable.cgi', 222743);return true;" oncontextmenu="javascript:getPage(this, 'variable.cgi', 222743);return true;">PROSPECTIVECOHORT</a>) identifying participants in this sub-study. Data users should use the relevant case-classification variable (<a href="javascript:getPage(this, 'variable.cgi', 222746);return true;" onclick="javascript:getPage(this, 'variable.cgi', 222746);return true;" oncontextmenu="javascript:getPage(this, 'variable.cgi', 222746);return true;">INCIDENTCASE</a>) and the relevant time-in-study variable (<a href="javascript:getPage(this, 'variable.cgi', 222745);return true;" onclick="javascript:getPage(this, 'variable.cgi', 222745);return true;" oncontextmenu="javascript:getPage(this, 'variable.cgi', 222745);return true;">FOLLOWUPYEARS</a>) when analyzing TMJD in this sub-study. It is recommended that data users apply statistical methods appropriate for cohort studies of a dynamic population (for example, Cox regression models, where <a href="javascript:getPage(this, 'variable.cgi', 222746);return true;" onclick="javascript:getPage(this, 'variable.cgi', 222746);return true;" oncontextmenu="javascript:getPage(this, 'variable.cgi', 222746);return true;">INCIDENTCASE</a> is the censoring variable and <a href="javascript:getPage(this, 'variable.cgi', 222745);return true;" onclick="javascript:getPage(this, 'variable.cgi', 222745);return true;" oncontextmenu="javascript:getPage(this, 'variable.cgi', 222745);return true;">FOLLOWUPYEARS</a> is time in study). </li> </ol>

Project description:Case-control studies have consistently associated psychological factors with chronic pain in general and with temporomandibular disorder (TMD) specifically. However, only a handful of prospective studies have explored whether preexisting psychological characteristics represent risk factors for first-onset TMD. The current findings derive from the prospective cohort study of the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) cooperative agreement. For this study, 3,263 TMD-free participants completed a battery of psychological instruments assessing general psychological adjustment and personality, affective distress, psychosocial stress, somatic symptoms, and pain coping and catastrophizing. Study participants were then followed prospectively for an average of 2.8 years to ascertain cases of first-onset of TMD, and 2,737 provided follow-up data and were considered in the analyses of TMD onset. In bivariate and demographically adjusted analyses, several psychological variables predicted increased risk of first-onset TMD, including reported somatic symptoms, psychosocial stress, and affective distress. Principal component analysis of 26 psychological scores was used to identify latent constructs, revealing 4 components: stress and negative affectivity, global psychological and somatic symptoms, passive pain coping, and active pain coping. In multivariable analyses, global psychological and somatic symptoms emerged as the most robust risk factor for incident TMD. These findings provide evidence that measures of psychological functioning can predict first onset of TMD. Future analyses in the OPPERA cohort will determine whether these psychological factors interact with other variables to increase risk for TMD onset and persistence.This article reports that several premorbid psychological variables predict first-onset TMD in the OPPERA study, a large prospective cohort study designed to discover causal determinants of TMD pain. Measures of somatic symptoms were most strongly associated with TMD onset, but perceived stress, previous life events, and negative affect also predicted TMD incidence.

Dataset Information

Preclinical episodes of orofacial pain symptoms and their association with health care behaviors in the OPPERA prospective cohort study.

Publications

Preclinical episodes of orofacial pain symptoms and their association with health care behaviors in the OPPERA prospective cohort study.

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