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AuthorAl-Hamed, F. S.
AuthorAlonso, A. A.
AuthorVivaldi, D.
AuthorSmith, S. B.
AuthorMeloto, C. B.
Available date2023-06-19T10:46:18Z
Publication Date2023-04-28
Publication NameJDR Clinical and Translational Research
Identifierhttp://dx.doi.org/10.1177/23800844231164076
CitationAl-Hamed, F. S., Alonso, A. A., Vivaldi, D., Smith, S. B., & Meloto, C. B. (2023). The Adaptive, Pain Sensitive, and Global Symptoms Clusters: Evidence from a Patient-Based Study. JDR Clinical & Translational Research, 23800844231164076.
ISSN2380-0844
URIhttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85159042853&origin=inward
URIhttp://hdl.handle.net/10576/44579
AbstractObjectives: The largest epidemiologic study conducted about painful temporomandibular disorders (pTMDs) to date identified 3 clusters of individuals with similar symptoms—adaptive, pain sensitive, and global symptoms—which hold promise as a means of personalizing pain care. Our goal was to compare the clinical and psychological characteristics that are consistent with a pTMD clinical examination among patients who are seeking care and assigned to the different clusters. Methods: This cross-sectional study used data from the medical records of patients attending Duke Innovative Pain Therapies between August 2017 and April 2021 who received a pTMD diagnosis (i.e., myalgia) and consented to have their data used for research. Data included orofacial and pain-related measures, dental features, and psychological measures. We used the Rapid OPPERA Algorithm to assign clusters to patients and multinomial regression to determine the likelihood (odds ratios [OR] and 95% confidence intervals [CI]) of being assigned to the pain sensitive or global symptoms cluster attributed to each measure. Results: In total, 131 patients were included in this study and assigned a cluster: adaptive (n = 54, 41.2%), pain sensitive (n = 49, 37.4%), and global symptoms (n = 28, 21.4%). The PS cluster displayed greater numbers of temporomandibular joint sites (OR, 1.29; 95% CI, 1.01 to 1.65) and masticatory (1.48; 1.19 to 1.83) and cervical (1.23; 1.09 to 1.39) muscles with pain evoked by palpation. The GS cluster displayed greater scores of pain catastrophizing (1.04; 1.01 to 1.06) and perceived stress (1.23; 1.03 to 1.46) and was more likely to report persistent pain (16.23; 1.92 to 137.1) of higher impact (1.43; 1.14 to 1.80). Conclusion: Our findings support that care-seeking patients with pTMDs who are assigned to the GS cluster display a poorer psychological profile, even though those assigned to the PS cluster display more measures consistent with orofacial pain. Findings also establish the PS cluster as a group that does not display psychological comorbidities despite being hypersensitive. Knowledge Transfer Statement: This study informs clinicians that patients seeking care for painful temporomandibular disorders, in specific cases of myalgia, can be classified into 1 of 3 groups that display unique profiles of symptoms. Most importantly, it emphasizes the importance of examining patients with painful temporomandibular disorders in a holistic manner that includes assessing symptoms of psychological distress. Patients with greater psychological distress will likely benefit from multidisciplinary treatment strategies that may include psychological treatments.
Languageen
PublisherSAGE
Subjectcluster analysis
cross-sectional studies
facial pain
odds ratio
tertiary care
TitleThe Adaptive, Pain Sensitive, and Global Symptoms Clusters: Evidence from a Patient-Based Study
TypeArticle
ESSN2380-0852
dc.accessType Open Access


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