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Correlation of RDC/TMD axis I diagnoses and axis II pain-related disability. A multicenter study

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Abstract

As part of an ongoing multicenter investigation involving four highly specialized tertiary clinics for temporomandibular disorders (TMD) treatment, retrospective analysis of Research Diagnostic Criteria for TMD (RDC/TMD) axis I and axis II data gathered on clinic and community cases were assessed with a twofold aim: (1) to search for a correlation between axis I diagnoses and axis II pain-related disability, and (2) to identify clinical (axis I) and psychosocial (axis II) predictors of high pain-related disability. Two samples of patients seeking treatment for TMD (clinic cases, N = 1,312) and a sample of general population subjects (community cases, N = 211) underwent a thorough assessment in accordance with the RDC/TMD version 1.0 [1] guidelines to receive both axis I and axis II diagnoses. Spearman’s test was performed to assess the level of correlation between axis I diagnoses and Graded Chronic Pain Scale (GCPS) pain-related disability. A stepwise multiple logistic regression model was used to identify the significant associations between 12 clinical and psychosocial predictors and the presence of high pain-related disability. Axis I findings were related with pain-related impairment (GCPS scores) in the overall study sample including both clinic community cases (Spearman correlation = 0.129, p = 0.000), but the results of the correlation analyses performed on the clinic sample alone were not significant (Spearman correlation = −0.018, p = 0.618). Predictors for high disability were related to axis II findings (severe depression and somatization) or psychosocial aspects related to the pain experience (pain lasting from more than 6 months; treatment-seeking behavior), while none of the axis I diagnoses remained in the final logistic regression model. The final model predicted the level of pain-related impairment at a fair level (R 2 = 26.7%). The correlation between axis I diagnoses and pain-related impairment is not significant in the patients populations. Treatment-seeking behavior and other factors related with the pain experience are likely to be more important than the physical findings to determine the degree of psychosocial impairment.

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Acknowledgments

The authors are kindly grateful to the following colleagues for their helpful and invaluable help during the phases of participants assessment and data gathering: Dr. Marta Beghetto, Dr. Laura Borella, Dr. Giorgia Mogno, Dr. Fabio Piccotti (TMD Clinic, Department of Maxillofacial Surgery, University of Padova, Italy); Prof. Mauno Könönen, Dr. Mikko Rantala, Dr. Tuija Suvinen (Department of Stomatognathic Physiology and Prosthetic Dentistry, Institute of Dentistry, University of Helsinki, Finland); Dr. Aslak Savolainen (Finnish Broadcasting Company, Occupational Health Care, Finland); Prof. Ilana Eli, Dr. Michal Steinkeller-Dekel, Dr. Shoshana Reiter (Department of Oral Rehabilitation, the Maurice and Gabriela Goldschleger School of Dentistry, University of Tel Aviv, Israel).

Conflicts of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. TMD Clinic, Department of Maxillofacial Surgery, University of Padova, Viale XX Settembre 298, 54033, Marina di Carrara, MS, Italy

    Daniele Manfredini & Luca Guarda-Nardini

  2. Department of Stomatognathic Physiology and Prosthetic Dentistry, Institute of Dentistry, University of Helsinki, Helsinki, Finland

    Jari Ahlberg

  3. Department of Oral Rehabilitation, the Maurice and Gabriela Goldschleger School of Dentistry, University of Tel Aviv, Tel Aviv, Israel

    Ephraim Winocur

  4. Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands

    Frank Lobbezoo

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  1. Daniele Manfredini
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  2. Jari Ahlberg
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  3. Ephraim Winocur
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  4. Luca Guarda-Nardini
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  5. Frank Lobbezoo
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Correspondence to Daniele Manfredini.

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Manfredini, D., Ahlberg, J., Winocur, E. et al. Correlation of RDC/TMD axis I diagnoses and axis II pain-related disability. A multicenter study. Clin Oral Invest 15, 749–756 (2011). https://doi.org/10.1007/s00784-010-0444-4

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