Prevalence of post-traumatic stress disorder symptoms on orofacial pain patients

de Leeuw R, Bertoli E et al Oral Surg 2005; 99: 558-568

Post-traumatic stress disorder (PTSD) may occur in 1/6 of patients with chronic orofacial pain, and has relevance to temporomandibular disorders.

Over a 5 year period, 1,478 patients were seen in a Kentucky orofacial pain clinic and diagnosed with masticatory /cervical muscle pain or TMJ pain. PTSD is diagnosed according to DSM-IV in relation to significant life-threatening traumatic exposures which are identified as stressors. On the basis of psychometric questionnaires, a PTSD-positive group (P+) of 218 was identified, and also a PTSD-negative group (P−) of 551 patients, with a stressor but without the disorder. The remaining 709 patients had no stressors (S−).

There were significant differences between the 3 groups (P < 0.01) on 8 of 12 scales of the Multidimensional Pain Inventory. In relation to primary oral diagnoses, 76% of P+ subjects had muscle pain, and 24% had TMJ pain; respective percentages for P- were 66 and 34, and for S−, 61 and 39 (P < 0.001). More dysfunctional, and fewer adaptive coping and anomalous, profiles occurred in the P+ group than in P− and S− groups. Psychological distress was higher in all respects in the P+ group. The authors conclude that P− patients with TMJ disorders show low levels of distress, and that such distress is a likely indicator of PTSD.