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On the relationship between spinal pain and temporomandibular disorders
Umeå University, Faculty of Medicine, Odontology, Clinical Oral Physiology.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Ryggvärk och käkfunktionsstörning : finns det ett samband? (Swedish)
Abstract [en]

Both spinal pain and temporomandibular disorders (TMD) commonly occur in the general population. Previous studies demonstrate neurophysiologic and biomechanical couplings between the trigeminal and cervical regions. This investigation tested the null hypothesis of no relationship between spinal pain (neck, shoulder and/or low back) and TMD, by using questionnaires and clinical examinations of the jaw function.

In an age- and sex-matched case-control study, the specific aim was to compare the prevalence of signs and symptoms of TMD among cases with long-term spinal pain and controls without spinal pain. The results showed that subjects with spinal pain had signs and symptoms of TMD significantly more often than did controls. The associations remained after excluding all participants with jaw pain. Furthermore, the comorbidity pattern was similar, regardless of location of spinal pain.

In a cross-sectional study, the specific aim was to test whether there is a reciprocal cross-sectional dose-response-like relationship between spinal pain and TMD. Two different designs were used, one with frequency/severity of spinal pain as independent variable, and the other, with frequency/severity of TMD symptoms as independent variable. The analysis showed increasing odds for presence of TMD symptoms with increasing frequency/severity of spinal pain, and increasing odds for presence of spinal pain with increasing frequency/severity of TMD symptoms.

In a case-control study within a 2-year prospective cohort, the specific aim was to test whether there is a reciprocal temporal relationship between signs and symptoms in trigeminally, and symptoms in spinally, innervated areas. Incidence of symptoms in these areas was analyzed in relation to presence of spinal pain, headaches, and signs and symptoms of TMD at baseline. The main findings were that presence of signs of TMD at baseline increased the onset of spinal pain and symptoms in the trigeminal area, and that spinal pain increased the onset of symptoms in the trigeminal area. An augmentation effect between the significant baseline variables was observed for the incidence of headaches and jaw pain.

In conclusion, the investigation demonstrated a cross-sectional and temporal relationship between spinal pain and TMD; thus, the null hypothesis was rejected. The results indicate common pathophysiological mechanisms in the development of spinal pain and TMD. The comorbidity and reciprocal influence that were found call for an integrated and multidimensional approach in the management of individuals with long-term spinal pain and TMD.

Place, publisher, year, edition, pages
Umeå: Umeå university , 2010. , 63 p.
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 109
Keyword [en]
back pain, comorbidity, cross-sectional, dose-response, headaches, matched case-control, musculoskeletal disorders, prospective cohort, spinal pain, temporomandibular disorders (TMD)
National Category
Dentistry
Research subject
Odontology
Identifiers
URN: urn:nbn:se:umu:diva-31240ISBN: 978-91-7264-920-0 (print)OAI: oai:DiVA.org:umu-31240DiVA: diva2:291918
Public defence
2010-02-26, By 1D, Sal D, Tandläkarhögskolan, Umeå, 13:30 (Swedish)
Opponent
Supervisors
Available from: 2010-02-05 Created: 2010-02-03 Last updated: 2010-02-05Bibliographically approved
List of papers
1. Back pain in relation to musculoskeletal disorders in the jaw-face: a matched case-control study
Open this publication in new window or tab >>Back pain in relation to musculoskeletal disorders in the jaw-face: a matched case-control study
2007 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 131, no 3, 311-319 p.Article in journal (Refereed) Published
Abstract [en]

Back pain and temporomandibular disorders are both common conditions in the population with influence on the human motor system, but a possible co-morbidity between these conditions has not been fully investigated. The aim of this study was to test the hypothesis of an association between long-term back pain and pain and/or dysfunction in the jaw-face region. Back pain was defined as pain in the neck, shoulders and/or low back. The study-population comprised 96 cases with long-term back pain and 192 controls without back pain. We used a screening procedure, a questionnaire and a clinical examination of the jaw function. The questionnaire focused on location, frequency, duration, intensity and impact on daily life of symptoms in the jaw-face and back regions. The analysis was conducted on 16 strata, matched by age and sex for case vs. control, using Mantel-Haenszel estimates of matched odds ratio (OR) and 95% confidence interval (CI) as well as the corrected Mantel-Haenszel chi(2) test. The overall prevalence of frequent symptoms in the jaw-face region, as reported in the questionnaire, was 47% among cases and 12% among controls. The difference was statistically significant (P<0.0001) with a sevenfold odds ratio (CI: 3.9-13.7). Moderate to severe signs from the jaw region were clinically registered among 49% of the cases and 17% of the controls (P<0.0001, OR: 5.2, CI: 2.9-9.2). The results showed statistically significant associations between long-term back pain and musculoskeletal disorders in the jaw-face and indicate co-morbidity between these two conditions.

Keyword
Back pain; Temporomandibular disorders; Matched case-control study; Co-morbidity; Musculoskeletal disorders; Jaw dysfunction
Identifiers
urn:nbn:se:umu:diva-20972 (URN)10.1016/j.pain.2007.03.018 (DOI)17459585 (PubMedID)
Available from: 2009-03-31 Created: 2009-03-31 Last updated: 2017-12-13Bibliographically approved
2. Does a dose-response relation exist between spinal pain and temporomandibular disorders?
Open this publication in new window or tab >>Does a dose-response relation exist between spinal pain and temporomandibular disorders?
2009 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 10, 28- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this study was to test whether a reciprocal dose-response relation exists between frequency/severity of spinal pain and temporomandibular disorders (TMD). METHODS: A total of 616 subjects with varying severity of spinal pain or no spinal pain completed a questionnaire focusing on symptoms in the jaw, head and spinal region. A subset of the population (n = 266) were sampled regardless of presence or absence of spinal pain. We used two different designs, one with frequency/severity of spinal pain, and the other, with frequency/severity of TMD symptoms as independent variable. All 616 participants were allocated to four groups, one control group without spinal pain and three spinal pain groups. The subjects in the subset were allocated to one control group without TMD symptoms and three TMD groups. Odds ratios (ORs) were calculated for presence of frequent TMD symptoms in the separate spinal pain groups as well as for frequent spinal pain in the separate TMD groups. RESULTS: The analysis showed increasing ORs for TMD with increasing frequency/severity of spinal pain. We also found increasing ORs for spinal pain with increasing frequency/severity of TMD symptoms. CONCLUSION: This study shows a reciprocal dose-response-like relationship between spinal pain and TMD. The results indicate that these two conditions may share common risk factors or that they may influence each other. Studies on the temporal sequence between spinal pain and TMD are warranted.

Identifiers
urn:nbn:se:umu:diva-20767 (URN)10.1186/1471-2474-10-28 (DOI)19254384 (PubMedID)
Available from: 2009-03-25 Created: 2009-03-25 Last updated: 2017-12-13Bibliographically approved
3. Reciprocal influence on the incidence of symptoms in trigeminally and spinally innervated areas
Open this publication in new window or tab >>Reciprocal influence on the incidence of symptoms in trigeminally and spinally innervated areas
2010 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, no 4, 366-371 p.Article in journal (Refereed) Published
Abstract [en]

Temporomandibular disorders (TMD), headaches, and spinal pain show co-morbidity and may therefore influence each other. The hypothesis tested is that the presence of any of these conditions will increase the risk of onset of new symptoms within a 2-year period. The study population comprised 280 dental students, who were examined three times at 12-month intervals. The incidence was calculated for a 2-year period, based on subjects without the defined symptom at baseline. Each participant was classified into five different case-control groups, representing incidence cases or no incidence (controls) of: (1) nonpain TMD symptoms; (2) jaw pain; (3) headaches; (4) spinal pain; and (5) TMD pain. Presence of headaches and of spinal pain and signs and symptoms of TMD at baseline were used as independent variables in logistic regression analyses, controlling for age and sex. Incidence cases with TMD pain reported spinal pain at baseline significantly more often than the controls, and were mostly women. Incidence cases with headaches and incidence cases with jaw pain significantly more often had signs of TMD and reported spinal pain at baseline, compared to controls. Incidence cases with nonpain TMD symptoms or spinal pain significantly more often presented with signs of TMD at baseline. Our findings show that pain and dysfunction in trigeminally innervated areas and pain in spinally innervated areas mutually predict the onset of new symptoms in dental students, indicating common pathophysiological mechanisms and individual vulnerability. This may be of importance in risk assessment and treatment planning of individuals with musculoskeletal pain.

Place, publisher, year, edition, pages
John Wiley & Sons, 2010
Keyword
Incidence, Temporomandibular disorders, Headaches, Spinal pain, Reciprocal influence, Prospective cohort
National Category
Dentistry
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-25688 (URN)10.1016/j.ejpain.2009.06.004 (DOI)000277881000006 ()
Available from: 2009-09-07 Created: 2009-08-28 Last updated: 2017-12-13Bibliographically approved

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