TY - JOUR
T1 - Identification of clusters of individuals relevant to temporomandibular disorders and other chronic pain conditions
T2 - The OPPERA study
AU - Bair, Eric
AU - Gaynor, Sheila
AU - Slade, Gary D.
AU - Ohrbach, Richard
AU - Fillingim, Roger B.
AU - Greenspan, Joel D.
AU - Dubner, Ronald
AU - Smith, Shad B.
AU - Diatchenko, Luda
AU - Maixner, William
N1 - Funding Information:
The authors thank Linda Adams for her assistance in proofreading the article. This work was supported by National Institutes of Health grants U01DE017018 (OPPERA cohort), RO1DE016155 (UNC cohort), and R03DE023592. E. Bair was partially supported by NIH/NCATS grant UL1RR025747 and NIH/NIEHS grant P03ES010126. The OPPERA program also acknowledges resources specifically provided for this project by the participating institutions: Battelle Memorial Institute; University at Buffalo; University of Florida; University of Maryland; and University of North Carolina at Chapel Hill.
Publisher Copyright:
© 2016 International Association for the Study of Pain.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - The classification of most chronic pain disorders gives emphasis to anatomical location of the pain to distinguish one disorder from the other (eg, back pain vs temporomandibular disorder [TMD]) or to define subtypes (eg, TMD myalgia vs arthralgia). However, anatomical criteria overlook etiology, potentially hampering treatment decisions. This study identified clusters of individuals using a comprehensive array of biopsychosocial measures. Data were collected from a case-control study of 1031 chronic TMD cases and 3247 TMD-free controls. Three subgroups were identified using supervised cluster analysis (referred to as the adaptive, pain-sensitive, and global symptoms clusters). Compared with the adaptive cluster, participants in the pain-sensitive cluster showed heightened sensitivity to experimental pain, and participants in the global symptoms cluster showed both greater pain sensitivity and greater psychological distress. Cluster membership was strongly associated with chronic TMD: 91.5% of TMD cases belonged to the pain-sensitive and global symptoms clusters, whereas 41.2% of controls belonged to the adaptive cluster. Temporomandibular disorder cases in the pain-sensitive and global symptoms clusters also showed greater pain intensity, jaw functional limitation, and more comorbid pain conditions. Similar results were obtained when the same methodology was applied to a smaller case-control study consisting of 199 chronic TMD cases and 201 TMD-free controls. During a median 3-year follow-up period of TMD-free individuals, participants in the global symptoms cluster had greater risk of developing first-onset TMD (hazard ratio 2.8) compared with participants in the other 2 clusters. Cross-cohort predictive modeling was used to demonstrate the reliability of the clusters.
AB - The classification of most chronic pain disorders gives emphasis to anatomical location of the pain to distinguish one disorder from the other (eg, back pain vs temporomandibular disorder [TMD]) or to define subtypes (eg, TMD myalgia vs arthralgia). However, anatomical criteria overlook etiology, potentially hampering treatment decisions. This study identified clusters of individuals using a comprehensive array of biopsychosocial measures. Data were collected from a case-control study of 1031 chronic TMD cases and 3247 TMD-free controls. Three subgroups were identified using supervised cluster analysis (referred to as the adaptive, pain-sensitive, and global symptoms clusters). Compared with the adaptive cluster, participants in the pain-sensitive cluster showed heightened sensitivity to experimental pain, and participants in the global symptoms cluster showed both greater pain sensitivity and greater psychological distress. Cluster membership was strongly associated with chronic TMD: 91.5% of TMD cases belonged to the pain-sensitive and global symptoms clusters, whereas 41.2% of controls belonged to the adaptive cluster. Temporomandibular disorder cases in the pain-sensitive and global symptoms clusters also showed greater pain intensity, jaw functional limitation, and more comorbid pain conditions. Similar results were obtained when the same methodology was applied to a smaller case-control study consisting of 199 chronic TMD cases and 201 TMD-free controls. During a median 3-year follow-up period of TMD-free individuals, participants in the global symptoms cluster had greater risk of developing first-onset TMD (hazard ratio 2.8) compared with participants in the other 2 clusters. Cross-cohort predictive modeling was used to demonstrate the reliability of the clusters.
KW - Classification of chronic pain
KW - Clustering
KW - Temporomandibular disorders
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U2 - 10.1097/j.pain.0000000000000518
DO - 10.1097/j.pain.0000000000000518
M3 - Article
C2 - 26928952
AN - SCOPUS:84971287285
SN - 0304-3959
VL - 157
SP - 1266
EP - 1278
JO - Pain
JF - Pain
IS - 6
ER -