Psychological factors associated with development of TMD: The OPPERA prospective cohort study

Roger B. Fillingim, Richard Ohrbach, Joel D. Greenspan, Charles Knott, Luda Diatchenko, Ronald Dubner, Eric Bair, Cristina Baraian, Nicole MacK, Gary D. Slade, William Maixner

Research output: Contribution to journalArticlepeer-review

168 Scopus citations


Case-control studies have consistently associated psychological factors with chronic pain in general and with temporomandibular disorder (TMD) specifically. However, only a handful of prospective studies have explored whether preexisting psychological characteristics represent risk factors for first-onset TMD. The current findings derive from the prospective cohort study of the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) cooperative agreement. For this study, 3,263 TMD-free participants completed a battery of psychological instruments assessing general psychological adjustment and personality, affective distress, psychosocial stress, somatic symptoms, and pain coping and catastrophizing. Study participants were then followed prospectively for an average of 2.8 years to ascertain cases of first-onset of TMD, and 2,737 provided follow-up data and were considered in the analyses of TMD onset. In bivariate and demographically adjusted analyses, several psychological variables predicted increased risk of first-onset TMD, including reported somatic symptoms, psychosocial stress, and affective distress. Principal component analysis of 26 psychological scores was used to identify latent constructs, revealing 4 components: stress and negative affectivity, global psychological and somatic symptoms, passive pain coping, and active pain coping. In multivariable analyses, global psychological and somatic symptoms emerged as the most robust risk factor for incident TMD. These findings provide evidence that measures of psychological functioning can predict first onset of TMD. Future analyses in the OPPERA cohort will determine whether these psychological factors interact with other variables to increase risk for TMD onset and persistence. Perspective: This article reports that several premorbid psychological variables predict firstonset TMD in the OPPERA study, a large prospective cohort study designed to discover causal determinants of TMD pain. Measures of somatic symptoms were most strongly associated with TMD onset, but perceived stress, previous life events, and negative affect also predicted TMD incidence.

Original languageEnglish (US)
Pages (from-to)T75-T90
JournalJournal of Pain
Issue number12 SUPPL.
StatePublished - Dec 2013
Externally publishedYes


  • Chronic pain somatic symptoms
  • Psychological risk factors
  • Psychosocial stress
  • Temporomandibular disorder

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


Dive into the research topics of 'Psychological factors associated with development of TMD: The OPPERA prospective cohort study'. Together they form a unique fingerprint.

Cite this