Oral Medicine
Prevalence of post-traumatic stress disorder symptoms in orofacial pain patients

https://doi.org/10.1016/j.tripleo.2004.05.016Get rights and content

Abstract

Objective

There is a high comorbidity between symptoms of post-traumatic stress disorder (PTSD) and chronic pain incidence. The objective of this investigation was to determine the prevalence of PTSD symptoms in chronic orofacial pain patients.

Study design

The study included 1478 adult patients (mean age 36.4 ± 12.7 years) with primary diagnoses of masticatory/cervical muscle pain or temporomandibular joint pain. Patients completed a battery of psychometric questionnaires including a screening for PTSD symptoms.

The sample was divided into a PTSD-positive group (n = 218, 15%) a PTSD-negative group (n = 551, 37%), and a no-stressor group (n = 709, 48%) according to stressor incidence and symptom severity.

Results

The current prevalence of PTSD symptomatology was considerably higher than that reported in surveys from the general population. Patients in the PTSD-positive symptom group reported significantly higher psychological distress, sleep dysfunction, and pain severity compared to patients in the other groups. Psychological distress as measured by the SCL-90-R reached clinically significant levels only in those patients with PTSD symptomatology.

Conclusions

The results of this study performed at a tertiary care center suggest that TMD patients without PTSD symptomatology show low levels of psychological distress, if any. Clinically significant levels of psychological distress are likely indicators for PTSD. PTSD screening should be included as part of a routine psychometric test battery in TMD patients.

Section snippets

Sample

The study sample consisted of 1,478 adult patients (201 males, mean age 36.0 years, SE = .88; 1277 females, mean age 36.4 years, SE = .36) seen between October 1997 and November 2002 at the Orofacial Pain Center of the University of Kentucky. These were all patients with primary diagnoses of either masticatory and/or cervical muscle pain (65.0%) or temporomandibular joint (TMJ) pain (35.0%). The diagnoses were established according to the Orofacial Pain Guidelines of the American Academy of

Stressors

In the current patient sample, 709 patients (48.0%) did not report a stressor and were therefore classified as the no-stressor group. Of the patients reporting 1 or more significant stressors, 218 (14.7%) exceeded the PCL-C cut-off score of 41 for PTSD-positive symptoms and were classified as the PPos group. The remaining 551 patients (37.3%) did not meet the PCL-C cut-off score of 41 and comprised the PNeg group. The stressor reported most often by patients in both the PPos and PNeg groups was

Discussion

Lifetime prevalence estimates of PTSD in the general population range from 1% to 14%.1., 22., 23., 24., 25. Current PTSD prevalence rates in the general population, however, appear to be less than 10%.26 Given these data, the current prevalence of PTSD-like symptoms of our sample with chronic orofacial pain at 15% was considerably higher than that previously reported in community studies. Our results are in agreement with those reported by Aghabeigi et al (1992), who also found a PTSD

Conclusion

This study indicated that almost 1 out of 6 patients with chronic head and neck pain disorders report symptoms consistent with a clinical presentation of PTSD. Not surprisingly, high levels of psychological distress were strongly associated with PTSD symptomatology. Interestingly though, psychological distress was minimal in chronic TMD patients without PTSD symptomatology. Consistent with the current literature, our chronic pain patients reporting PTSD-positive symptoms were more prone to be

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