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. 2016 Jun;157(6):1266-1278.
doi: 10.1097/j.pain.0000000000000518.

Identification of clusters of individuals relevant to temporomandibular disorders and other chronic pain conditions: the OPPERA study

Eric Bair  1 , Sheila Gaynor, Gary D Slade, Richard Ohrbach, Roger B Fillingim, Joel D Greenspan, Ronald Dubner, Shad B Smith, Luda Diatchenko, William Maixner
Affiliations

Identification of clusters of individuals relevant to temporomandibular disorders and other chronic pain conditions: the OPPERA study

Eric Bair et al. Pain. 2016 Jun.

Abstract

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.

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Conflict of interest statement

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Conflict of interest statement

The authors have no conflicts of interest to declare.

R. Fillingim, G. Slade, and S. Smith are consultants and equity stock holders, and L. Diatchenko and W. Maixner are cofounders and equity stock holder in Algynomics, Inc, a company providing research services in personalized pain medication and diagnostics.

Figures

Figure 1
Figure 1
Z-scores of selected variables. These plots show the mean values (and associated 95% confidence intervals) for a selected subset of the pain sensitivity and psychosocial variables in the (A) OPPERA cohort and (B) UNC cohort. Each variable displayed in the figure was normalized to have mean 0 and SD 1. PPT, pressure pain threshold.
Figure 2
Figure 2
Kaplan–Meier plots for first-onset temporomandibular disorder (TMD). This plot shows the probability that a participant in a given cluster remains TMD free after a specified number of years. HR, hazard ratio.
See this image and copyright information in PMC

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