Temporomandibular disorders--pain outside the head and face is rarely acknowledged in the chief complaint

Abstract

Statement of problem: With diagnostic and therapeutic procedures being heavily influenced by the patient's chief complaint, the question arises whether this information alone represents a solid basis for clinical action.

Purpose: The aim of this investigation was to assess the agreement between pain complaints and patient generated paper-and-pencil drawings of the distribution of pain in patients suffering from temporomandibular disorders.

Methods: The study included 140 adult female patients with temporomandibular disorders. Pain drawings served as a standard, against which the oral reports were compared. In 40 (29%) of the patients, pain was limited to the head and face; in the remaining subjects, it exceeded the boundaries of these regions. Nine potential pain sites were distinguished (head, face, neck, shoulders, arms, chest, abdomen, back, and legs). Whenever one of these regions was part of the drawing or the pain complaint, it was counted. Sensitivity, specificity, and kappa indices were computed for each site.

Results: Patients with pain limited to the head and face showed a close correspondence between pain report and drawing. On the other hand, patients with temporomandibular disorders with concomitant pain sites outside the head and face frequently did not mention these additional pain locations. This was reflected in low sensitivities (minimum: 0.00; maximum: 0.48) and low kappa values (minimum: -0.02; maximum: 0.19).

Conclusions: This study showed that the chief complaint frequently underestimates the real extent of pain involvement.