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The Relationship of Somatization and Depression to Experimental Pain Response in Women With Temporomandibular Disorders

From the Departments of Oral Medicine (J.J.S., L.L., K.H.H., J.C.S., S.F.D.), Dental Public Health Sciences (L.A.M.), and Psychiatry and Behavioral Sciences (S.F.D.), University of Washington, Seattle, Washington.

Address correspondence and reprint requests to Jeffrey J. Sherman, PhD, Box 356570, Department of Oral Medicine, University of Washington, Seattle, WA 98195-6370. E-mail: jeffreys{at}u.washington.edu

OBJECTIVE: Patients with temporomandibular pain disorders (TMD) have greater experimental pain perception when compared with pain-free controls. Common psychological features of TMD include somatization and depression. The impact of depression on experimental pain perception has received considerable attention. However, the role of somatization on experimental pain in a chronic pain population has not been explored.

METHODS: Fifty-six women with TMD and 59 pain-free controls underwent three experimental pain procedures, including palpation at fixed amounts of pressure, pressure pain thresholds, and an ischemic pain task. Levels of depression and somatization were assessed using the Research Diagnostic Criteria for TMD. Multiple regression analyses were performed to determine the extent to which depression and somatization were associated with experimental pain response.

RESULTS: After controlling for characteristic pain intensity and depression, somatization explained a significant proportion of variance in numbers of masticatory sites rated as painful (R² change = 6.7%, p = .046) with the full model explaining 16.4% of the variance (p = .024). This did not meet an adjusted level of statistical significance (p = .008). After controlling for characteristic pain, only depression added significantly to the model predicting ischemic pain threshold and tolerance. The full models including characteristic pain and depression explained 49% and 20% of the variance in ischemic pain threshold and tolerance, respectively.

CONCLUSIONS: These findings suggest that depression and somatization are associated with different measures of experimental pain. Somatization may be related to more attentional and perceptual measures of clinically relevant pain while depression may be related to more behavioral measures of pain.

Key Words: pain, • depression, • somatization, • threshold, • tolerance.

Abbreviations: TMD = temporomandibular disorders;; TMJ = temporomandibular joint;; RDC = research diagnostic criteria;; MTPS = Manual Tender Point Survey;; CPI = characteristic pain intensity;; IPT = ischemic pain threshold;; IPTol = ischemic pain tolerance;; IPS = ischemic pain sensitivity;; PPT = pressure pain threshold;; Kpa/s = kilo-Pascals per second.