References

bekhterev

Обозрение психиатрии и медицинской психологии имени В.М.Бехтерева

V.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY

2313-70532713-055X

V. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY OF THE RUSSIAN FEDERATION MINISTRY OF HEALTH

10.31363/2313-7053-2025-3-1061

bekhterev-1169

Research Article

ИССЛЕДОВАНИЯ

INVESTIGATIONS

Тревога, депрессия: коморбидное расстройство хронической орофациальной боли при синдроме дисфункции височно-нижнечелюстного сустава

Anxiety, depression: comorbidity of chronic orofacial pain disorder in temporomandibular joint dysfunction syndrom

https://orcid.org/0000-0001-9881-5942

Коцюбинская

Ю. В.

Kotsiubinskaya

Yu. V.

Коцюбинская Юлия Вадимовна — к.м.н., ведущий научный сотрудник отделения реабилитации больных психоневрологического профиля.

Санкт-Петербург

Yulia V. Kotsiubinskaya.

St. Petersburg

platonk-juliak@yandex.ru

Национальный медицинский исследовательский центр психиатрии и неврологии им. В.М. БехтереваРоссияV.M. Bekhterev National Research Medical Center for Psychiatry and NeurologyRussian Federation

2025

25092025

5939098

2025

Коцюбинская Ю.В.

Kotsiubinskaya Y.V.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.bekhterevreview.com/jour/article/view/1169

Постоянная орофациальная боль относится к ряду болевых состояний нестоматологической этиологии в области лица и рта, оказывает значительное влияние на качество жизни и имеет биопсихосоциальную природу. Синдром болевой дисфункции височно-нижнечелюстного сустава (СБД ВНЧС) является одной из наиболее распространенных причин хронических болей в орофациальной области, затрагивающих жевательную мускулатуру; это мышечно-скелетное расстройство, характеризующееся болью и дискомфортом в мышцах и суставах, участвующих в жевании и движении челюсти. Важную роль в возникновении и поддержании постоянных болей и мышечной дисфункции в орофациальной области играют такие психопатологические факторы, как тревога и депрессия.

Цель исследования: исследование степени выраженности проявленности тревоги и депрессии у пациентов с хронической орофациальной болью при синдроме дисфункции височно-нижнечелюстного сустава. Материалы: Обследовано 354 пациента с хроническими орофациальными болями, с превалированием в клинической картине заболевания болевой симптоматики и выраженными мышечно-тоническими нарушениями жевательной мускулатуры, при развитии которых коморбидно формируется тревожное и депрессивное расстройство (код по МКБ-10 — К07.8+F43; F45.8) Средний возраст обследованных составил 48,6±12,9 года. Результаты: В исследуемой группе пациентов выявляются высокие, отличные от здоровой популяции, показатели тревоги и депрессии. Проявления эти носят в большинстве случаев субклинический характер и на практике представляют собой ряд соматизированных жалоб и легкую тревогу, а также критику к своему внешнему виду. Пациенты с жалобами на мышечно-тонические расстройства и боли в орофациальной области без выраженных проявлений тревоги и депрессии составляли 52,0 %. Пациентов с выраженным тревожным расстройством на фоне орофациальной дисфункции было 6,8 %, а у 41,2% пациентов было диагностировано депрессивное расстройство различной степени выраженности. В возникновении и развитии болевой дисфункции ВНЧС и коморбидных тревожно-депрессивных расстройств участвуют соматические и психологические группы факторов, что делает целесообразным рассмотрение данной патологии с психосоматических позиций.

Persistent orofacial pain belongs to a group of pain conditions of non-dental etiology affecting the face and mouth, significantly impacting quality of life and having a biopsychosocial nature. Temporomandibular joint pain dysfunction syndrome (TMD) is one of the most common causes of chronic orofacial pain, involving the masticatory muscles. It is a musculoskeletal disorder characterized by pain and discomfort in the muscles and joints responsible for chewing and jaw movement. Psychopathological factors such as anxiety and depression play an important role in the development and maintenance of persistent pain and muscle dysfunction in the orofacial region. Objective: To study the severity of anxiety and depression in patients with chronic orofacial pain associated with temporomandibular joint dysfunction syndrome. Materials: A total of 354 patients with chronic orofacial pain were examined.

The clinical picture of their condition was dominated by pain symptoms and pronounced myotonic disorders of the masticatory muscles, which were comorbidly associated with anxiety and depressive disorders (ICD-10 codes: K07.8+F43; F45.8). The average age of the patients was 48.6±12.9 years. Results: The studied group showed significantly higher levels of anxiety and depression compared to the healthy population. These manifestations were mostly subclinical in nature and often presented as somatized complaints, mild anxiety, and self-critical attitudes towards appearance. Patients with complaints of myotonic disorders and orofacial pain without marked symptoms of anxiety and depression constituted 52.0% of the group. Among the patients, 6.8% had pronounced anxiety disorders on the background of orofacial dysfunction, while 41.2% were diagnosed with depressive disorders of varying severity. Both somatic and psychological factors are involved in the development of TMD pain dysfunction and comorbid anxiety-depressive disorders, making it reasonable to approach this pathology from a psychosomatic perspective.

тревогадепрессиякоморбидное расстройствоорофациальная больжевательная мускулатурадисфункция височно-нижнечелюстного сустава

anxietydepressioncomorbid disorderorofacial painmasticatory musclestemporomandibular joint dysfunction

References1

Слесарев О.В. Заболевания височно-нижнечелюстного сустава: междисциплинарный подход к диагностике и лечению. Санкт-Петербург: Издательство «Человек»; 2022.

Slesarev O.V. Zabolevaniya visochno-nizhnechelyustnogo sustava: mezhdisciplinarnyj podhod k diagnostike i lecheniyu. Sankt-peterburg: Izdatel’stvo «Chelovek»; 2022. (In Russ.).

Aggarwal VR, Macfarlane GJ, Farragher TM, Mc-Beth J. Risk factors for onset of chronic oro-facial pain: results of the North Cheshire oro-facial pain prospective population study. Pain. 2010;149(2):354–359. https://doi.org/10.1016/j.pain.2010.02.040

Ahuja V, Ranjan V, Passi D, et al. Study of stress induced temporomandibular disorders among dental students: An institutional study. Maxillofac Surg. 2018 Jul-Dec;9(2):147-154. https://doi.org/10.4103/njms.NJMS_20_18.

Ângelo DF, Rodrigues RN, Teixeira MC, et al. Influence of a Diagnosis of Depression and/or Anxiety on Temporomandibular Joint Treatment—A Retrospective Study. The European Journal of Stomatology, Oral and Facial Surgery. [ejsofs.com]. ejsofs. com; 2024. https://doi.org/10.61318/ejsofs.v1i1.18 Available at: https://ejsofs.com/index.php/journal/article/view/18

Auerbach SM, Laskin DM, Frantsve LM, Orr T. Depression, pain, exposure to stressful life events, and long-term outcomes in temporomandibular disorder patients. J. Oral Maxillofac. Surg. 2001; 59:628–33; discussion634. https://doi.org/10.1053/joms.2001.23371.

Beecroft EV, Durham J, Thomson P. Retrospective examination of the healthcare ‘journey’ of chronic orofacial pain patients referred to oral and maxillofacial surgery. Br Dent J. 2013;214(5): E12. https://doi.org/10.1038/sj.bdj.2013.221.

Brandini DA, Benson J, Nicholas MK, Murray GM, Peck CC. Chewing in temporomandibular disorder patients: an exploratory study of an association with some psychological variables. J Orofac Pain. 2011;25(1):56-67.

Buenaver LF, Quartana PJ, Grace EG, et al. Evidence for indirect effects of pain catastrophizing on clinical pain among myofascial temporomandibular disorder participants: the mediating role of sleep disturbance. Pain. 2012;153:1159–1166. https://doi.org/10.1016/j.pain.2012.01.023

Bueno CH, Pereira DD, Pattussi MP et al. Gender differences in temporomandibular disorders in adult populational studies: a systematic review and meta-analysis. J Oral Rehabil. 2018;45(9):720-729. https://doi.org/10.1111/joor.12661.

Chisnoiu AM, Picos AM, Popa S, et al. Factors Involved in the Etiology of Temporomandibular Disorders—A Literature Review. Med. Pharm. Rep. 2015;88(4):473-8. https://doi.org/10.15386/cjmed-485.

Chow JC, Cioffi I. Effects of trait anxiety, somatosensory amplification, and facial pain on self-reported oral behaviors. Clin Oral Investig. 2019;23(4):1653-1661. https://doi.org/10.1007/s00784-018-2600-1.

Dinan JE, Hargitai IA, Watson N, Smith A, Schmidt JE. Pain catastrophising in the oro-facial pain population. J Oral Rehabil. 2021;48(6):643-653. https://doi.org/10.1111/joor.13166

Dworkin SF, Huggins KH, Wilson L, Mancl L, Turner J, Massoth D, Len Resche L, Truelove E. A randomized clinical trial using research diagnostic criteria for temporomandibular disorders–axis II to target clinic cases for a tailored self-care TMD treatment program. J Orofac Pain. 2002;16(1):48–63.

Dworkin SF. Perspectives on the interaction of biological, psychological and social factors in TMD. J Am Dent Assoc. 1994; 125(7):856–863. https://doi.org/10.14219/jada.archive.1994.0212

Fernandez-de-las-Penas C, Svensson P. Myofascial Temporomandibular Disorder. Current Rheumatology Reviews. 2016;12(1):40–54. https://doi.org/10.2174/1573397112666151231110947

Ferrando M, Andreu Y, Galdón MJ et al. psychological variables and temporomandibular disorders: distress, coping, and personality. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98(2):153-60. https://doi.org/10.1016/j.tripleo.2003.12.030

Fillingim RB, Ohrbach R, Greenspan JD et al. Potential psychosocial risk factors for chronic TMD: Descriptive data and empirically identified domains from the OPPERA case-control study. J Pain. 2011;12(11 Suppl):46–60. https://doi.org/10.1016/j.jpain.2011.08.007.

Fillingim RB, Slade GD, Greenspan JD et al. Long-Term Changes in Biopsychosocial Characteristics Related to Temporomandibular Disorder. Pain. 2018;159:2403–2413. https://doi.org/10.1097/j.pain.0000000000001348.

Garofalo JP, Gatchel RJ, Wesley AL, Ellis E. Predicting chronicity in acute temporomandibular joint disorders using the research diagnostic criteria. J. Am. Dent. Assoc. 1998; 129:438–447. https://doi.org/10.14219/jada.archive.1998.0242.

Gatchel RJ, Garofalo JP, Ellis E, Holt C. Major psychological disorders in acute and chronic TMD: An initial examination. J Am Dent Assoc.1996;127(9):1365-70, 1372, 1374. https://doi.org/10.14219/jada.archive.1996.0450.

Giannakopoulos NN, Keller L, Rammelsberg P, Kronmüller KT, Schmitter M. Anxiety and depression in patients with chronic temporomandibular pain and in controls. J Dent. 2010;38(5):369-76. https://doi.org/10.1016/j.jdent.2010.01.003.

Hanen Ben Khalifa, Raja Chebbi, Sonia Ghoul, Monia Dhidah. The epidemiological profile of temporomandibular joint disorders in the Tunisian population: A cross-sectional study. The Saudi Dental Journal. 2024;36(5):799-803. https://doi.org/10.1016/j.sdentj.2024.02.010

Helkimo M. Epidemiological surveys of dysfunction of the masticatory system. Oral Sci Rev. 1976;7:54-69.

Henningsen P, Jakobsen T, Schiltenwolf M, Weiss MG. Somatization revisited: diagnosis and perceived causes of common mental disorders. Nerv Ment Dis. 2005;193:85-92. https://doi.org/10.1097/01.nmd.0000152796.07788.b6.

Jagdhari SB, Patni LVM, Motwani M et al. Evaluation of laser therapy and routine treatment modalities in the management of myofascial pain dysfunction syndrome. Journal of Indian Academy of Oral Medicine and Radiology. 2015;27(4):553-558. https://doi.org/10.4103/0972-1363.188760

Kalladka M, Young A, Khan J. Myofascial pain in temporomandibular disorders: Updates on etiopathogenesis and management. J. Bodyw. Mov. Ther. 2021;(28):104–113. https://doi.org/10.1016/j.jbmt.2021.07.015.

Kindler S, Samietz S, Houshmand M et al. Depressive and Anxiety Symptoms as Risk Factors for Temporomandibular Joint Pain: A Prospective Cohort Study in the General Population. J. Pain. 2012; 13:1188–1197. https://doi.org/10.1016/j.jpain.2012.09.004.

Liu F, Steinkeler A. Epidemiology, diagnosis, and treatment of temporomandibular disorders. Dent. Clin. North Am. 2013;57:465–479. https://doi.org/10.1016/j.cden.2013.04.006.

Manfredini D, Winocur E, Ahlberg J, GuardaNardini L, Lobbezoo F. Psychosocial impairment in temporomandibular disorders patients. RDC/TMD axis II findings from a multicentre study. J. Dent. 2010;(38):765–772. https://doi.org/10.1016/j.jdent.2010.06.007.

Mc Kinney MW, Londeen TF, Turner SP, Levitt SR. Chronic TM disorder and non-TM disorder pain: A comparison of behavioral and psychological characteristics. Cranio. 1990;8(1):40-6. https://doi.org/10.1080/08869634.1990.11678298.

Medeiros RAD, Vieira DL, Silva EVFD, Rezende LVMDL, Santos RWD, Tabata LF. Prevalence of symptoms of temporomandibular disorders, oral behaviors, anxiety, and depression in Dentistry students during the period of social isolation due to COVID-19. J Appl Oral Sci. 2020;28: e20200445. https://doi.org/10.1590/1678-7757-2020-0445.

Mongini F, Ciccone G, Ceccarelli M, Baldi I, Ferrero L. Muscle tenderness in different types of facial pain and its relation to anxiety and depression: A cross-sectional study on 649 patients. Pain. 2007; 131:106-11. https://doi.org/10.1016/j.pain.2006.12.017.

Ohrbach R, Dworkin SF. Five-year outcomes in TMD: relationship of changes in pain to changes in physical and psychological variables. Pain.1998;74:315–326. https://doi.org/10.1016/s0304-3959(97)00194-2.

Proença DSJ, Baad-Hansen L, do Vale Braido GV, Campi LB, de Godoi Gonçalves DA. Clinical features of chronic primary pain in individuals presenting painful temporomandibular disorder and comorbidities. J Oral Rehabil. 2024;51(2):255-265. https://doi.org/10.1111/joor.13598

Quartana, PJ, Buenaver, LF, Edwards, RR, Klick, B, Haythornthwaite, JA, and Smith, MT. Pain catastrophizing and salivary cortisol responses to laboratory pain testing in temporomandibular disorder and healthy participants. J Pain. 2010;11:186–194. https://doi.org/10.1016/j.jpain.2009.07.008

Qvintus V, Sipilä K, Le Bell Y, Suominen AL. Prevalence of clinical signs and pain symptoms of temporomandibular disorders and associated factors in adult Finns. Acta Odontol Scand. 2020;78(7):515-521. https://doi.org/10.1080/00016357.2020.1746395.

Rehm D, Progiante P, Pattussi M, Pellizzer E, Grossi P, Grossi M. Depression and Somatization in patients with Temporomandibular disorders in a Population-based cross-sectional study in Southern Brazil. Int J Prosthodont. 2019;32:248–50. https://doi.org/10.11607/ijp.6209.

Reis PHF, Laxe LAC, Lacerda-Santos R, Münchow EA. Distribution of anxiety and depression among different subtypes of temporomandibular disorder: a systematic review and meta-analysis. J Oral Rehabil. 2022;49(7):754-767. https://doi.org/10.1111/joor.13331.

Reiter S, Emodi-Perlman A, Goldsmith C, Friedman-Rubin P, Winocur E. Comorbidity Between Depression and Anxiety in Patients with Temporomandibular Disorders According to the Research Diagnostic Criteria for Temporomandibular Disorders. Journal of Oral & Facial Pain and Headache. 2015;29(2):135–143. https://doi.org/10.11607/ofph.1297

Rollman GB, Gillespie JM. The Role of Psychosocial Factors in Temporomandibular Disorders. Curr. Rev. Pain. 2000;(4):71–81. https://doi.org/10.1007/s11916-000-0012-8.

Schutz R, Rees C, Smith A, Slater H, Campbell JM, O’Sullivan P. How can we best reduce pain catastrophizing in adults with chronic noncancer pain? A systematic review and meta-analysis. J Pain. 2018;19(3):233-256. https://doi.org/10.1016/j.jpain.2017.09.010.

Seweryn P, Orzeszek S, Waliszewska-Prosół M, Jenča A, Osiewicz M, Paradowska-Stolarz A, Winocur-Arias O, Ziętek M, Bombała W, Więckiewicz M. Relationship between Pain Severity, Satisfaction with Life and the Quality of Sleep in Polish Adults with Temporomandibular Disorders. Dent. Med. Probl. 2023;60:609–617. https://doi.org/10.17219/dmp/171894

Shueb S, Nixdorf D, John M, Alonso BF, Durham J. What is the impact of acute and chronic orofacial pain on quality of life? J Dent. 2015;43(10):1203–1210. https://doi.org/10.1016/j.jdent.2015.06.001

Simoen L, Van den Berghe L, Jacquet W, Marks L. Depression and Anxiety Levels in Patients with Temporomandibular Disorders: Comparison with the General Population. Clin. Oral Investig. 2020;24:3939–3945. https://doi.org/10.1007/s00784-020-03260-1.

Slade GD, Fillingim RB, Sanders AE et al. Summary of findings from the OPPERA prospective cohort study of incidence of firstonset temporomandibular disorder: implications and future directions. J Pain. 2013;14(12 Suppl):116-24. https://doi.org/10.1016/j.jpain.2013.09.010

Slade GD, Ohrbach R, Greenspan JD, Fillingim RB, Bair E, Sanders AE, Dubner R, Diatchenko L, Meloto CB, Smith S. Painful Temporomandibular Disorder. J. Dent. Res. 2016;95:1084–1092. https://doi.org/10.1177/0022034516653743

Stockstill JW, Callahan CD. Personality hardiness, anxiety, and depression as constructs of interest in the study of temporomandibular disorders. J Craniomandib Disord. 1991;5:129–134.

Sullivan MJL, Bishop SR, Pivik J. The pain catastrophizing scale: Development and validation. Psychol Assess. 1995;7(4):524-532. https://doi.org/10.1037/1040-3590.7.4.524

Vassend O, Krogstad BS, Dahl BL. Negative affectivity, somatic complaints, and symptoms of temporomandibular disorders. J Psychosom Res. 1995;39:889–899. https://doi.org/10.1016/0022-3999(95)00041-9

Vedolin GM, Lobato VV, Conti PCR, Lauris JRP. The impact of stress and anxiety on the pressure pain threshold of myofascial pain patients. J. Oral Rehabil. 2009;36:313–321. https://doi.org/10.1111/j.1365-2842.2008.01932. x.

Velly AM, Look JO, Schiffman E. et al. The effect of fibromyalgia and widespread pain on the clinically significant temporomandibular muscle and joint pain disorders: a prospective 18-month cohort study. J Pain. 2010;11:1155-64. https://doi.org/10.1016/j.jpain.2010.02.009.

Warzocha J, Gadomska-Krasny J, Mrowiec J. Etiologic Factors of Temporomandibular Disorders: A Systematic Review of Literature Containing Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) from 2018 to 2022. Healthcare. 2024;12:575. https://doi.org/10.3390/healthcare12050575

Wieckiewicz M, Jenca A, Seweryn P, Orzeszek S, Petrasova A, Grychowska N, Winocur-Arias O, Emodi-Perlman A, Kujawa K. Determination of Pain Intensity, Pain-Related Disability, Anxiety, Depression, and Perceived Stress in Polish Adults with Temporomandibular Disorders: A Prospective Cohort Study. Front. Integr. Neurosci. 2022;16:1026781. https://doi.org/10.3389/fnint.2022.1026781.

Zigmond A.S., Snait R.P. The Hospital Anxiety and Depression scale. Acta Psychiatr. Scand; 1983.

Zwiri А, Al-Hatamleh MAI, Ahmad WMAW, Ahmed Asif J, Khoo SP, Husein A, Ab-Ghani Z, Kassim NK. Biomarkers for Temporomandibular Disorders: Current Status and Future Directions. Diagnostics. 2020;(10):303. https://doi.org/10.3390/diagnostics10050303

The authors declare that there are no conflicts of interest present.