Major Research Update – The OPPERA Study: The Largest TMJ Disorder Study To Date

You may want to sit down, grab a cup of coffee or a smoothie 😉 and maybe even take some notes. This is one of the most important blog posts that you have ever read about TMJ disorder research.

I’m excited to be writing about this study – the OPPERA study – because it is by far the largest study to date about TMJ disorder, and they’ve uncovered some fascinating information that should really help each and every one of us.

The last time there was an update on the OPPERA study, we covered it, in May 2010. They had just a little bit of the results at that time. This time, however, is completely different. There is so much to report on this time that they have published an entire supplement to November’s issue of the Journal of Pain (meaning that this study was given a lot of attention and its own special issue in the well known peer-reviewed journal)!

So let’s start with a synopsis of what the OPPERA study is. Secondly, we will talk about what they found, and last (but not least!), I want to know what questions you have. Make sure you read to the end because I really need your feedback. If you ask a question, your question may be featured in an interview later this week! 🙂

1. What is OPPERA? The basics:

The OPPERA study (or Orofacial Pain Prospective Evaluation and Risk Assessment) followed 3,200 pain-free individuals ages 18-44 for three to five years. The results we are talking about today were part of the study in the very beginning, when they compared the 3,200 pain-free individuals to 185 patients who had chronic TMJ disorder. After that part of the study was over, they continued following the 3,200 pain-free individuals to see who developed their first bout of TMJD.

2. What did the researchers find about TMJ disorder?

They found a lot of very interesting information. Some of this information may seem basic to you as a TMJ disorder patient, but it is still extremely important because for the most part, this is the very first time we have had definitive data that actually proves these findings.

• Most TMJ disorder patients are women, and the risk of developing TMJD is higher as women age. It seems to drop off after the late childbearing years.
• Compared with pain-free individuals, those with TMJ disorder were more sensitive to pain, their heart rate increases during mild physical and psychological stress, and they are more aware of body sensations.
• TMJ disorder patients have a higher rate of conditions like earaches, hearing loss, tinnitus, dizziness, fainting, and seizures – all neural or sensory related conditons.
• Pain disorders are more common in those who have TMD, including headaches, low back pain, and fibromyalgia. Other disorders were also common: irritable bowel syndrome being one common one.
• Abnormal jaw function was associated with clenching and teeth grinding. In later investigations, they will attempt to figure out whether clenching and grinding is caused by TMJ disorder, or is a consequence of it. At this point they believe that clenching and grinding are very likely both – a cause AND a consequence.
• TMJ disorder does not seem to be tied to socio-economic status. This is a unique finding because many chronic pain conditions are tied to it (meaning that with other conditions they have found a higher incidence of the condition with a lower socio-economic status).
• Chronic TMJ disorder patients have variations in several genes. These include genes that are known to influence inflammation, stress response, and psychological well-being.
• Not one single risk factor was found to be the one, meaning that because the disorder is so complex, they doubt that there will ever be one singular cause of TMJ disorder. In the studies, they referred several times to what they call a “web of causation”.
• Most of the 185 chronic TMD patients studied had both muscle pain and joint pain, while a very small percentage had just muscle pain (5%) or just joint pain (10%).
• Past orthodontic treatment was only weakly associated with TMJ disorder. Just orthodontic treatment alone does not seem to improve or cause TMD.
• One important item they will study more in the future is the idea that many of these factors that they’re measuring (for example, increased psychological distress, higher awareness of sensations) may actually be consequences or exacerbating factors of TMD rather than factors contributing to the actual onset of the disorder. This is an important distinction – are the issues we are facing as TMJ disorder patients the reason we’ve developed TMJ disorder, or are these issues consequences of having the disorder?
• TMD patients have a higher number of sites on their body that are painful to palpation.

As you can see, these are very interesting findings that will influence our diagnosis and treatment in the very near future.

Personally, I think these are the biggest takeaways:

1. Other pain disorders are more common in people with TMJ disorder.

What does this mean? Do we have these conditions before we developed TMJ disorder? Or is it the opposite, that patients actually develop TMJ disorder first, then the other pain conditions?

2. TMD seems to be linked to a person’s perception of and ability to suppress pain.

3. Finally, it is becoming clearer through research like this that TMJ disorder is not just a head/neck/face pain disorder.

And last, but not least – what are your questions?
I’m happy to say that I will be talking with one of the lead researchers later this week, and I would love to incorporate some of your questions into the discussion.

What would you most like to know? Do these findings bring up new questions for you?