Improvement in patients with a TMD-pain report. A 6-month follow-up study.

UNLABELLED: Even though chronic TMD pain tends to persist in most patients, some chronic patients show improvement. It is largely unknown which factors contribute to the improvement of chronic pain. The aim of this study is to investigate which factors, from a biopsychosocial perspective, help to predict improvement in patients with a report of TMD pain. METHODS: Subjects with a report of TMD pain were recruited in seven TMD clinics. They received a baseline questionnaire which included a wide range of possible predictors for improvement. After 6 months they received a follow-up questionnaire which included a measure to determine which participants were 'improved' or 'not improved'. To study which predictive variables were associated with improvement, multiple regression models were built. RESULTS: From the 129 patients who responded to the baseline questionnaire, 100 patients also filled in the follow-up questionnaire (85% women, mean age (years) ± s.d. = 46·0 ± 13·8). Fifty percentage of these subjects had improved at the 6-month follow-up. Pain duration was the strongest (negative) predictor for 6-month improvement (P = 0·009). Also the number of care providers (P = 0·017) and the degree of hindrance on function (P = 0·045) helped to predict improvement. CONCLUSIONS: The duration of the TMD-pain complaint, the number of care practitioners attended and the degree of hindrance on function (negatively) helped to predict 6-month improvement. No evidence is found to support the role of psychological or social factors on the improvement in patients with a report of TMD pain.

Social support in chronic pain: development and preliminary psychometric assessment of a new instrument.

Satisfaction with social support (pain-relevant social support) may influence pain experience and behaviour in patients with chronic pain. Prior studies on measurement of social support, however, have been limited by the use of general, rather than of pain-specific assessment instruments. In this study, a new pain-relevant social support instrument, the Social support and Pain Questionnaire (SPQ), is presented together with an evaluation of its psychometric properties. A literature search was performed to establish different aspects of social support. For each of the six aspects found, one item was selected for inclusion in the new questionnaire. The draft version of the questionnaire was field tested. Thereafter, the psychometric properties of the SPQ were assessed in 250 patients with oro-facial pain. Principal component analysis (n=250) showed that the SPQ had a one-factor structure. The test-retest reliability of the SPQ (in a subsample of 54 patients) was fair-to-good (R=0·70; P<0·000). Convergent validity, as compared with a non-specific social support instrument, was good (n=140; R=0·54; P<0·000). The SPQ is a valid and reliable instrument, which offers the possibility to explore the patient's satisfaction with pain-related social support. With the SPQ, a useful tool to assess the influence of social support in patients with various types of pain is provided.