Muscle tenderness in different types of facial pain and its relation to anxiety

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Pain. 2007 Jan 25

Muscle tenderness in different types of facial pain and its relation

to anxiety and depression: A cross-sectional study on 649 patients.

Mongini F, Ciccone G, Ceccarelli M, Baldi I, Ferrero L.

Section Headache-Facial Pain, Department of Clinical

Pathophysiology, University of Turin, 14 Corso Dogliotti, I-10126

Torino, Italy.

To evaluate in patients with different types of facial pain the

association between muscle tenderness and a set of characteristics,

649 consecutive outpatients with facial myogenous pain (MP), TMJ

disorder, neuropathic pain (NP) and facial pain disorder (FPD) (DSM-

IV) were enrolled. For each patient a psychological assessment on

the Axis 1 of the DSM-IV and standardized palpation of pericranial

and cervical muscles were carried out. A pericranial muscle

tenderness score (PTS), a cervical muscle tenderness score (CTS) and

a cumulative tenderness score (CUM, range 0-6) were calculated.

Univariate analyses (one-way analysis of variance or chi(2) test)

indicated that both age- and sex-distribution, tenderness scores and

prevalence of psychiatric disorders markedly differed between

groups. The prevalence of depression was highest in FPD patients

(44.9%). Both muscle tenderness scores (either PTS or CTS) and

prevalence of anxiety were higher in patients with MP than in those

with TMJ or NP. To assess associations between CUM score and

patients' demographic and clinical characteristics an ordered logit

model was fit and interactions between psychiatric disorders and

diagnostic groups were tested. The analysis showed that, regardless

of the diagnostic group, anxiety and depression independently

increase the likelihood of having one point higher muscle tenderness

score (OR=1.55, 95% CI: 1.13-2.12 and OR=1.56, 95% CI: 1.10-2.21,

respectively). A careful screening for the presence of an underlying

psychiatric disorder, either anxiety or depression, should be part

of the clinical evaluation in patients suffering from facial pain