Neck and back pain in patients with temporomandibular disorders in comparison with symptom-free controls

The following questions are addressed: To what extent are patients with a temporomandibular disorder (TMD) and controls affected by neck and back pain? Do differences exist between patients and controls? Do differences exist between TMD subgroups characterized by myofascial pain, joint pathology, or a combination of these? One hundred and thirty-four TMD patients and 38 asymptomatic controls were evaluated. Patients with muscle-related and combined disorders were found to be significantly more often affected by neck and back pain than were controls. Patients with only joint-related disorders did not significantly differ from controls. The muscle-related and combined groups also gave significantly higher values for TMD-associated pain intensity than the joint-related group. Multivariate logistical regression analysis showed that the presence of myofascial pain of the mastication muscles was the most powerful predictive parameter for the occurrence of neck and back pain. The presence of joint disorders together with myofascial pain still gave significantly elevated factors compared to controls. Joint disorders without myofascial pain proved not to be significantly associated with elevated prevalence of neck and back pain. With regard to neck and back pain in TMD patients, significant differences exist between TMD subgroups characterized by joint pathology and/or myofascial pain. This might be related to different states of the nociception processing neurological systems resulting in different levels and distribution patterns of widespread musculoskeletal pain. Keywords: orofacial pain, musculoskeletal pain, temporomandibular disorder, neck pain, back pain, widespread pain