The Effect of Central Sensitization on Long-Term Prognosis and Comorbidity Levels in Temporomandibular Disorders: A Prospective Longitudinal Study.

BACKGROUND

Temporomandibular disorders (TMD) have the potential to progress to a chronic form associated with various comorbidities. Prolonged symptoms may lead to central sensitization (CS), resulting in decreased treatment response and highlighting the need for personalized treatment strategies.

OBJECTIVE

This study evaluated psychological conditions and comorbidities in TMD patients based on CS-related symptom levels measured by the Central Sensitization Inventory (CSI) and investigated the association between these levels and long-term treatment outcomes.

MATERIALS AND

METHODS

CS-related symptom levels were assessed using the CSI in 112 TMD patients (score ≥ 40 indicating significant levels of CS symptoms). Psychological, sleep, autonomic and pain-related comorbidities were evaluated by validated questionnaires. Participants received standardized conservative treatment, including behavioural, physical, stabilization splint and pharmacological therapies. After 6 months, patients were re-evaluated for clinical signs. Data were statistically compared between the high (n = 40) and low (n = 72) CSI groups and associations between clinical characteristics and CSI levels were analyzed. Longitudinal changes were analyzed using Generalized Estimating Equations.

RESULTS

High CSI (35.7%) was associated with higher McGill Pain Questionnaire (MPQ) scores, widespread pain and higher levels of anxiety, depression, somatization and autonomic symptoms (all padj < 0.05 after Bonferroni correction). At 6-month follow-up, the high CSI group showed a trend toward a smaller reduction in pain (group × time interaction, χ2 = 5.587, p = 0.018), suggesting a potentially less favourable treatment response to conservative therapy.

CONCLUSION

TMD patients with higher CSI scores exhibit more multidimensional comorbidities and diminished response to conservative therapy. Early identification of CS-related symptoms may be beneficial for establishing personalized treatment strategies.