Background & Aims
In psychology is assumed that facial expressions are a key factor for non-verbal communication of emotions and to tests recognize of emotion we can use cognitive tests on 6 fundamentals facial expressions (fear, angry, surprise, happiness, disgust, sadness).
This study is a novel approach and needs to explore which outcomes and which methods are good for understanding this relationship, also we need data to better build future studies.
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Methods
45 patients with a diagnosis of TMD disorders join the clinic. 23 of those was eligible for the study according to inclusion criteria.
As a pilot study we previously set an arbitrary population from 20 to 30 subjects.
For facial recognition we used 140 images selected by Karolinska Directed Emotional Faces
Software based evaluation of facial recognition
1. personal data collection,
2. Cognitive test of facial perception, with clear instruction page in the test and a warm-up phase.
a. Recognition of facial expressions (fear, joy, surprise, anger, disgust, sadness). See Figure 1.
b. Right/left lateral recognition.
3. Psychosocial Rating Scales:
a- Graded Chronic Pain Scale, measures pain and disability, validated in Italian version.
b- Craniofacial Pain and Disability Inventory, measures pain and jaw function, validated in Italian version.
c- Central Sensitization Inventory, measure of central sensitization, validated in Italian version.
Results
On 23 patients we had only 4 men (17.4%), consistent with prevalence studies its show us how MTD are a highly frequent in women. Median age was 39, almost 70% of patient (16 on 23) has a high school level.
We observed 9 patients with disc pathology, 11 with myofascial pain, TMD cephalgia (1), articular degeneration (2) and subluxation (1) was less represented. Half patient, 12 on 23, had not a specific pharmacological therapy, 4 had anxiolytics, 4 had NSAIDs, 2 had triptans and 1 subject had a prescription of biological therapy due to comorbidities.
Median accuracies and score of questionnaires are shown in table 1. Accuracy in expression recognition was from 69.15% to 80.00%, underling a difficulty in responding this task. Accuracy in left/right discrimination was 100% in all subjects, so is clear that our design of task B is too easy. Central value for total score in GCPS was grade 2 disability (GCPS is from 0 to 4) in the total score, which means a low-disability, high-intensity pain. Partial scores are according to this, we had from 0 to 2 disability points and from 53 to 78 intensity points. CFDI scores was from 48 to 78, moderate high, according to GCPS intensity scores. CSI was from 32 to 49 and median value was 41, that means over 1 to 2 of our patients are positive CS.
Conclusions
Our results were not statistically significant for any correlation. The subjects oh this study show high level of pain, moderate level of disability and over 1 on 2 seems to have central sensitization elements in their pain condition. Median accuracy in expressions recognition was 76.7%, our group of patients miss almost 1 on 4 answer on fundamental emotion. We need further larger study on this cognitive phenomenon that as important social implication.
We need other studies with a bigger population to make any hypotheses on correlation between expression recognition and pain questionnaires scores. We need to understand what database of picture and which methods are better to evaluate a left/right discrimination task.
References
[1] Bowering KL et al. 2013 The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. “Journal of Pain”
[2] Chiarotto A et al. 2018 Cross-cultural adaptation and validity of the Italian version of the Central Sensitization Inventory. “Musculoskeletal Science and Practise”
[3] Daffada PJ et al 2015 The impact of cortical remapping interventions on pain and disability in chronic low back pain: a systematic review. “Physiotherapy”
[4] Ekman, P. 1993 Facial expression and emotion. “American Psychologist”
[5] Malfliet A et al. 2017 Brain changes associated with cognitive and emotional factors in chronic pain: A systematic review. “European Journal of Pain”
[6] Monticone M et al. 2019 Cross Cultural Adaptation, reliability and validation of the Craniofacial Pain and Disability Inventory in patient with chronic temporomandibular joint disorders. “BMC Oral Health”
[7] Moseley GL. 2004 Graded motor imagery is effective for long standing complex regional pain syndrome: a randomized controlled trial. ”PAIN”
[8] Gil-Martínez A 2018 Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. “Journal of Pain Research”
[9] Goeleven E et al. 2008 The Karolinska Directed Emotional Faces: A validation study. “Cognition and Emotion”
[10] Polli A et al 2017 Graded motor imagery for patients with stroke: a non-randomized controlled trial of a new approach. “Eur J Phys Rehabil Med”
[11] Ramachandran VS et al. 2009 The use of visual feedback, in particular mirror visual feedback, in restoring brain function. ”Brain”
[12] Salaffi F et al. 2006 Reliability and validity of the Italian version of the Chronic Pain Grade questionnaire in patients with musculoskeletal disorders. “Clinical Reumatology”
[13] Schiffman et al. 2016 Executive Summary of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications. “Journal of American Dental Association”
[14] Sójka A et al. 2019 Is there a relationship between psychological factors and TMD? Brain and Behavior
[15] Von Piekartz H et al. 2015; People with chronic facial pain perform worse than controls at a facial emotion recognition task. “Journal of Oral Rehabilitation”
[16] Welte-Jzyk C et al. 2018 Somatosensory profiles of patients with chronic myogenic temporomandibular disorders in relation to their painDETECT score. “BMC Oral Health”
Presenting Author
Simone Regnani
Poster Authors
Simone Regnani
MSc
Research Unit, Master TMFM, GSTM
Lead Author
Topics
- Assessment and Diagnosis