TMD and Whiplash: Psychological and Somatic Complaints

The goal of this current study¹ was to study the relationship between psychological distress and somatic complaints in two groups of TMD—one with a history of whiplash and one without. The researchers also tested the efficacy of conservative treatment on TMD-related symptoms, specifically headache intensity and frequency.

Both groups contained 12 women and 4 men. The dominant complaint was myofascial pain. The whiplash patients complained of a higher incidence of headaches as compared to the TMD patients, which is appropriate since headaches are the most common symptom of whiplash.

The researchers used the Somatic Complaints Questionnaire to assess muscle pain and all other symptoms. The whiplash patients' scores were higher, and they reported more general muscle pain than did the TMD patients.

The authors expected to find higher anxiety incidence with the whiplash group, but were surprised to find the TMD-only group scored higher—declaring that anxiety was not distinctive among whiplash with TMD patients. Yet, when comparing the psychological components, gathered by the SCL-90-R, whiplash patients scored high in the areas of obsession, somatization, depression, and anger/hostility.

The authors explain the obsession subscores as worry or disturbing thoughts about the effect of illness on a patient's lifestyle rather than as an indication of psychopathologic symptoms. They also surmise the high somatization scores are due to, "an increased psychobiologic sensitivity to minor or even normal changes in body signals, probably as a result of stress associated with the injury."²

The authors attribute the whiplash patients' feelings of anger and hostility to the way in which their chronic and severe pain has been handled:

"Often they do not receive a proper diagnosis, and the treatments given may therefore be accidental. Most therapeutic interventions currently used in patients with whiplash have been based on either fashion or faith, and have not been evaluated in a scientifically rigorous manner. ^3,4 The anger/hostility trend in the whiplash patients may also be explained by the way the pain has occurred. The TMD patients' pain most often developed gradually, while the whiplash patients' pain occurred suddenly after an accident, for which they often feel they were not responsible. Therefore, these patients may feel that their pain is unjustified."

The conservative treatment plan, which consisted of information, counseling, muscle exercises, and splint therapy, was effective only in the TMD-without-whiplash group. The treatment aided the TMD patients in all areas, but only reduced the number of tender muscles in the whiplash patients.

1. Krogstad BS, Jostad A, Dahl BL, Soboleva U. Somatic complaints, psychologic distress, and treatment outcome in two groups of TMD patients, one previously subjected to whiplash injury. Journal of Orofacial Pain 1998; 12(2):136-144.
2. Ursin H. Sensitization, somatization, and subjective health complaints. A review. International Journal of Behavioral Medicine 1997; 4:105-116.
3. Bogduk N. Post whiplash syndrome. Australian Family Physician 1994; 23:2303-2307.
4. Cassidy JD. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: Redefining "whiplash" and its management. Spine 1995; 20(suppl):8.