Potential autonomic risk factors for chronic TMD: Descriptive data and empirically identified domains from the OPPERA case-control study

William Maixner, Joel D. Greenspan, Ronald Dubner, Eric Bair, Flora Mulkey, Vanessa Miller, Charles Knott, Gary D. Slade, Richard Ohrbach, Luda Diatchenko, Roger B. Fillingim

Research output: Contribution to journalArticlepeer-review

71 Scopus citations


Several case-control studies have been conducted that examine the association between autonomic variables and persistent pain conditions; however, there is a surprising dearth of published studies in this area that have focused on temporomandibular disorders (TMD). The current study presents autonomic findings from the baseline case-control study of the OPPERA (Orofacial Pain: Prospective Evaluation and Risk Assessment) cooperative agreement. Measures of arterial blood pressure, heart rate, heart rate variability, and indirect measures of baroreflex sensitivity were assessed at rest and in response to a physical (orthostatic) and psychological (Stroop) stressors in 1,633 TMD-free controls and 185 TMD cases. In bivariate and demographically adjusted analyses, greater odds of TMD case status were associated with elevated heart rates, reduced heart rate variability, and reduced surrogate measures of baroreflex sensitivity across all experimental procedures. Principal component analysis was undertaken to identify latent constructs revealing 5 components. These findings provide evidence of associations between autonomic factors and TMD. Future prospective analyses in the OPPERA cohort will determine if the presence of these autonomic factors predicts increased risk for developing new onset TMD. Perspective: This article reports autonomic findings from the OPPERA Study, a large prospective cohort study designed to discover causal determinants of TMD pain. Findings indicate statistically significant differences between TMD cases and controls across multiple autonomic constructs at rest and during both physical and psychologically challenging conditions. Future analyses will determine whether these autonomic factors increase risk for new onset TMD.

Original languageEnglish (US)
Pages (from-to)T75-T91
JournalJournal of Pain
Issue number11 SUPPL.
StatePublished - Nov 2011
Externally publishedYes


  • Temporomandibular disorders
  • baroreflex sensitivity
  • blood pressure
  • heart rate
  • heart rate variability
  • orthostatic
  • stroop

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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