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J Oral Rehabil. 2017 Jun;44(6):415-425. doi: 10.1111/joor.12499. Epub 2017 Mar 21.

Influence of culture on pain comorbidity in women with and without temporomandibular disorder-pain.

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Department of Oral Basic and Clinical Sciences, College of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia.
Department of Orofacial Pain and Jaw Functions, Faculty of Odontology, Malmö University, Malmö, Sweden.
Scandinavian Center for Orofacial Neurosciences (SCON), Malmö, Sweden.
Department of Orthodontics and Temporomandibular disorders, University of Naples Federico II, Naples, Italy.
Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, NY, USA.


Evidence on cultural differences in prevalence and impact of common chronic pain conditions, comparing individuals with temporomandibular disorders (TMD) versus individuals without TMD, is limited. The aim was to assess cross-cultural comorbid pain conditions in women with chronic TMD pain. Consecutive women patients (n = 122) with the index condition of chronic TMD pain diagnosed per the research diagnostic criteria for TMD and TMD-free controls (n = 121) matched for age were recruited in Saudi Arabia, Italy and Sweden. Self-report questionnaires assessed back, chest, stomach and head pain for prevalence, pain intensity and interference with daily activities. Logistic regression was used for binary variables, and ancova was used for parametric data analysis, adjusting for age and education. Back pain was the only comorbid condition with a different prevalence across cultures; Swedes reported a lower prevalence compared to Saudis (P < 0·01). Saudis reported higher prevalence of work reduced >50% due to back pain compared to Italians or Swedes (P < 0·01). Headache was the most common comorbid condition in all three cultures. The total number of comorbid conditions did not differ cross-culturally but were reported more by TMD-pain cases than TMD-free controls (P < 0·01). For both back and head pain, higher average pain intensities (P < 0·01) and interference with daily activities (P < 0·01) were reported by TMD-pain cases, compared to TMD-free controls. Among TMD-pain cases, Italians reported the highest pain-related disability (P < 0·01). Culture influences the associated comorbidity of common pain conditions. The cultural influence on pain expression is reflected in different patterns of physical representation.


chronic; comorbid conditions; cross-cultural comparison; disability; headache; low back pain; pain

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