Cognitive Domain Impairments in Chronic Painful Temporomandibular Disorders: Associations With Pain Intensity, Hypervigilance and Catastrophising: A Cross-Sectional Analysis.

Background: This study aimed to investigate the associations between pain intensity, hypervigilance and catastrophising with specific cognitive domains in patients with chronic painful temporomandibular disorders (TMD), focusing on identifying cognitive deficit domains.

Methods: A cross-sectional study was conducted with a sample of 80 participants (41 chronic painful, 39 controls). TMD was diagnosed according to the Diagnostic Criteria for TMD. Cognitive performance was assessed using the Montreal Cognitive Assessment (MOCA), while pain-related factors were evaluated using the Pain Vigilance Awareness Questionnaire, the Pain Catastrophizing Scale and Pain Intensity. Statistical analyses included independent t-tests to compare group means, followed by multiple regression analysis to examine the associations between cognitive domains and pain-related variables.

Results: Compared to controls, TMD patients showed significantly lower MOCA scores in visuospatial/executive functioning (mean difference = 3.3, p = 0.03), attention (mean difference = -2.5, p < 0.002) and memory (mean difference = -1.8, p = 0.001). Higher pain intensity was significantly associated with visuospatial/executive deficits (β = -0.34, 95% CI: -0.50 to -0.18; p < 0.001), while catastrophising was strongly linked to reduced attention (β = -0.05, 95% CI: -0.08 to -0.02; p < 0.001). Hypervigilance showed a significant negative correlation with memory performance (β = -0.04, p = 0.003).

Conclusions: Our study reveals that chronic painful TMD is associated with some cognitive impairments, particularly in visuospatial/executive functioning, attention and memory. Elevated pain intensity and catastrophising emerged as the most impactful factors, closely linked to deficits in these cognitive domains. These findings identify executive control, attention and memory as the cognitive domains most vulnerable to the influence of chronic pain in TMD patients.

Significance: This study provides novel insights into the cognitive impairments associated with chronic painful TMD. By demonstrating strong associations between pain intensity, hypervigilance and catastrophising with deficits in executive function, attention and memory, our findings highlight the cognitive burden of chronic TMD. These results underscore the necessity of integrating cognitive and psychological assessments into clinical management, fostering a more comprehensive approach to treatment that extends beyond pain relief to improving cognitive function and overall quality of life.