Local myalgia compared to myofascial pain with referral according to the DC/TMD: Axis I and II results

Orit Winocur-Arias, Pessia Friedman-Rubin, Kian Abu Ras, Larry Lockerman, Alona Emodi-Perlman, Tzvika Greenbaum, Shoshana Reiter*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) categorized TMD muscle disorders into 3 subgroups: local myalgia, myofascial pain with spreading and myofascial pain with referral. However, the rationale for such division into subgroups and the pathogenesis and prognosis of muscle-related TMD are still poorly understood. The aim of this study was to explore the differences between local myalgia and myofascial pain with referral by means of a biopsychosocial model based on the DC/TMD. Methods: This retrospective study included all consecutive TMD patients who were diagnosed according to the DC/TMD in our institution between 2015 and 2018. The Axis I and II findings of patients diagnosed with local myalgia were compared to those of patients with myofascial pain with referral. A p value < 0.05 was considered statistically significant. Results: A total of 255 patients (61 men and 194 women, mean age 37.8 ± 15.34 years) were enrolled into the study, 114 in the local myalgia group and 83 in the myofascial pain with referral group. The levels of depression and nonspecific physical symptoms, headache attributed to TMD (HAattrTMD), and characteristic pain intensity (CPI) were significantly higher in the latter group. The significant differences for depression and nonspecific physical symptoms persisted after excluding patients diagnosed with HAattrTMD, however, the levels of significance were lower (p = 0.006 compared to p = 0.033 for depression total score, and p = 0.001 compared to p = 0.046 for nonspecific physical symptoms total score). CPI levels, extent of disability, and pain duration were similar for both groups when excluding for HAattrTMD. Conclusion: The current study findings highlight the importance of differentiating between subgroups of myalgia according to the DC/TMD. The diagnosis of myofascial pain with referral may point to a significant Axis II component.

Original languageEnglish
Article number27
JournalBMC Oral Health
Issue number1
StatePublished - Dec 2022


  • Axis II
  • DC/TMD
  • Local myalgia
  • Myofascial pain with referral


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