Impact of Psychological Stress on Chronic Pain in Temporomandibular Joint Disorders with Normal Imaging Findings and the Efficacy of Pharmacological Management: A Retrospective Study in a Tertiary Care Dental Outpatient Department

Background: Temporomandibular joint disorders (TMDs) are a prevalent cause of orofacial pain, frequently associated with psychological stress and mental health comorbidities. Despite significant pain, many patients present with normal imaging findings, suggesting a substantial non-structural component. Objective: To investigate the relationship between self-reported stress and chronic TMD pain in patients with normal imaging, and evaluate the effectiveness of pharmacological management in a tertiary care dental OPD of western Rajasthan. Methods: We retrospectively analyzed records of 150 consecutive TMD patients (age 18–60) presenting with chronic pain (≥3 months) and normal X-ray, CT, and MRI findings, attending a tertiary care dental OPD from January to June 2025. Demographics, self-reported stress (10-point scale), pain intensity (VAS), pharmacological interventions, and comorbidities were captured. Ethical approval was waved off as data is retrospective document based and anonymized Results: Of 150 patients, 68% were female. High stress was present in 78% and strongly correlated with increased pain (VAS 7.2±1.4), compared to moderate (5.8±1.2) and low (4.1±1.0) stress (p<0.001). The majority had myofascial pain (myalgia, 72%). NSAIDs (85%), muscle relaxants (60%), and low-dose antidepressants (35%) reduced pain in 65% of cases, achieving optimal benefit when combined. Anxiety and/or depression affected 40% of patients. Conclusions: Stress is a critical influence on chronic TMD pain when imaging is normal. Conservative pharmacological approaches are effective, but integration of stress management and psychological interventions is recommended for optimal outcomes