Psychosocial burden and central sensitization–related symptoms in the association between temporomandibular-region and pelvic pain: a cross-sectional study

Background: Chronic pelvic pain and temporomandibular pain frequently co-occur, yet their combined psychosocial and sensitization profile remains poorly characterized. We quantified their association, compared psychosocial and sensitization burden across presentations, and examined associations of central sensitization–related symptoms with psychosocial factors and pain intensity. Methods: In this cross-sectional study, 133 Spanish-speaking adults were classified into neither temporomandibular nor pelvic pain (n = 18), temporomandibular pain only (n = 17), pelvic pain only (n = 30), and combined pain (n = 68). Central sensitization–related symptoms (Central Sensitization Inventory (CSI)), kinesiophobia, perceived stress, state anxiety, quality of life, and regional pain intensity were assessed. Poisson regression with robust variance estimated prevalence ratios (PRs) for pelvic pain; groups were compared using Kruskal–Wallis tests with Dunn post-hoc comparisons and Spearman correlations. Results: Temporomandibular pain was associated with pelvic pain unadjusted (crude PR = 1.28; 95% confidence interval (CI) 1.00–1.63; p = 0.047), but not after adjustment for age, sex, perceived stress, and central sensitization–related symptoms (adjusted prevalence ratio (aPR) = 1.12; 95% CI 0.87–1.43; p = 0.378). Perceived stress (aPR = 1.01; p = 0.016) and CSI (aPR = 1.01; p = 0.003) remained independently associated with pelvic pain. The combined group showed the highest CSI scores and perceived stress (both p < 0.001). CSI correlated with perceived stress (ρ = 0.52), pain intensity (ρ = 0.40–0.52), and inversely with quality of life (ρ = −0.63; all p < 0.001). Conclusions: Co-occurring temporomandibular and pelvic pain is a high-burden multisite presentation in which psychosocial distress and central sensitization–related symptoms are more closely associated with pelvic pain than temporomandibular status alone. The cross-sectional design precludes causal interpretation. Clinical Trial registration: NCT07323797 (https://clinicaltrials.gov/study/NCT07323797).