1
|
Salbego RS, Conti PCR, Soares FFC, Ferreira DMAO, Herreira-Ferreira M, de Lima-Netto BA, Svensson P, Costa YM, Bonjardim LR. Influence of psychometric and sleep quality features on painful mechanical sensitivity and pain modulation in patients with temporomandibular disorders. Clin Oral Investig 2024; 28:302. [PMID: 38714576 DOI: 10.1007/s00784-024-05699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/28/2024] [Indexed: 05/10/2024]
Abstract
Investigating the collective impact of psychometric properties and sleep quality on pain sensitivity in temporomandibular disorder (TMD) patients could improve clinical management strategies. OBJECTIVE Assessing whether combined psychometric properties and sleep quality impact painful mechanical sensitivity and pain modulation in TMD patients. MATERIALS AND METHODS A cross-sectional study using secondary data analysis of 77 TMD patients and 101 controls. All participants completed questionnaires characterizing their psychometric profile (anxiety, depression, stress and catastrophizing) and sleep quality, alongside psychophysical tests for painful mechanical sensory (mechanical pain threshold (MPT), pressure pain threshold (PPT), and wind-up ratio (WUR)) and conditioned pain modulation (CPM). Participants were grouped into "High distress" or "Low distress" categories based on psychometric properties and sleep quality using hierarchical cluster and k-means analyses. Multiple linear regression evaluated the influence of TMD, age, and the distress cluster on MPT, WUR, PPT, and CPM in masseter and thenar muscles. Differences were statistically significant when p < 0.05. RESULTS The presence of TMD was the strongest predictor of mechanical painful sensitivity in the trigeminal region (MPT[F(3,174) = 51.902;p < .001;R2 = .463]; TMD presence (β = -.682) / PPT[F(3,174) = 15.573;p < .001;R2 = .198] TMD presence (β = -.452), and extra-trigeminal (MPT[F(3,174) = 35.897;p < .001;R2 = .382] TMD (β = -.647) / CPM [F(3,174) = 4.106;p < .05;R2 = .050] TMD presence (β = .197). Furthermore, neither the high distress group nor the low distress group were able to significantly influence the variation of the values of any of the psychophysical variables evaluated (p > .05). CONCLUSIONS There is not a significant influence of impairment clusters based on psychological variables and sleep quality on painful mechanical sensitivity and pain modulation, regardless of the presence of TMD. CLINICAL RELEVANCE This outcome suggests that psychosocial factors and sleep quality may not play a decisive role in the sensory-discriminative aspect of pain, particularly concerning painful TMD.
Collapse
Affiliation(s)
- Rafaela Stocker Salbego
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
| | - Paulo César Rodrigues Conti
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | | | - Matheus Herreira-Ferreira
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | | | - Yuri Martins Costa
- Department of Biosciences, Piracicaba School of Dentistry, University of Campinas, Piracicaba, Brazil
| | | |
Collapse
|
2
|
Svensson P. Could painful temporomandibular disorders be nociplastic in nature? A critical review and new proposal. Acta Odontol Scand 2024; 83:144-150. [PMID: 38623025 DOI: 10.2340/aos.v83.40586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 04/17/2024]
Abstract
Classification of temporomandibular disorders (TMD) and, indeed, all types of orofacial pains has significantly progressed in the last decade based on international consensus work and operationalized clustering of signs and symptoms. A challenging gap nevertheless continues to exist in terms of understanding the underlying pain mechanisms and link to management. Recently, a novel mechanistic descriptor 'nociplastic pain' was introduced, and diagnostic algorithms and characteristic features were proposed. This narrative and critical review aim to discuss to what extent could painful TMD conditions fit into this category. Moreover, a number of less common types of orofacial pain could possibly also reflect nociplastic pain mechanisms. A model to differentiate TMD pain mechanisms is proposed, and the implications for management are discussed. The purpose of this review is to stimulate original and novel research into mechanisms of orofacial pain and hopefully thereby improve management of the individual patient.
Collapse
Affiliation(s)
- Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus C, Denmark; Faculty of Dentistry, Malmø University, Malmö, Sweden; Scandinavian Center for Orofacial Neurosciences, Aarhus University, Aarhus C, Denmark.
| |
Collapse
|
3
|
Cayrol T, Meeus M, Aron V, Gatto C, Mouraux A, Roussel N, Sallaz L, van den Broeke E, Pitance L. Evidence for alterations to dynamic quantitative sensory tests in patients with chronic temporomandibular myalgia: a systematic review of observational studies with meta-analysis. J Oral Rehabil 2022; 49:654-670. [PMID: 35342987 DOI: 10.1111/joor.13320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Conflicting results exist between somatosensory profiles of patients with temporomandibular myalgia (TMDm). The objective of this review was to examine whether adults with TMDm show altered responses to dynamic quantitative sensory tests compared with healthy controls. METHODS We searched five electronic databases for studies, excluding those without suitable controls or where TMDm was associated with confounding non-musculoskeletal disorders. Risk of bias was assessed with the SIGN case-control study checklist. Findings were structured around dynamic quantitative sensory tests and their localization. Where possible, we performed meta-analysis with a random inverse variance model to compare patients with TMDm and healthy controls. Statistical heterogeneity was estimated with Chi² test and inconsistency index, I². RESULTS We extracted data from 23 studies comprising 1284 adults with chronic TMDm and 2791 healthy controls. Risk of bias was assessed as high for 20 studies. Mechanical temporal summation, the most studied phenomenon (14 studies), is increased in the upper limb of patients with TMDm (SMD = .43; 95% CI: .11 to .75; p = .0001) but not in the jaw area (p = .09) or in the cervical area (p = .29). Very little evidence for altered thermal temporal summation (five studies), conditioned pain modulation (seven studies), exercise-induced hypoalgesia (two studies), placebo analgesia (two studies), stress-induced hypoalgesia (one study) and offset analgesia (one study) was found. DISCUSSION A major limitation of this review was the risk of bias of included studies. Future studies would benefit from following methodological guidelines and consideration of confounding factors.
Collapse
Affiliation(s)
- Timothée Cayrol
- Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group, Belgium
| | - Vladimir Aron
- Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Claire Gatto
- Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - André Mouraux
- Institute of Neuroscience (IoNS), Université Catholique de Louvain, Brussels, Belgium
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Wilrijk, Belgium
| | - Léo Sallaz
- Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | | | - Laurent Pitance
- Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| |
Collapse
|
4
|
Banafa A, Sipilä K, Suvisaari J, Suominen AL. Low-grade inflammation as a potential mediator between depressive symptoms and temporomandibular pain: an 11-year follow-up study on Finnish adults. Acta Odontol Scand 2021; 79:545-553. [PMID: 33861677 DOI: 10.1080/00016357.2021.1909746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Low-grade inflammation and depressiveness have been associated with chronic pain conditions. OBJECTIVE To examine whether low-grade inflammation mediates the association between depressive symptoms and temporomandibular (TM) pain in Finnish adults based on the Health 2000/2011 Surveys (BRIF8901). METHODS The sample comprised subjects who underwent clinical TM pain examination (pain on palpation of the masticatory muscles and temporomandibular joints) in 2000 and 2011 and responded to questions on TM pain symptoms in 2011. The serum level of hs-CRP was obtained in both years, and depressiveness was assessed using the Beck Depression Inventory-21 (BDI-21) in 2000 and BDI-13 in 2011. Four subgroups were formed based on the presence of TM pain: No pain, pain in 2000-only, pain in the 2011-only, and pain in both-years. Analyses included Rao Scott's chi-square test cross-sectionally, and multinomial logistic regression longitudinally with the level of hs-CRP and BDI-21 score in 2000 as predictors. Mediation was tested using Hayes A. Processv3.5. RESULTS Higher BDI-21/-13 and hs-CRP levels corresponded to higher prevalences of TM pain in both years. Longitudinally, in men, higher hs-CRP level predicted TM pain in 2000-only and TM pain in both-years. Higher BDI-21 score predicted having TM pain in 2011-only. In women, higher BDI-21 score predicted TM pain in 2000-only and having TM pain in both-years. Both BDI-21 and hs-CRP had a direct effect on TM pain outcome with no mediation detected. CONCLUSION While depressiveness may increase the risk of chronic TM pain in women, the risk in men is increased by low-grade inflammation.
Collapse
Affiliation(s)
- Aisha Banafa
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Kirsi Sipilä
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Oral and Maxillofacial Department, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Jaana Suvisaari
- Department of Public Health Solutions, Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
- Public Health Evaluation and Projection Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| |
Collapse
|
5
|
Poluha RL, De la Torre Canales G, Bonjardim LR, Conti PCR. Somatosensory and psychosocial profile of patients with painful temporomandibular joint clicking. J Oral Rehabil 2020; 47:1346-1357. [DOI: 10.1111/joor.13081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Rodrigo Lorenzi Poluha
- Bauru Orofacial Pain Group Department of Prosthodontics Bauru School of Dentistry University of São Paulo Bauru Brazil
| | - Giancarlo De la Torre Canales
- Bauru Orofacial Pain Group Department of Prosthodontics Bauru School of Dentistry University of São Paulo Bauru Brazil
| | - Leonardo Rigoldi Bonjardim
- Bauru Orofacial Pain Group Department of Biological Sciences Bauru School of Dentistry University of São Paulo Bauru Brazil
| | - Paulo César Rodrigues Conti
- Bauru Orofacial Pain Group Department of Prosthodontics Bauru School of Dentistry University of São Paulo Bauru Brazil
| |
Collapse
|
6
|
The Usefulness of the Pressure Algometer in the Diagnosis and Treatment of Orofacial Pain Patients: A Systematic Review. Occup Ther Int 2020; 2020:5168457. [PMID: 32684869 PMCID: PMC7341437 DOI: 10.1155/2020/5168457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/13/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives The pressure pain threshold (PPT) may be an efficient approach to screen and evaluate orofacial pain. However, the results of previous PPT studies have varied greatly. The aim of this paper was to determine whether the PPT is an efficient approach for screening and evaluating orofacial pain. Methods The search yielded 123 articles. After removal of duplicates and screening of abstracts, 32 articles were selected for further evaluation. The Cochrane Collaboration tool for assessing the risk of bias was used for the evaluation of the studies. Results The studies covered a total of 4403 adult patients, aged 16-62, and 30 children. The studies investigated the reliability and validity of the PPT (measured by a pressure algometer) in TMD patients. The PPT was investigated in relation to headache, menstrual cycle, oral contraception, occlusal interference, and occlusal appliances. Generally, the risk of bias was low to unclear. Some structural limitations were inherent in the studies, such as small samples and short duration of the testing involved. Also, the analyzed studies lacked consistency in study design and patient management. Pressure increase values differed from 20 kPa/s to 50 kPa/s and from 0.5 kg/cm2/s to 2 kg/cm2/s. Descriptions of the PPT examination points also varied, from very precise and repeatable to a simple listing of anatomical points. The number of measurements varied from 1 to 5 at each visit. The intervals ranged from 5 seconds to 15 minutes. However, some studies confirmed that the pressure algometer is an effective tool for determining the source of orofacial pain. Conclusions Based on the analyzed articles, the authors argue that the PPT is not an efficient approach for screening and evaluating orofacial pain. What is more, it should not be used as the only diagnostics tool for patients with orofacial pain. Importantly, however, additional factors should be considered in the future for the evaluation of the PPT, including body symmetry and posture, hormone levels and the menstrual phase in women, and the use of medications and its influence on the PPT. Further clinical trials should also be performed on the PPT, examining head and neck pain patients, with more precise study design and larger samples.
Collapse
|
7
|
Effects on migraine, neck pain, and head and neck posture, of temporomandibular disorder treatment: Study of a retrospective cohort. Arch Oral Biol 2020; 114:104718. [DOI: 10.1016/j.archoralbio.2020.104718] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 12/26/2022]
|
8
|
Cleland T, Jain NB, Chae J, Hansen KM, Hisel TZ, Gunzler DD, Whitehair VC, Kim CH, Wilson RD. The protocol for a multisite, double blind, randomized, placebo-controlled trial of axillary nerve stimulation for chronic shoulder pain. Trials 2020; 21:248. [PMID: 32143732 PMCID: PMC7059286 DOI: 10.1186/s13063-020-4174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shoulder impingement syndrome is one of the most common causes of shoulder pain, accounting for approximately 30% of all shoulder pain. Approximately 35% of patients with shoulder impingement syndrome are refractory to conservative treatment. For patients who fail conservative treatment, there is no established treatment to successfully treat their chronic pain. Prior randomized control trials have demonstrated efficacy for the use of a single lead intramuscular peripheral nerve stimulation of the axillary nerve at the motor points of the deltoid muscle for treatment of hemiplegic shoulder pain. This is the first controlled trial to utilize the same novel technology to treat shoulder impingement syndrome outside of the stroke population. METHODS This is a dual-site, placebo-controlled, double-blinded, randomized control trial. Participants will be randomized to two treatment groups. The intervention group will be treated with active peripheral nerve stimulation of the axillary nerve of the affected shoulder and the control group will be treated with sham peripheral nerve stimulation of the axillary nerve of the affected shoulder. Both groups will receive a standardized exercise therapy program directed by a licensed therapist. DISCUSSION This study protocol will allow the investigators to determine if this novel, non-pharmacologic treatment of shoulder pain can demonstrate the same benefit in musculoskeletal patients which has been previously demonstrated in the stroke population. TRIAL REGISTRATION Clinicaltrials.gov, NCT03752619. Registered on 26 November 2018.
Collapse
Affiliation(s)
- Travis Cleland
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Nitin B. Jain
- Vanderbilt University Medical Center, 3319 West End Ave, Nashville, TN 37203 USA
| | - John Chae
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Kristine M. Hansen
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Terri Z. Hisel
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Douglas D. Gunzler
- Center for Healthcare Research and Policy, MetroHealth System, 2500 MetroHealth Dr., Cleveland, OH 44109 USA
| | - Victoria C. Whitehair
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Chong H. Kim
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Richard D. Wilson
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| |
Collapse
|
9
|
Quantitative sensory testing of periauricular skin in healthy adults. Sci Rep 2020; 10:3728. [PMID: 32111937 PMCID: PMC7048815 DOI: 10.1038/s41598-020-60724-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/16/2020] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to investigate the test-retest reliability of quantitative sensory testing (QST) and mechanical sensitivity mapping of the periauricular skin. Twenty volunteers (10 men, 10 women) participated in two sessions at intervals of one week. Cold and warm detection threshold (CDT&WDT), cold and heat pain threshold (CPT&HPT), mechanical detection and pain threshold (MDT&MPT), pressure pain threshold (PPT) and two-point discrimination (2PD) were measured at five sites: bilateral subauricular and postauricular sites (LA, RA, LB, RB) and the dorsum of left hand (control). Pressure stimulation was applied at each of the four periauricular test sites. The test-retest reliability of the QST data implied fair to excellent agreement as evaluated by the intra-class correlation coefficients (ICC; all >0.4) for different days. There was no difference between each side in the QST parameters and mechanical sensitivity mapping (P ≥ 0.057). Significant differences between subauricular and postauricular sites were shown for WDT and PPT (P ≤ 0.028). NRS scores of mechanical sensitivity mapping showed significant effects of gender, site and point (P ≤ 0.040). QST and mechanical sensitivity mapping can be considered to be a reliable technique to assess somatosensory function of the periauricular skin.
Collapse
|
10
|
Banafa A, Suominen AL, Sipilä K. Factors associated with signs of temporomandibular pain: an 11-year-follow-up study on Finnish adults. Acta Odontol Scand 2020; 78:57-63. [PMID: 31401930 DOI: 10.1080/00016357.2019.1650955] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Pain in the temporomandibular region is a main complaint causing disability and distress among temporomandibular disorders sufferers.Objectives: The aim of the study was, over an 11-year follow-up on Finnish adult population, to investigate the prevalence of clinically assessed pain-related temporomandibular disorder (TMD) signs, i.e. temporomandibular joint (TMJ) and masticatory muscles (MM) pain on palpation, and their association with sociodemographic background and denture status.Methods: The data were based on the nationally representative Finnish Health 2000 and Health 2011 Surveys (BRIF8901). The sample comprised 1210 adults who underwent clinical oral examinations including TMD signs assessment. Statistical evaluations included chi-square tests and logistic regressions.Results: The prevalence of palpatory MM pain decreased from 9.5% at baseline to 4.6% in the follow-up. Cross-sectionally, presence of palpatory MM pain significantly associated with gender (p < .001, p = .002) and educational level (p < .001, p = .001) in both years, and with age (p = .006) and denture status (p = .022) at baseline. The prevalence of palpatory TMJ pain increased from 2.1% at baseline to 3.5% in the follow-up. Presence of palpatory TMJ pain significantly associated with gender in both years (p = .012, p = .032). Female gender, lower education and palpatory MM pain at baseline predicted palpatory MM pain in the follow-up.Conclusion: Palpatory MM pain is relatively prevalent in adults, yet with a favourable prognosis. Women and people with low education are more susceptible groups. Previous experience of palpatory MM pain increases the risk of exhibiting it later in life.
Collapse
Affiliation(s)
- Aisha Banafa
- Faculty of Health Sciences, School of Medicine, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
- Public Health Evaluation and Projection Unit, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Kirsi Sipilä
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Oral and Maxillofacial Department, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| |
Collapse
|
11
|
Tuna T, Van Obbergh L, Van Cutsem N, Engelman E. Usefulness of the pain sensitivity questionnaire to discriminate the pain behaviour of chronic pain patients. Br J Anaesth 2018; 121:616-622. [PMID: 30115260 DOI: 10.1016/j.bja.2018.04.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 04/01/2018] [Accepted: 05/09/2018] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Chronic pain is no longer an effective warning system, but a syndrome with co-morbidities and many causes, needing a careful evaluation. Questions remain about the pain behaviour of chronic pain patients compared with patients with acute pain, or healthy subjects that we investigated. METHODS We compared three populations: healthy (HS, n=280), with acute pain (AP=110 patients), and chronic pain (CP=280 patients) by assessing their pain behaviour with the pain sensitivity questionnaire (PSQ-total and PSQ-minor). The influence of central sensitisation syndrome (CSS) on chronic pain behaviour, including catastrophising, was further investigated by using the central sensitisation inventory. RESULTS Compared with the AP patients and HS, the CP patients exhibited significantly higher catastrophising scores; higher PSQ-minor scores [29.0 (21.0-39.0), than for AP 24.0 (14.0-32.5), and for healthy subjects 25.0 (17.0-34.0); and PSQ-total scores of for CP, 63.5 for AP, and 64.0 for HS. No significant difference was observed between the HS and AP populations. Significant differences were observed between the CP patients with and without CSS. The median PSQ-minor for patients with CSS was 33.0 and without CSS was 25.0 (P<0.05); the median PSQ-total for patients with CSS was 82.0 and without CSS was 65 (P<0.05). The CP patients without CSS did not show any significant difference compared with the AP and HS groups, except for catastrophising. CONCLUSIONS This study highlights the influence of CSS in the results of PSQ and catastrophising by chronic pain patients in comparison with healthy controls and acute pain patients. CLINICAL TRIAL REGISTRATION P2014/134.
Collapse
Affiliation(s)
- T Tuna
- Department of Anesthesiology and Perioperative Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - L Van Obbergh
- Department of Anesthesiology and Perioperative Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - N Van Cutsem
- Department of Anesthesiology and Perioperative Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - E Engelman
- Department of Anesthesiology and Perioperative Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
12
|
Giudice AL, Brewer I, Leonardi R, Roberts N, Bagnato G. Pain threshold and temporomandibular function in systemic sclerosis: comparison with psoriatic arthritis. Clin Rheumatol 2018; 37:1861-1867. [PMID: 29445986 DOI: 10.1007/s10067-018-4028-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/26/2018] [Accepted: 02/06/2018] [Indexed: 01/20/2023]
Abstract
The aim of the study was to evaluate whether a reduced pain threshold is associated with increased temporomandibular dysfunction in systemic sclerosis (SSc) compared to psoriatic arthritis (PsA) and healthy controls. Ninety subjects participated in the study (30 SSc, 30 PsA, and 30 healthy controls). The Helkimo index was used to evaluate temporomandibular dysfunction. Digital palpation was performed at the temporomandibular joint (TMJ) surface and at the superficial masseter muscle (SMM) and pain intensity was recorded on a visual analog scale (VAS), while pain pressure threshold (PPT) was measured at the same sites through a pressure algometer. PPT scores were lower in SSc patients compared to PsA patients and controls. In addition, the average Helkimo index score, measuring the degree of TMJ dysfunction, was higher in SSc compared to PsA and controls. A significant inverse correlation was observed between every PPT score, and both Helkimo index and VAS palpation in SSc and PsA. Both the range of motion and all the other pain-related subdomains of the Helkimo index score (pain on movement, pain palpation TMJ and pain palpation muscle) were significantly worse in SSc compared to PsA, while no significant differences were observed in the TMJ function subdomain. In SSc patients, the skin score was directly associated with the range of motion subdomain of the Helkimo index. Our results confirm that TMJ function is impaired in SSc; further longitudinal studies are needed to assess the role of pain threshold in the assessment of limitations in TMJ function and to identify an objective marker of therapeutic response.
Collapse
Affiliation(s)
- Antonino Lo Giudice
- Department of Medical-Surgical Specialties, Department of Orthodontics, Policlinico Universitario "Vittorio Emanuele", University of Catania, Via Santa Sofia 78, 95123, Catania, Italy. .,Department of Biomedical and Dental Sciences and Morphofunctional Imaging - Section of Orthodontics, School of Dentistry, Policlinico Universitario "G. Martino", University of Messina, Via Consolare Valeria, 98123, Messina, Italy.
| | - Idona Brewer
- Department of Medicine, Division of Rheumatology, University of Louisville School of Medicine, 401 E. Chestnut St. Suite 690, Louisville, KY, 40202, USA
| | - Rosalia Leonardi
- Department of Medical-Surgical Specialties, Department of Orthodontics, Policlinico Universitario "Vittorio Emanuele", University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Neal Roberts
- Department of Medicine, Division of Rheumatology, University of Louisville School of Medicine, 401 E. Chestnut St. Suite 690, Louisville, KY, 40202, USA
| | - Gianluca Bagnato
- Division of Rheumatology, Department of Clinical and Experimental Medicine, Policlinico Universitario "G. Martino", University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| |
Collapse
|
13
|
Van Damme S, Vanden Bulcke C, Van Den Berghe L, Poppe L, Crombez G. Do patients with chronic unilateral orofacial pain due to a temporomandibular disorder show increased attending to somatosensory input at the painful side of the jaw? PeerJ 2018; 6:e4310. [PMID: 29379693 PMCID: PMC5786881 DOI: 10.7717/peerj.4310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/10/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients with chronic orofacial pain due to temporomandibular disorders (TMD) display alterations in somatosensory processing at the jaw, such as amplified perception of tactile stimuli, but the underlying mechanisms remain unclear. This study investigated one possible explanation, namely hypervigilance, and tested if TMD patients with unilateral pain showed increased attending to somatosensory input at the painful side of the jaw. METHODS TMD patients with chronic unilateral orofacial pain (n = 20) and matched healthy volunteers (n = 20) performed a temporal order judgment (TOJ) task indicated which one of two tactile stimuli, presented on each side of the jaw, they had perceived first. TOJ methodology allows examining spatial bias in somatosensory processing speed. Furthermore, after each block of trials, the participants rated the perceived intensity of tactile stimuli separately for both sides of the jaw. Finally, questionnaires assessing pain catastrophizing, fear-avoidance beliefs, and pain vigilance, were completed. RESULTS TMD patients tended to perceive tactile stimuli at the painful jaw side as occurring earlier in time than stimuli at the non-painful side but this effect did not reach conventional levels of significance (p = .07). In the control group, tactile stimuli were perceived as occurring simultaneously. Secondary analyses indicated that the magnitude of spatial bias in the TMD group is positively associated with the extent of fear-avoidance beliefs. Overall, intensity ratings of tactile stimuli were significantly higher in the TMD group than in the control group, but there was no significant difference between the painful and non-painful jaw side in the TMD patients. DISCUSSION The hypothesis that TMD patients with chronic unilateral orofacial pain preferentially attend to somatosensory information at the painful side of the jaw was not statistically supported, although lack of power could not be ruled out as a reason for this. The findings are discussed within recent theories of pain-related attention.
Collapse
Affiliation(s)
- Stefaan Van Damme
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | | | | | - Louise Poppe
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Center for Pain Research, University of Bath, Bath, United Kingdom
| |
Collapse
|
14
|
Marcos-Martín F, González-Ferrero L, Martín-Alcocer N, Paris-Alemany A, La Touche R. Multimodal physiotherapy treatment based on a biobehavioral approach for patients with chronic cervico-craniofacial pain: a prospective case series. Physiother Theory Pract 2018; 34:671-681. [PMID: 29338489 DOI: 10.1080/09593985.2017.1423522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this prospective case series was to observe and describe changes in patients with chronic cervico-craniofacial pain of muscular origin treated with multimodal physiotherapy based on a biobehavioral approach. Nine patients diagnosed with chronic myofascial temporomandibular disorder and neck pain were treated with 6 sessions over the course of 2 weeks including: (1) orthopedic manual physiotherapy (joint mobilizations, neurodynamic mobilization, and dynamic soft tissue mobilizations); (2) therapeutic exercises (motor control and muscular endurance exercises); and (3) patient education. The outcome measures of craniofacial (CF-PDI) and neck disability (NDI), kinesiophobia (TSK-11) and catastrophizing (PCS), and range of cervical and mandibular motion (ROM) and posture were collected at baseline, and at 2 and 14 weeks post-baseline. Compared to baseline, statistically significant (p < 0.01) and clinically meaningful improvements that surpassed the minimal detectable change were observed at 14 weeks in CF-PDI (mean change, 8.11 points; 95% confidence interval (CI): 2.55 to 13.69; d = 1.38), in NDI (mean change, 5 cm; 95% CI: 1.74-8.25; d = 0.98), and in the TSK-11 (mean change, 6.55 cm; 95% CI: 2.79-10.32; d = 1.44). Clinically meaningful improvements in self-reported disability, psychological factors, ROM, and craniocervical posture were observed following a multimodal physiotherapy treatment based on a biobehavioral approach.
Collapse
Affiliation(s)
- Fernando Marcos-Martín
- a Departamento de Fisioterapia , Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid , Aravaca , Madrid , Spain
| | - Luis González-Ferrero
- a Departamento de Fisioterapia , Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid , Aravaca , Madrid , Spain
| | - Noelia Martín-Alcocer
- a Departamento de Fisioterapia , Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid , Aravaca , Madrid , Spain
| | - Alba Paris-Alemany
- a Departamento de Fisioterapia , Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid , Aravaca , Madrid , Spain.,b Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle , Universidad Autónoma de Madrid , Aravaca , Madrid , Spain.,c Institute of Neuroscience and Craniofacial Pain (INDCRAN) , Madrid , Spain.,d Hospital La Paz Institute for Health Research, IdiPAZ , Madrid , Spain
| | - Roy La Touche
- a Departamento de Fisioterapia , Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid , Aravaca , Madrid , Spain.,b Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle , Universidad Autónoma de Madrid , Aravaca , Madrid , Spain.,c Institute of Neuroscience and Craniofacial Pain (INDCRAN) , Madrid , Spain.,d Hospital La Paz Institute for Health Research, IdiPAZ , Madrid , Spain
| |
Collapse
|
15
|
Lee YH, Lee KM, Auh QS, Hong JP. Magnetic Resonance Imaging-Based Prediction of the Relationship between Whiplash Injury and Temporomandibular Disorders. Front Neurol 2018; 8:725. [PMID: 29375466 PMCID: PMC5767220 DOI: 10.3389/fneur.2017.00725] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/14/2017] [Indexed: 01/03/2023] Open
Abstract
Purpose Whiplash injury can cause internal derangement of the temporomandibular joint (TMJ) and lead to temporomandibular disorders (TMDs). Our aim was to evaluate whether the initial clinical findings in TMD patients with whiplash injury are correlated with their magnetic resonance imaging (MRI) characteristics. Materials and methods This case–control study involved 219 patients (135 women, 84 men; mean age: 37.84 years) who visited our orofacial pain clinic with TMD; TMD was diagnosed using the diagnostic criteria for TMD Axis I. Patients were categorized into three groups based on the presence and type of macrotrauma: in the “wTMD” group, patients had suffered whiplash injury; patients in the “pTMD” group had post-traumatic TMD; the “iTMD” group comprised patients who had presented with TMD symptoms and had sustained no macrotrauma. We investigated the presence of disk displacement, effusion, disk deformity, and condylar degeneration, and changes in the lateral pterygoid muscle (LPM). To evaluate the severity of TMD pain and objectively analyze symptoms, we used a visual analog scale (VAS), palpation index (PI), neck PI, dysfunction index, and craniomandibular index (CMI). Results The VAS scores, and the severity indexes of the TMD including PI, neck PI, and CMI were highest in the wTMD patients. Atrophy of the LPM was most commonly seen in the wTMD group, as was disk deformity. In wTMD patients only, VAS score was significantly correlated with stress; it was correlated with headache in wTMD and iTMD patients. The clinical symptoms of TMD were not correlated with MRI findings in the wTMD group. However, alterations in the LPM were strongly correlated with disk displacement. Conclusion If clinicians recognize alterations in the LPM and disk displacement in the TMJ, they will better understand the clinical symptoms and pathophysiology of TMD with whiplash injury. Whiplash injury may lead to TMD via different mechanisms from other macrotraumas.
Collapse
Affiliation(s)
- Yeon-Hee Lee
- Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, South Korea
| | - Kyung Mi Lee
- Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Q-Schick Auh
- Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, South Korea
| | - Jyung-Pyo Hong
- Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, South Korea
| |
Collapse
|
16
|
La Touche R, Paris-Alemany A, Hidalgo-Pérez A, López-de-Uralde-Villanueva I, Angulo-Diaz-Parreño S, Muñoz-García D. Evidence for Central Sensitization in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis of Observational Studies. Pain Pract 2017; 18:388-409. [DOI: 10.1111/papr.12604] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 05/25/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Roy La Touche
- Department of Physiotherapy; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Motion in Brains Research Group; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Institute of Neuroscience and Craniofacial Pain (INDCRAN); Madrid Spain
- Hospital La Paz Institute for Health Research; IdiPAZ; Madrid Spain
| | - Alba Paris-Alemany
- Department of Physiotherapy; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Motion in Brains Research Group; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Institute of Neuroscience and Craniofacial Pain (INDCRAN); Madrid Spain
- Hospital La Paz Institute for Health Research; IdiPAZ; Madrid Spain
| | - Amanda Hidalgo-Pérez
- Department of Physiotherapy; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Physiotherapy; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Motion in Brains Research Group; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Institute of Neuroscience and Craniofacial Pain (INDCRAN); Madrid Spain
- Hospital La Paz Institute for Health Research; IdiPAZ; Madrid Spain
| | - Santiago Angulo-Diaz-Parreño
- Motion in Brains Research Group; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Faculty of Medicine; San Pablo CEU University; Madrid Spain
| | - Daniel Muñoz-García
- Department of Physiotherapy; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Motion in Brains Research Group; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
| |
Collapse
|
17
|
Kothari SF, Baad-Hansen L, Hansen LB, Bang N, Sørensen LH, Eskildsen HW, Svensson P. Pain profiling of patients with temporomandibular joint arthralgia and osteoarthritis diagnosed with different imaging techniques. J Headache Pain 2016; 17:61. [PMID: 27349657 PMCID: PMC4923011 DOI: 10.1186/s10194-016-0653-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/17/2016] [Indexed: 11/20/2022] Open
Abstract
Background Clinical differentiation between pain mechanisms of temporomandibular joint (TMJ) arthralgia and osteoarthritis (OA) is challenging. The aims were to compare somatosensory function at the TMJs and conditioned pain modulation (CPM) effects between TMJ arthralgia and OA patients diagnosed clinically and based on different imaging techniques and age- and gender-matched healthy controls (n = 41). Methods Patients (n = 58) underwent standard clinical examination and three different TMJ imaging modalities. After each examination, they were classified into arthralgia or OA based on the findings. TMJ region somatosensory testing was performed in all participants. Z-scores were calculated for patients based on healthy reference data. CPM was tested by comparing pressure pain thresholds (PPTs) at TMJ and thenar (control) before, during and after the application of painful and nonpainful cold stimuli. Data were analyzed using analyses of variance. Results Somatosensory abnormalities were commonly detected in both patient groups. Assessment of somatosensory function at the TMJ revealed that arthralgia patients were less sensitive to warmth, cold and tactile stimuli than OA patients (P < 0.048). OA patients showed pressure hyperalgesia compared with arthralgia patients (P = 0.025). There was a significant CPM effect at both test sites during painful cold application in all groups (P < 0.001). There was no significant difference in the relative CPM effect between groups except for clinically diagnosed arthralgia patients showing reduced CPM effect compared with controls (P = 0.047). Conclusions Pain profiles including somatosensory function differed between TMJ arthralgia and OA patients although CPM effects were similar in patients and controls. Thus, different TMJ pain conditions may share common pain mechanisms but the present study for the first time also indicated that differential pain mechanisms could be involved. Electronic supplementary material The online version of this article (doi:10.1186/s10194-016-0653-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Simple Futarmal Kothari
- Section of Orofacial Pain and Jaw Function, Institute of Odontology and Oral Health, Aarhus University, Vennelyst Boulevard 9, DK-8000, Aarhus C, Denmark. .,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University Hospital, Aarhus, Denmark.
| | - Lene Baad-Hansen
- Section of Orofacial Pain and Jaw Function, Institute of Odontology and Oral Health, Aarhus University, Vennelyst Boulevard 9, DK-8000, Aarhus C, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels Bang
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Institute of Odontology and Oral Health, Aarhus University, Vennelyst Boulevard 9, DK-8000, Aarhus C, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University Hospital, Aarhus, Denmark.,Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
18
|
Carvalho GF, Chaves TC, Florencio LL, Dach F, Bigal ME, Bevilaqua-Grossi D. Reduced thermal threshold in patients with Temporomandibular Disorders. J Oral Rehabil 2016; 43:401-8. [DOI: 10.1111/joor.12386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2016] [Indexed: 11/30/2022]
Affiliation(s)
- G. F. Carvalho
- Department of Biomechanics; Medicine and Locomotor Apparatus Rehabilitation - Ribeirão Preto Medical School; University of São Paulo; Ribeirão Preto-SP Brazil
| | - T. C. Chaves
- Department of Neurosciences and Behavioral Sciences - Ribeirão Preto Medical School; University of São Paulo; Ribeirão Preto-SP Brazil
| | - L. L. Florencio
- Department of Biomechanics; Medicine and Locomotor Apparatus Rehabilitation - Ribeirão Preto Medical School; University of São Paulo; Ribeirão Preto-SP Brazil
| | - F. Dach
- Department of Neurosciences and Behavioral Sciences - Ribeirão Preto Medical School; University of São Paulo; Ribeirão Preto-SP Brazil
| | - M. E. Bigal
- Migraine & Headache Clinical Development; Global Branded R&D; Pennsylvania PA USA
| | - D. Bevilaqua-Grossi
- Department of Biomechanics; Medicine and Locomotor Apparatus Rehabilitation - Ribeirão Preto Medical School; University of São Paulo; Ribeirão Preto-SP Brazil
| |
Collapse
|
19
|
Somatosensory assessment and conditioned pain modulation in temporomandibular disorders pain patients. Pain 2015; 156:2545-2555. [DOI: 10.1097/j.pain.0000000000000325] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
La Touche R, Paris-Alemany A, Gil-Martínez A, Pardo-Montero J, Angulo-Díaz-Parreño S, Fernández-Carnero J. Masticatory sensory-motor changes after an experimental chewing test influenced by pain catastrophizing and neck-pain-related disability in patients with headache attributed to temporomandibular disorders. J Headache Pain 2015; 16:20. [PMID: 25902781 PMCID: PMC4385233 DOI: 10.1186/s10194-015-0500-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/04/2015] [Indexed: 01/03/2023] Open
Abstract
Background Recent research has shown a relationship of craniomandibular disability with neck-pain-related disability has been shown. However, there is still insufficient information demonstrating the influence of neck pain and disability in the sensory-motor activity in patients with headache attributed to temporomandibular disorders (TMD). The purpose of this study was to investigate the influence of neck-pain-related disability on masticatory sensory-motor variables. Methods An experimental case–control study investigated 83 patients with headache attributed to TMD and 39 healthy controls. Patients were grouped according to their scores on the neck disability index (NDI) (mild and moderate neck disability). Initial assessment included the pain catastrophizing scale and the Headache Impact Test-6. The protocol consisted of baseline measurements of pressure pain thresholds (PPT) and pain-free maximum mouth opening (MMO). Individuals were asked to perform the provocation chewing test, and measurements were taken immediately after and 24 hours later. During the test, patients were assessed for subjective feelings of fatigue (VAFS) and pain intensity. Results VAFS was higher at 6 minutes (mean 51.7; 95% CI: 50.15-53.26) and 24 hours after (21.08; 95% CI: 18.6-23.5) for the group showing moderate neck disability compared with the mild neck disability group (6 minutes, 44.16; 95% CI 42.65-45.67/ 24 hours after, 14.3; 95% CI: 11.9-16.7) and the control group. The analysis shows a decrease in the pain-free MMO only in the group of moderate disability 24 hours after the test. PPTs of the trigeminal region decreased immediately in all groups, whereas at 24 hours, a decrease was observed in only the groups of patients. PPTs of the cervical region decreased in only the group with moderate neck disability 24 hours after the test. The strongest negative correlation was found between pain-free MMO immediately after the test and NDI in both the mild (r = −0.49) and moderate (r = −0.54) neck disability groups. VAFS was predicted by catastrophizing, explaining 17% of the variance in the moderate neck disability group and 12% in the mild neck disability group. Conclusion Neck-pain-related disability and pain catastrophizing have an influence on the sensory-motor variables evaluated in patients with headache attributed to TMD.
Collapse
Affiliation(s)
- Roy La Touche
- Department of Physiotherapy, Faculty of Health Science, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain. .,Motion in Brains Research Group, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madird, Aravaca, Madrid, Spain. .,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain. .,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.
| | - Alba Paris-Alemany
- Department of Physiotherapy, Faculty of Health Science, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain. .,Motion in Brains Research Group, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madird, Aravaca, Madrid, Spain. .,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain. .,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.
| | - Alfonso Gil-Martínez
- Department of Physiotherapy, Faculty of Health Science, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain. .,Motion in Brains Research Group, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madird, Aravaca, Madrid, Spain. .,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain. .,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.
| | - Joaquín Pardo-Montero
- Department of Physiotherapy, Faculty of Health Science, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain. .,Motion in Brains Research Group, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madird, Aravaca, Madrid, Spain. .,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain. .,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.
| | - Santiago Angulo-Díaz-Parreño
- Motion in Brains Research Group, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madird, Aravaca, Madrid, Spain. .,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain. .,Faculty of Medicine, Universidad San Pablo CEU, Madrid, Spain.
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madird, Aravaca, Madrid, Spain. .,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain. .,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| |
Collapse
|
21
|
Ruscheweyh R, Becker T, Born Y, Çolak-Ekici R, Marziniak M, Evers S, Gerlach AL, Wolowski A. Effects of stress and relaxation on pain perception in subjects with pain-free occlusional disharmony compared with healthy controls. Oral Dis 2014; 21:400-7. [PMID: 25307775 DOI: 10.1111/odi.12296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/29/2014] [Accepted: 09/29/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The significance of occlusal disharmony for the development of painful temporomandibular disorder (TMD) is controversial. The ongoing biomechanical strain caused by occlusal disharmony might lead to sensitization processes in the nociceptive system. Understanding these processes might be an important step toward understanding the possible relationship between occlusal disharmony and TMD. In this study, we therefore investigated whether subjects with occlusal disharmony (n = 22) differ from healthy controls (n = 26) in their pain perception and pain modulation by stress and relaxation. MATERIALS AND METHODS Trigeminal and extratrigeminal experimental pain perception (pinprick, heat, and pressure pain) was assessed before and after stress (mental arithmetic) and relaxation (viewing of low-arousal pictures). RESULTS There were no group differences in pain perception at baseline or during the stress task. Compared with controls, the occlusal disharmony group exhibited an inadequate reduction in pain perception during relaxation, which was significant for the extratrigeminal site (P < 0.01) and reached a trend for significance at the trigeminal site (P = 0.1). CONCLUSIONS These results suggest that subjects with occlusal disharmony show signs of disturbed endogenous pain inhibition during relaxation. CLINICAL RELEVANCE There is evidence for the presence of sensitization of the nociceptive system in subjects with occlusal disharmony. Possibly, deficient inhibition of extratrigeminal and trigeminal pain perception by relaxation might contribute to the development of TMD or other chronic pain disorders.
Collapse
Affiliation(s)
- R Ruscheweyh
- Department of Neurology, University of Münster, Münster, Germany; Department of Neurology, University of München, München, Germany
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Vierck CJ, Wong F, King CD, Mauderli AP, Schmidt S, Riley JL. Characteristics of sensitization associated with chronic pain conditions. Clin J Pain 2014; 30:119-28. [PMID: 23629594 PMCID: PMC4389646 DOI: 10.1097/ajp.0b013e318287aac7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe and understand varieties and characteristics of sensitization contributing to hyperalgesia in participants with chronic pain conditions. METHODS Thermal stimulation was delivered to the face, forearm, and calf of pain-free participants and individuals with irritable bowel syndrome, temporomandibular pain disorder (TMD), and fibromyalgia syndrome (FM). Three-second contacts by a preheated thermode occurred at 30-second intervals in ascending and then in descending series (0.7°C steps). RESULTS Thermal pain ratings during ascending series were greater at each site in individuals diagnosed with chronic pain. Intense pain at the time of testing further enhanced the ratings at all sites, but mild or moderate clinical pain did not have this effect. Thermal pain in all participants was greater during descending series compared with the ascending series of arm and leg stimulation. The hypersensitivity during the descending series was comparable in pain-free, FM and TMD participants but was increased in duration for arm or leg stimulation of FM participants. DISCUSSION The widespread sensitization for irritable bowel syndrome and TMD participants does not rely on mechanisms of spatial and temporal summation often invoked to explain widespread hyperalgesia associated with chronic pain. Increased sensitivity during descending series of stimulation of an arm or leg but not the face indicates a propensity for sensitization of nociceptive input to the spinal cord. Abnormally prolonged sensitization for FM participants reveals a unique influence of widespread chronic pain referred to deep somatic tissues.
Collapse
Affiliation(s)
- Charles J. Vierck
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville FL 32610
| | - Fong Wong
- Department of Prosthodontics, University of Florida, Gainesville FL 32610
| | - Christopher D. King
- Department of Behavioral Science, University of Florida, Gainesville FL 32610
| | - Andre P. Mauderli
- Department of College of Dentistry, University of Florida, Gainesville FL 32610
| | - Siegfried Schmidt
- Department of Community Health and Family Medicine, College of Medicine, University of Florida; Gainesville FL 32610
| | - Joseph L. Riley
- Department of Prosthodontics, University of Florida, Gainesville FL 32610
| |
Collapse
|
23
|
Orofacial pain and sensory characteristics of chronic patients compared with controls. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:e37-45. [DOI: 10.1016/j.oooo.2013.02.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 02/06/2013] [Accepted: 02/16/2013] [Indexed: 11/22/2022]
|
24
|
Vierck CJ, Whitsel BL, Favorov OV, Brown AW, Tommerdahl M. Role of primary somatosensory cortex in the coding of pain. Pain 2013; 154:334-344. [PMID: 23245864 PMCID: PMC4501501 DOI: 10.1016/j.pain.2012.10.021] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 09/15/2012] [Accepted: 10/29/2012] [Indexed: 02/04/2023]
Abstract
The intensity and submodality of pain are widely attributed to stimulus encoding by peripheral and subcortical spinal/trigeminal portions of the somatosensory nervous system. Consistent with this interpretation are studies of surgically anesthetized animals, demonstrating that relationships between nociceptive stimulation and activation of neurons are similar at subcortical levels of somatosensory projection and within the primary somatosensory cortex (in cytoarchitectural areas 3b and 1 of somatosensory cortex, SI). Such findings have led to characterizations of SI as a network that preserves, rather than transforms, the excitatory drive it receives from subcortical levels. Inconsistent with this perspective are images and neurophysiological recordings of SI neurons in lightly anesthetized primates. These studies demonstrate that an extreme anterior position within SI (area 3a) receives input originating predominantly from unmyelinated nociceptors, distinguishing it from posterior SI (areas 3b and 1), long recognized as receiving input predominantly from myelinated afferents, including nociceptors. Of particular importance, interactions between these subregions during maintained nociceptive stimulation are accompanied by an altered SI response to myelinated and unmyelinated nociceptors. A revised view of pain coding within SI cortex is discussed, and potentially significant clinical implications are emphasized.
Collapse
Affiliation(s)
- Charles J Vierck
- Department of Neuroscience, University of Florida College of Medicine, Gainesville, FL 32610-0244, USA Department of Physiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA Department of Computer Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA Senior School, Shadyside Academy, Pittsburgh, PA, USA
| | | | | | | | | |
Collapse
|
25
|
Corsalini M, Di Venere D, Pettini F, Lauritano D, Petruzzi M. Temporomandibular disorders in burning mouth syndrome patients: an observational study. Int J Med Sci 2013; 10:1784-9. [PMID: 24273452 PMCID: PMC3837237 DOI: 10.7150/ijms.6327] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 10/07/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Burning Mouth Syndrome (BMS) is a chronic disease characterized by absence of any lesions and burning of the oral mucosa associated to a sensation of dry mouth and/or taste alterations. The purpose of our study is to estimate signs and symptoms of Temporomandibular Disorders (TMD) in patients with BMS and to investigate for the existence of an association between BMS and TMD. MATERIALS AND METHODS Forty-four BMS patients were enrolled; BMS subtype was established according to the classification of Lamey. After a gnathological evaluation, according to the protocol of the European Academy of Craniomandibular Disorders, patients were classified by RDC/TMD criteria. The data were compared and analyzed using a chi-square test to describe the existence of an association between BMS and TMD. RESULTS 65.9% the BMS patients showed disorders classified as primary signs and symptoms of TMD according to RDC / TMD criteria, and 72.7% showed parafunctional habits. The chi-square test revealed a statistically significant association (p = 0.035) between BMS and TMD. CONCLUSION The data suggest that there is a possible relationship not yet well understood between BMS and TMD, may be for neurophatic alterations assumed for BMS that could be also engaged in TMD pathogenesis.
Collapse
Affiliation(s)
- Massimo Corsalini
- 1. MD, DMD Assistant professor, Dental School University of Bari, Section of TMD Diagnosis and Treatment
| | | | | | | | | |
Collapse
|
26
|
A Mechanism-Based Approach to Prevention of and Therapy for Fibromyalgia. PAIN RESEARCH AND TREATMENT 2012; 2012:951354. [PMID: 22110947 PMCID: PMC3200141 DOI: 10.1155/2012/951354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 07/06/2011] [Indexed: 11/17/2022]
Abstract
Fibromyalgia syndrome (FMS) is characterized by pain referred to deep tissues. Diagnosis and treatment of FMS are complicated by a variable coexistence with regional pain, fatigue, sleep disruption, difficulty with mentation, and depression. The widespread, deep pain of FMS can be a consequence of chronic psychological stress with autonomic dysregulation. Stress acts centrally to facilitate pain and acts peripherally, via sympathetic vasoconstriction, to establish painful muscular ischemia. FMS pain, with or without a coexistent regional pain condition, is stressful, setting up a vicious circle of reciprocal interaction. Also, stress interacts reciprocally with systems of control over depression, mentation, and sleep, establishing FMS as a multiple-system disorder. Thus, stress and the ischemic pain it generates are fundamental to the multiple disorders of FMS, and a therapeutic procedure that attenuates stress and peripheral vasoconstriction should be highly beneficial for FMS. Physical exercise has been shown to counteract peripheral vasoconstriction and to attenuate stress, depression, and fatigue and improve mentation and sleep quality. Thus, exercise can interrupt the reciprocal interactions between psychological stress and each of the multiple-system disorders of FMS. The large literature supporting these conclusions indicates that exercise should be considered strongly as a first-line approach to FMS therapy.
Collapse
|
27
|
Plesh O, Adams SH, Gansky SA. Self-reported comorbid pains in severe headaches or migraines in a US national sample. Headache 2012; 52:946-56. [PMID: 22553936 DOI: 10.1111/j.1526-4610.2012.02155.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS To compare prevalence of self-reported comorbid temporomandibular joint muscle disorder-type, neck, back, and joint pains in people with severe headache or migraine; and analyze these self-reported pains in the 2000-2005 US National Health Interview Survey by gender and age for non-Hispanic whites, Hispanics, and non-Hispanic blacks (African Americans). METHODS National Health Interview Survey data included information on gender, age, race, ethnicity, health status, and common pain types: severe headache or migraine, temporomandibular joint muscle disorder-type, neck, and low back in the last 3 months, as well as prior-month joint pains. Analyses included survey prevalence estimation and survey logistic regression to obtain odds ratios and 95% confidence intervals. RESULTS The study included 189,967 adults: 48% males, 52% females; 73% white, 12% Hispanic, and 11% black. Of the entire sample, 29,712 (15%) reported severe headache or migraine, and 19,228 (64%) had severe headache or migraine with at least 1 comorbid pain. Two or more comorbid pains were reported in 10,200 (33%), with no gender difference, and with Hispanics (n = 1847 or 32%) and blacks (n = 1301 or 30%) less likely to report 2 or more comorbid pains than whites (n = 6747 or 34%) (odds ratio = 0.91, P = .032; OR = 0.82, P < .001, respectively). This group also reported significantly lower ratings of self-rated health (P < .001). Differences in type of comorbid pain by age patterns were found. CONCLUSIONS Severe headache or migraine is often associated with other common pains, seldom existing alone. Two or more comorbid pains are common, similarly affecting gender and racial/ethnic groups.
Collapse
Affiliation(s)
- Octavia Plesh
- Department of Preventive and Restorative Dental Sciences, Division of Adolescent Medicine, University of California-San Francisco, CA 94143, USA.
| | | | | |
Collapse
|
28
|
Ruscheweyh R, Verneuer B, Dany K, Marziniak M, Wolowski A, Çolak-Ekici R, Schulte TL, Bullmann V, Grewe S, Gralow I, Evers S, Knecht S. Validation of the pain sensitivity questionnaire in chronic pain patients. Pain 2012; 153:1210-1218. [PMID: 22541722 DOI: 10.1016/j.pain.2012.02.025] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 02/10/2012] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
Abstract
Recently, a self-rating measure for pain perception based on imagined painful daily life situations, the Pain Sensitivity Questionnaire (PSQ), has been developed and shown to correlate with experimentally obtained pain intensity ratings in healthy subjects. Here, we assessed the validity of the PSQ for investigation of general pain perception (ie, pain perception outside the site of clinical pain) in chronic pain patients. PSQ scores were obtained in 134 chronic pain patients and compared to those of 185 healthy control subjects. In a subgroup of 46 chronic pain patients, we performed experimental pain testing outside the clinical pain site, including different modalities (heat, cold, pressure, and pinprick) and different measures (pain thresholds, pain intensity ratings). Results show that PSQ scores were significantly correlated with both experimental pain intensity ratings (Pearson's r=0.71, P<.001) and experimental pain thresholds (r=-0.52, P<.001). In addition, chronic pain patients exhibited significantly elevated PSQ scores as compared to healthy controls, consistent with the generalized increase of experimentally determined pain perception that has repeatedly been reported in chronic pain patients. These results demonstrate that the PSQ constitutes a valid self-rating measure of pain perception outside the clinical pain site in chronic pain patients and might serve as an alternative to experimental assessment of pain perception outside the clinical pain site in situations where experimental pain testing is not feasible.
Collapse
Affiliation(s)
- Ruth Ruscheweyh
- Department of Neurology, University of Münster, Münster, Germany Department of Neurology, University of Munich, München, Germany Department of Prosthodontics, University of Münster, Münster, Germany Department of Anaesthesiology, University of Münster, Münster, Germany Department of Orthopaedics and Tumororthopaedics, University of Münster, Münster, Germany Eye Hospital, University of Münster, Münster, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Feldreich A, Ernberg M, Lund B, Rosén A. Increased β-Endorphin Levels and Generalized Decreased Pain Thresholds in Patients With Limited Jaw Opening and Movement-Evoked Pain From the Temporomandibular Joint. J Oral Maxillofac Surg 2012; 70:547-56. [DOI: 10.1016/j.joms.2011.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 09/14/2011] [Accepted: 09/16/2011] [Indexed: 12/11/2022]
|
30
|
Ribeiro-Dasilva MC, Goodin BR, Fillingim RB. Differences in suprathreshold heat pain responses and self-reported sleep quality between patients with temporomandibular joint disorder and healthy controls. Eur J Pain 2012; 16:983-93. [PMID: 22344627 DOI: 10.1002/j.1532-2149.2011.00108.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2011] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to examine differences in heat pain threshold (HPTh) and heat pain tolerance (HPTo) between temporomandibular joint disorder (TMJD) patients and healthy controls. Using suprathreshold heat pain, this study also examined between-group (i.e. TMJD vs. healthy controls) differences in hyperalgesia and temporal summation (TS) of heat pain. Lastly, whether between-group differences in these heat pain outcomes were mediated by self-reported sleep quality was also tested. A total of 119 participants (41% TMJD) completed the current study. HPTh and HPTo responses were assessed at the ventral forearm with an ascending method of limits, while hyperalgesia and TS responses were assessed at the dorsal forearm at temperatures of 46, 48 and 50 °C. Prior to completion of heat pain procedures, participants completed the Pittsburgh Sleep Quality Index. Significant between-group differences in HPTh and HPTo were not observed. TMJD patients demonstrated significantly greater hyperalgesia than healthy controls at 46 °C only, but there were no differences for TS. Furthermore, TMJD patients reported significantly poorer sleep quality compared with healthy controls. Data analysis revealed a significant simple mediation effect whereby the presence of TMJD was strongly associated with poorer self-reported sleep quality, which, in turn, was related to enhanced hyperalgesia at 46 °C. These findings support the hypothesis that the thermal hyperalgesia demonstrated by TMJD patients may be related to poor quality of their self-reported sleep. The ability of interventions that improve sleep quality to also affect pain sensitivity is currently the topic of ongoing investigation.
Collapse
Affiliation(s)
- M C Ribeiro-Dasilva
- University of Florida College of Dentistry, University of Florida, Gainesville, USA.
| | | | | |
Collapse
|
31
|
Huehne K, Leis S, Muenster T, Wehrfritz A, Winter S, Maihöfner C, Foertsch T, Croner R, Reis A, Winterpacht A, Rautenstrauss B. High post surgical opioid requirements in Crohn's disease are not due to a general change in pain sensitivity. Eur J Pain 2012; 13:1036-42. [DOI: 10.1016/j.ejpain.2008.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 12/01/2008] [Accepted: 12/14/2008] [Indexed: 11/30/2022]
|
32
|
Potential processes involved in the initiation and maintenance of whiplash-associated disorders: discussion paper 3. Spine (Phila Pa 1976) 2011; 36:S322-9. [PMID: 22101752 DOI: 10.1097/brs.0b013e318238853f] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Nonsystematic review and discussion of the etiological processes involved in whiplash-associated disorders (WAD). OBJECTIVE To summarize the research and identify priorities for future research. SUMMARY OF BACKGROUND DATA Although there is convergent evidence of a peripheral lesion in some individuals after whiplash injury, in the majority of injured people, a lesion cannot be established with current imaging technology. Therefore, it is important to consider processes that underlie the initiation and maintenance of whiplash pain as this may allow for the development and testing of interventions to target these processes and improve outcomes. METHODS A nonsystematic review was performed to summarize current knowledge regarding potential etiological processes involved in the initiation and maintenance of WAD and to identify future research priorities. RESULTS There are several etiological processes potentially involved in the initiation and maintenance of WAD. These include augmented nociceptive processing, stress system responses, and psychosocial and sociocultural factors. Recent findings also indicate that morphological changes in the neck muscles of injured people show some association with poor recovery, but the mechanisms underlying these changes are not clear. Preliminary evidence indicates associations between these processes. Future research priorities include the following: more sophisticated investigation and analysis of interactions between the various processes; whether the modification of these processes is achievable and if modification can improve health outcomes; and to clarify factors involved in the initiation of whiplash pain versus those involved in symptom maintenance. CONCLUSION Research to date indicates that there are several physiological and psychological etiological processes that may underlie the initiation and maintenance of whiplash-related pain and disability. Further research is required to determine relationships and interactions between these factors and to determine whether their modification is possible and will improve outcomes after injury.
Collapse
|
33
|
Sterling M. Whiplash-associated disorder: musculoskeletal pain and related clinical findings. J Man Manip Ther 2011; 19:194-200. [PMID: 23115472 PMCID: PMC3201650 DOI: 10.1179/106698111x13129729551949] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The aim of this paper was to review the physical and psychological processes associated with whiplash-associated disorders. There is now much scientific data available to indicate the presence of disturbed nociceptive processing, stress system responses, muscle and motor changes as well as psychological factors in both acute and chronic whiplash-associated disorders. Some of these factors seem to be associated with the transition from acute to chronic pain and have demonstrated prognostic capacity. Further investigation is required to determine if these processes can be modified and if modification will lead to improved outcomes for this condition. The burden of whiplash injuries, the high rate of transition to chronicity, and evidence of limited effects of current management on transition rates demand new directions in evaluation and management. The understanding of processes underlying this condition is improving and this lays the foundation for the development of more effective management approaches.
Collapse
Affiliation(s)
- Michele Sterling
- Centre for National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland, Australia
| |
Collapse
|
34
|
Svensson P, Baad-Hansen L, Pigg M, List T, Eliav E, Ettlin D, Michelotti A, Tsukiyama Y, Matsuka Y, Jääskeläinen SK, Essick G, Greenspan JD, Drangsholt M. Guidelines and recommendations for assessment of somatosensory function in oro-facial pain conditions--a taskforce report. J Oral Rehabil 2011; 38:366-94. [PMID: 21241350 DOI: 10.1111/j.1365-2842.2010.02196.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The goals of an international taskforce on somatosensory testing established by the Special Interest Group of Oro-facial Pain (SIG-OFP) under the International Association for the Study of Pain (IASP) were to (i) review the literature concerning assessment of somatosensory function in the oro-facial region in terms of techniques and test performance, (ii) provide guidelines for comprehensive and screening examination procedures, and (iii) give recommendations for future development of somatosensory testing specifically in the oro-facial region. Numerous qualitative and quantitative psychophysical techniques have been proposed and used in the description of oro-facial somatosensory function. The selection of technique includes time considerations because the most reliable and accurate methods require multiple repetitions of stimuli. Multiple-stimulus modalities (mechanical, thermal, electrical, chemical) have been applied to study oro-facial somatosensory function. A battery of different test stimuli is needed to obtain comprehensive information about the functional integrity of the various types of afferent nerve fibres. Based on the available literature, the German Neuropathic Pain Network test battery appears suitable for the study of somatosensory function within the oro-facial area as it is based on a wide variety of both qualitative and quantitative assessments of all cutaneous somatosensory modalities. Furthermore, these protocols have been thoroughly described and tested on multiple sites including the facial skin and intra-oral mucosa. Standardisation of both comprehensive and screening examination techniques is likely to improve the diagnostic accuracy and facilitate the understanding of neural mechanisms and somatosensory changes in different oro-facial pain conditions and may help to guide management.
Collapse
Affiliation(s)
- P Svensson
- Department of Clinical Oral Physiology, Aarhus University, Aarhus, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Engel-Yeger B, Dunn W. Relationship Between Pain Catastrophizing Level and Sensory Processing Patterns in Typical Adults. Am J Occup Ther 2011. [DOI: 10.5014/ajot.2011.09004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We examined the relationship between pain perception, as expressed by pain catastrophizing level, and sensory processing patterns among typical adults.
METHOD. Two hundred ninety healthy adults participated in this study: 138 men and 152 women. Their ages ranged from 18 to 50 (mean age = 30.2 ± 6.8). All participants completed the Adolescent/Adult Sensory Profile and the Pain Catastrophizing Scale (PCS).
RESULTS. PCS scores significantly correlated with Low Registration, Sensory Sensitivity, and Sensation Avoiding. Women had higher sensory sensitivity and a higher pain catastrophizing level than did men.
CONCLUSION. Sensory processing patterns may be related to individual pain perception, as expressed in pain catastrophizing level. Intervention programs should take these factors into account to be more focused on the specific needs of each client, facilitate his or her optimal engagement in daily living activities, and elevate well-being.
Collapse
Affiliation(s)
- Batya Engel-Yeger
- Batya Engel-Yeger, PhD, is Senior Lecturer, Occupational Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa 31905 Israel;
| | - Winnie Dunn
- Winnie Dunn, PhD, OTR, FAOTA, is Professor and Chair, Department of Occupational Therapy Education, School of Allied Health, University of Kansas Medical Center, Kansas City
| |
Collapse
|
36
|
Whitsel BL, Favorov OV, Li Y, Lee J, Quibrera PM, Tommerdahl M. Nociceptive afferent activity alters the SI RA neuron response to mechanical skin stimulation. Cereb Cortex 2010; 20:2900-15. [PMID: 20308203 PMCID: PMC2978241 DOI: 10.1093/cercor/bhq039] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Procedures that reliably evoke cutaneous pain in humans (i.e., 5-7 s skin contact with a 47-51 °C probe, intradermal algogen injection) are shown to decrease the mean spike firing rate (MFR) and degree to which the rapidly adapting (RA) neurons in areas 3b/1 of squirrel monkey primary somatosensory cortex (SI) entrain to a 25-Hz stimulus to the receptive field center (RF(center)) when stimulus amplitude is "near-threshold" (i.e., 10-50 μm). In contrast, RA neuron MFR and entrainment are either unaffected or enhanced by 47-51 °C contact or intradermal algogen injection when the amplitude of 25-Hz stimulation is 100-200 μm (suprathreshold). The results are attributed to an "activity dependence" of γ-aminobutyric acid (GABA) action on the GABA(A) receptors of RA neurons. The nociceptive afferent drive triggered by skin contact with a 47-51 °C probe or intradermal algogen is proposed to activate nociresponsive neurons in area 3a which, via corticocortical connections, leads to the release of GABA in areas 3b/1. It is hypothesized that GABA is hyperpolarizing/inhibitory and suppresses stimulus-evoked RA neuron MFR and entrainment whenever RA neuron activity is low (as when the RF(center) stimulus is weak/near-threshold) but is depolarizing/excitatory and augments MFR and entrainment when RA neuron activity is high (when the stimulus is strong/suprathreshold).
Collapse
Affiliation(s)
- B L Whitsel
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC 27599, USA.
| | | | | | | | | | | |
Collapse
|
37
|
Ruscheweyh R, Stumpenhorst F, Knecht S, Marziniak M. Comparison of the cold pressor test and contact thermode-delivered cold stimuli for the assessment of cold pain sensitivity. THE JOURNAL OF PAIN 2010; 11:728-36. [PMID: 20338822 DOI: 10.1016/j.jpain.2009.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 10/22/2009] [Accepted: 10/30/2009] [Indexed: 01/29/2023]
Abstract
UNLABELLED Sensitivity to suprathreshold cold pain stimuli constitutes an important part of comprehensive pain sensitivity testing and can be assessed by the cold pressor test or by using a contact thermode-based testing device. One major difference between the 2 methods is the size of the surface area stimulated, which is thought to affect both recruitment of endogenous pain control mechanisms and vasomotor reactions. It is therefore not clear if the 2 methods can be used interchangeably for the assessment of cold pain. Here we applied 60-second-long stimuli at approximately 3 degrees C to the hands of 47 subjects by both methods. Pain intensity ratings (on a scale from 0 to 10) were significantly higher in the cold pressor test than in the thermode cold test (6.3 +/- 1.8 vs 3.9 +/- 2), associated with a higher rate of dropouts within the 60 seconds (64 vs 11%). Nonetheless, pain intensity ratings obtained with both methods were highly correlated (r = .70). However, the thermode cold test shared a larger amount of variance with 1 or more of the other pain intensity rating tests (phasic and tonic heat, pinprick) than the cold pressor test (53% vs 30%) while the cold pressor test contained a larger proportion of unique variance (39 vs 26%). PERSPECTIVE This article compares 2 methods of cold pain assessment in humans and analyzes their relationship to heat and pinprick pain. It could help researchers select the appropriate cold pain test for their study. It may also promote our understanding of commonalities and differences between different pain modalities.
Collapse
Affiliation(s)
- Ruth Ruscheweyh
- Department of Neurology, University of Münster, Albert-Schweitzer-Strasse 33, Münster, Germany.
| | | | | | | |
Collapse
|
38
|
Bevilaqua Grossi D, Lipton RB, Bigal ME. Temporomandibular disorders and migraine chronification. Curr Pain Headache Rep 2010; 13:314-8. [PMID: 19586596 DOI: 10.1007/s11916-009-0050-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Among the established and potential comorbidities of migraine, the temporomandibular disorders (TMD) are rarely discussed, although they are of importance for several reasons. TMD may cause headaches per se, worsen existent primary headaches, and add to the burden of headache disorders. This article explores the potential comorbidity between migraine and TMD and the role of TMD as a potential factor to induce chronic migraine. We discuss the similarities between both conditions, review evidence to support the idea that both disorders are comorbid, and highlight the limited evidence suggesting that TMD influence migraine progression. Finally, we discuss the importance of cutaneous allodynia mediating the TMD/frequent headache relationship.
Collapse
Affiliation(s)
- Debora Bevilaqua Grossi
- Department of Biomechanics Medicine and Rehabilitation of the Locomotor Apparatus, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil.
| | | | | |
Collapse
|
39
|
Bevilaqua-Grossi D, Lipton RB, Napchan U, Grosberg B, Ashina S, Bigal ME. Temporomandibular disorders and cutaneous allodynia are associated in individuals with migraine. Cephalalgia 2010; 30:425-32. [PMID: 19614688 DOI: 10.1111/j.1468-2982.2009.01928.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The objective of this study was to estimate and contrast the occurrence of ictal and interictal cutaneous allodynia (CA) in individuals with migraine with and without temporomandibular disorders (TMD). Both TMD and CA are common in migraine and may be associated with migraine transformation from episodic into a chronic form. Herein we hypothesize that TMD contributes to the development of CA and to more severe headaches. In a clinic-based sample of individuals with episodic migraine, the presence of TMD was assessed using the research diagnostic criteria for myofascial or mixed (myofascial and arthralgic) TMD. Ictal CA was quantified using the validated Allodynia Symptom Checklist (ASC-12). The ASC-12 measures CA over the preceding month by asking 12 questions about the frequency of allodynia symptoms during headaches. Interictal CA was assessed in the domains of heat, cold and mechanical static allodynia using quantitative sensory testing. Our sample consists of 55 individuals; 40 (73%) had TMD (23 with myofascial TMD and 17 with the mixed type). CA of any severity (as assessed by ASC-12) occurred in 40% of those without TMD (reference group), 86.9% of those with myofascial TMD (P = 0.041, RR = 3.2, 95% CI = 1.5-7.0) and in 82.3% of those with mixed TMD (P = 0.02, RR = 2.5, 95% CI = 1.2-5.3). Individuals with TMD were more likely to have moderate or severe CA associated with their headaches. Interictally (quantitative sensory testing), thresholds for heat and mechanical nociception were significantly lower in individuals with TMD. Cold nociceptive thresholds were not significantly different in migraine patients with and without TMD. TMDs were also associated with change in extra-cephalic pain thresholds. In logistical regression, TMD remained associated with CA after adjusting for aura, gender and age. TMD and CA are associated in individuals with migraine.
Collapse
Affiliation(s)
- D Bevilaqua-Grossi
- Department of Biomechanics Medicine and Rehabilitation of the Locomotor Apparatus, University of Sao Paulo Ribeirão Preto Brazil, Sao Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
40
|
Pfau DB, Rolke R, Nickel R, Treede RD, Daublaender M. Somatosensory profiles in subgroups of patients with myogenic temporomandibular disorders and fibromyalgia syndrome. Pain 2009; 147:72-83. [DOI: 10.1016/j.pain.2009.08.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 07/08/2009] [Accepted: 08/13/2009] [Indexed: 10/20/2022]
|
41
|
Spinal manipulative therapy has an immediate effect on thermal pain sensitivity in people with low back pain: a randomized controlled trial. Phys Ther 2009; 89:1292-303. [PMID: 19797305 PMCID: PMC2794479 DOI: 10.2522/ptj.20090058] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Current evidence suggests that spinal manipulative therapy (SMT) is effective in the treatment of people with low back pain (LBP); however, the corresponding mechanisms are unknown. Hypoalgesia is associated with SMT and is suggestive of specific mechanisms. OBJECTIVE The primary purpose of this study was to assess the immediate effects of SMT on thermal pain perception in people with LBP. A secondary purpose was to determine whether the resulting hypoalgesia was a local effect and whether psychological influences were associated with changes in pain perception. DESIGN This study was a randomized controlled trial. SETTING A sample of convenience was recruited from community and outpatient clinics. PARTICIPANTS Thirty-six people (10 men, 26 women) currently experiencing LBP participated in the study. The average age of the participants was 32.39 (SD=12.63) years, and the average duration of LBP was 221.79 (SD=365.37) weeks. INTERVENTION AND MEASUREMENTS Baseline demographic and psychological measurements were obtained, followed by quantitative sensory testing to assess temporal summation and Adelta fiber-mediated pain perception. Next, participants were randomly assigned to ride a stationary bicycle, perform low back extension exercises, or receive SMT. Finally, the same quantitative sensory testing protocol was reassessed to determine the immediate effects of each intervention on thermal pain sensitivity. RESULTS Hypoalgesia to Adelta fiber-mediated pain perception was not observed. Group-dependent hypoalgesia of temporal summation specific to the lumbar innervated region was observed. Pair-wise comparisons indicated significant hypoalgesia in participants who received SMT, but not in those who rode a stationary bicycle or performed low back extension exercises. Psychological factors did not significantly correlate with changes in temporal summation in participants who received SMT. LIMITATIONS Only immediate effects of SMT were measured, so the authors are unable to comment on whether the inhibition of temporal summation is a lasting effect. Furthermore, the authors are unable to comment on the relationship between their findings and changes in clinical pain. CONCLUSIONS Inhibition of Adelta fiber-mediated pain perception was similar for all groups. However, inhibition of temporal summation was observed only in participants receiving SMT, suggesting a modulation of dorsal horn excitability that was observed primarily in the lumbar innervated area.
Collapse
|
42
|
Nixdorf DR, John MT, Schierz O, Bereiter DA, Hellekant G. Self-reported severity of taste disturbances correlates with dysfunctional grade of TMD pain. J Oral Rehabil 2009; 36:792-800. [PMID: 19747196 DOI: 10.1111/j.1365-2842.2009.01996.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Altered central neural processing of sensory information may be associated with temporomandibular disorders (TMD) pain. The objectives of this study were to compare the prevalence of self-reported taste disturbances in TMD pain patients and in a control population, and to determine whether frequency of taste disturbances was correlated with dysfunctional grade of TMD pain. Subjects were 2026 people within a German population sample and 301 consecutive TMD patients diagnosed using the Research Diagnostic Criteria. Taste disturbances were measured using two questions from the Oral Health Impact Profile. Dysfunctional grade of TMD pain was measured with the Graded Chronic Pain Scale. A two-sample test of proportions revealed that TMD patients reported a greater frequency of taste disturbances, 6%, than did the general population subjects, 2% (P < 0.001). Moreover, the frequency of taste disturbances correlated with the dysfunctional grade of TMD pain. For each 1 unit increase in taste disturbance, the odds of observing a higher grade of TMD pain increased by 29% (95% CI: 3-63%, P = 0.03). Analysis by individual taste question and adjustment for age and gender did not substantially affect the results. These findings are consistent with a central neural dysfunction in TMD pain and suggest that a common neural substrate may underlie sensory disturbances of multiple modalities in chronic pain patients. Further research regarding taste disturbances and trigeminally mediated pains such as in TMD is warranted.
Collapse
Affiliation(s)
- D R Nixdorf
- Division of TMD & Orofacial Pain, School of Dentistry, University of Minnesota, 6-320 Moos Tower, 515 Delaware Street S.E., Minneapolis, MN 55455, USA.
| | | | | | | | | |
Collapse
|
43
|
Pain sensitivity can be assessed by self-rating: Development and validation of the Pain Sensitivity Questionnaire. Pain 2009; 146:65-74. [PMID: 19665301 DOI: 10.1016/j.pain.2009.06.020] [Citation(s) in RCA: 221] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 05/15/2009] [Accepted: 06/12/2009] [Indexed: 02/07/2023]
Abstract
Experimental determination of pain sensitivity has received increasing attention because of emerging clinical applications (including prediction of postoperative pain and treatment response) and scientific implications (e.g. it has been proposed that above-average pain sensitivity is a risk factor for the development of chronic pain disorders). However, the use of experimental pain sensitivity assessment on a broad scale is hampered by its requirements on time, equipment and human resources and the fact that it is painful for the tested subject. Alternatives to experimental pain testing are currently lacking. Here we developed a self-rating instrument for the assessment of pain sensitivity, the Pain Sensitivity Questionnaire (PSQ) that is based on pain intensity ratings of daily life situations and takes 5-10min to complete. Adequate reliability of the PSQ was confirmed in 354 subjects. In a validation study comprising 47 healthy subjects, the results of comprehensive experimental pain testing, including different modalities (heat, cold, pressure, and pinprick) and different measures (pain thresholds, pain intensity ratings), were compared to the results of the PSQ. PSQ scores were significantly correlated to experimental pain intensity ratings (r = 0.56, p < 0.001) but not to pain thresholds (r = 0.03). Prediction of experimental pain intensity ratings by the PSQ was better than by pain-associated psychological factors (pain catastrophizing, depression, anxiety). This shows that the PSQ may be a simple alternative to experimental pain intensity rating procedures in healthy subjects and makes the PSQ a highly promising tool for clinical and experimental pain research.
Collapse
|
44
|
SVENSSON P, JADIDI F, ARIMA T, BAAD-HANSEN L, SESSLE BJ. Relationships between craniofacial pain and bruxism. J Oral Rehabil 2008; 35:524-47. [DOI: 10.1111/j.1365-2842.2008.01852.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|