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Wei SQ, Wei JX, Zhao S, Cao DY, Liang L. Downregulation of lysine-specific histone demethylase 1A (KDM1A/LSD1) in medial prefrontal cortex facilitates chronic stress-induced pain and emotional dysfunction in female mice. Neuropharmacology 2024; 254:109992. [PMID: 38723742 DOI: 10.1016/j.neuropharm.2024.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/22/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
Chronic primary pain, characterized by overlapping symptoms of chronic pain, anxiety, and depression, is strongly associated with stress and is particularly prevalent among females. Recent research has convincingly linked epigenetic modifications in the medial prefrontal cortex (mPFC) to chronic pain and chronic stress. However, our understanding of the role of histone demethylation in the mPFC in chronic stress-induced pain remains limited. In this study, we investigated the function of lysine-specific histone demethylase 1A (KDM1A/LSD1) in the context of chronic overlapping pain comorbid with anxiety and depression in female mice. We employed a chronic variable stress model to induce pain hypersensitivity in the face and hindpaws, as well as anxiety-like and depression-like behaviors, in female mice. Our findings revealed that chronic stress led to a downregulation of KDM1A mRNA and protein expression in the mPFC. Notably, overexpressing KDM1A in the mPFC alleviated the pain hypersensitivity, anxiety-like behaviors, and depression-like behaviors in female mice, without affecting basal pain responses or inducing emotional distress. Conversely, conditional knockout of KDM1A in the mPFC exacerbated pain sensitivity and emotional distress specifically in females. In summary, this study highlights the crucial role of KDM1A in the mPFC in modulating chronic stress-induced overlapping pain, anxiety, and depression in females. Our findings suggest that KDM1A may serve as a potential therapeutic target for treating chronic stress-related overlap pain and associated negative emotional disorders.
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Affiliation(s)
- Si-Qi Wei
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Testing Center of Stomatology, Xi'an Jiaotong University College of Stomatology, Xi'an, Shaanxi, 710061, PR China
| | - Jian-Xiong Wei
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China; Institute of Neuroscience, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Shijie Zhao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Testing Center of Stomatology, Xi'an Jiaotong University College of Stomatology, Xi'an, Shaanxi, 710061, PR China
| | - Dong-Yuan Cao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Testing Center of Stomatology, Xi'an Jiaotong University College of Stomatology, Xi'an, Shaanxi, 710061, PR China.
| | - Lingli Liang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China; Institute of Neuroscience, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China.
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Son JY, Choi OS, Kim YM. Oral habits and temporomandibular joint disorders according to stress levels among military personnel in South Korea: A cross-sectional study. J Oral Rehabil 2024; 51:1499-1506. [PMID: 38706184 DOI: 10.1111/joor.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/21/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Military personnel suffer from stress-induced temporomandibular joint disorders (TMD). No previous studies have evaluated the oral habits and TMD in military personnel based on their stress levels. OBJECTIVES To examine the correlation between oral habits and TMD based on stress levels. In addition, we assessed the relationship between stress levels and TMD by military rank as well as the impact of oral habits on TMD. METHOD This cross-sectional survey included 89 military personnel who visited the Armed Forces Medical Center in Korea with discomfort in the temporomandibular joint (TMJ) discomfort. Oral habits, stress level, TMD and general characteristics of the subjects were investigated. A questionnaire was distributed to the subjects who agreed to the study, and they were asked to respond in a self-written form. Multiple linear regression analysis was performed to examine the factors that affect oral habits and TMJ symptoms. RESULTS Stress scores and oral habits were highest in the 'Private' rank. In contrast, temporomandibular joint symptoms were highest in the 'Corporal' rank. Additionally, the high-risk stress group exhibited higher scores in oral habits and TMD compared to the potential stress group. Furthermore, there was a positive correlation between an increase in high-risk stress scores and a rise in oral habits. And individuals with more oral habits are at an increased likelihood of experiencing TMD. CONCLUSION Our study findings suggest that military personnel with prevent TMD and improve oral habits by addressing stress levels.
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Affiliation(s)
- Ji-Young Son
- Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Korea
- Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Ok-Sun Choi
- Department of dental hygiene, Gangdong University, Eumseong-gun, Korea
| | - You-Mi Kim
- Department of Spinal Cord Injury Rehabilitation, National Rehabilitation Center, Seoul, Korea
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Yap AU, Tan SHX. Conceptualising TMD symptom burden in youths: Symptom duration, frequency, intensity and interference. J Oral Rehabil 2024; 51:1486-1498. [PMID: 38706175 DOI: 10.1111/joor.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 03/15/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE This study aimed to conceptualise Temporomandibular disorder (TMD) symptom burden and severity and explored their interrelationships with somatic symptoms and psychological distress. METHODS Participants were recruited from a local polytechnic. The quintessential five TMD symptoms (5Ts) of the Diagnostic Criteria for TMDs (DC/TMD) were appraised and extended to evaluate the duration, frequency, intensity and interference of discrete TMD symptoms. Global TMD severity (GS) was computed by totaling the points for all TMD symptoms and dimensions. TMD (TS) and somatic symptom (SS) burden were assessed based on the Somatic Symptoms Scale-8, while psychological distress was measured with the Depression, Anxiety and Stress Scales-21. Statistical analyses were performed using Kruskal-Wallis/Dunn tests and Spearman's correlation (α = .05). RESULT Of the 366 eligible participants (mean age 19.1 ± 2.3 years), 51.4% were 5Ts-negative and 48.6% were 5Ts-positive. Among the 5Ts-positive individuals, 25.3%/64.0% were 'bothered a little' whereas 4.5%/10.7% were 'bothered a lot' by TMD pain/headache. Correspondingly, 32.6%/12.4%/5.1% were 'bothered a little' while 2.8%/2.8%/1.1% were 'bothered a lot' by TMJ sounds/closed/open locking. TS burden was moderate-to-strongly correlated to aggregate symptom duration, frequency, intensity, interference, GS and SS burden (rs = .50-.88). While TS burden and GS were weakly associated with psychological distress (rs = .18-.36), SS burden was moderately related to depression, anxiety and stress (rs = .47-.53). CONCLUSIONS TS burden can serve as a proxy for global TMD severity and may be more meaningful than the mere presence of TMD symptoms in clinical and research settings.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore
- National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, National Dental Research Institute Singapore, Singapore, Singapore
| | - Sharon Hui Xuan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Vallin S, Liv P, Häggman-Henrikson B, Visscher CM, Lobbezoo F, Lövgren A. Temporomandibular disorder pain is associated with increased sick leave and reduced health related quality of life. Eur J Pain 2024. [PMID: 39072933 DOI: 10.1002/ejp.2314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/15/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Temporomandibular disorders (TMD) are the most common reason for chronic pain in the orofacial area and significantly impact the lives of those affected. The role of lifestyle factors in TMD, however, remains less explored. This cohort study aims to estimate TMD prevalence by addressing potential selection biases and to evaluate the association between TMD and lifestyle factors with a specific focus on sick leave and health related quality of life. METHODS By linking data on TMD in the general population in Västerbotten, northern Sweden (n = 180,000) to health survey data (n = 120,000), information on sociodemographic factors and quality of life was available for 52,961 individuals (50.6% women) with a mean age of 53 years. We applied inverse probability weighting to adjust for selection bias and Poisson regression to explore associations with TMD. RESULTS TMD prevalence was 9.2% during the study period, being higher in women (12.9%) than men (5.4%). Weighting for varying visiting frequencies did not affect TMD prevalence (average difference 0.4% points). Individuals with TMD, especially women, reported more sick leave and use of pain medication, with a significant association between TMD and increased sick leave (prevalence ratio 1.89, 95% CI: 1.78-2.01) among both women and men. In addition, TMD was associated with a lower health related quality of life (p < 0.001). CONCLUSION The association of TMD with sick leave highlights the condition's profound impact on the lives of affected individuals. These findings underscore the influence of TMD on work life and the burden of TMD on the societal level. SIGNIFICANCE STATEMENT The findings provide insight into how TMD affect individuals, by incorporating lifestyle factors, social determinants and the impact of sick leave at a population level. By incorporating these areas into the study of TMD, we can deepen our understanding of how TMD affects individuals' lives. This approach may also create opportunities to develop more comprehensive strategies to address TMD, focusing on broader implications beyond the clinical symptoms.
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Affiliation(s)
- S Vallin
- Department of Odontology, Orofacial Pain and Jaw Function, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - P Liv
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - B Häggman-Henrikson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - C M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A Lövgren
- Department of Odontology, Orofacial Pain and Jaw Function, Faculty of Medicine, Umeå University, Umeå, Sweden
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Li JH, Zhao SJ, Guo Y, Chen F, Traub RJ, Wei F, Cao DY. Chronic stress induces wide-spread hyperalgesia: The involvement of spinal CCK 1 receptors. Neuropharmacology 2024; 258:110067. [PMID: 38992792 DOI: 10.1016/j.neuropharm.2024.110067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/15/2024] [Accepted: 07/06/2024] [Indexed: 07/13/2024]
Abstract
Chronic primary pain (CPP) occurs in the absence of tissue injury and includes temporomandibular disorders (TMD), fibromyalgia syndrome (FMS) and irritable bowel syndrome (IBS). CPP is commonly considered a stress-related chronic pain and often presents as wide-spread pain or comorbid pain conditions in different regions of the body. However, whether prolonged stress can directly result in the development of CPP comorbidity remains unclear. In the present study, we adapted a 21 day heterotypic stress paradigm in mice and examined whether chronic stress induced wide-spread hyperalgesia, modeling comorbid CPP in the clinic. We found that chronic stress induced anxiety- and depression-like behaviors, and resulted in long-lasting wide-spread hyperalgesia over several body regions such as the orofacial area, hindpaw, thigh, upper back and abdomen in female mice. We further found that the expression of cholecystokinin (CCK)1 receptors was significantly increased in the L4-L5 spinal dorsal horn of the female mice after 14 and 21 day heterotypic stress compared with the control animals. Intrathecal injection of the CCK1 receptor antagonist CR-1505 blocked pain hypersensitivity in the subcervical body including the upper back, thigh, hindpaw and abdomen. These findings suggest that the upregulation of spinal CCK1 receptors after chronic stress contributes to the central mechanisms underlying the development of wide-spread hyperalgesia, and may provide a potential and novel central target for clinical treatment of CPP.
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Affiliation(s)
- Jia-Heng Li
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Xi'an Jiaotong University College of Stomatology, 98 West 5th Road, Xi'an, Shaanxi, 710004, China
| | - Shi-Jie Zhao
- Department of Neurology, The Second School of Clinical Medicine, Shaanxi University of Chinese Medicine, 5 Weiyang West Road, Xianyang, Shaanxi, 712046, China
| | - Yi Guo
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Xi'an Jiaotong University College of Stomatology, 98 West 5th Road, Xi'an, Shaanxi, 710004, China
| | - Fei Chen
- Department of Neurology, The Second School of Clinical Medicine, Shaanxi University of Chinese Medicine, 5 Weiyang West Road, Xianyang, Shaanxi, 712046, China
| | - Richard J Traub
- Department of Neural and Pain Sciences, School of Dentistry, The UM Center to Advance Chronic Pain Research, University of Maryland Baltimore, 650 West Baltimore Street, Baltimore, MD, 21201, USA
| | - Feng Wei
- Department of Neural and Pain Sciences, School of Dentistry, The UM Center to Advance Chronic Pain Research, University of Maryland Baltimore, 650 West Baltimore Street, Baltimore, MD, 21201, USA.
| | - Dong-Yuan Cao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Xi'an Jiaotong University College of Stomatology, 98 West 5th Road, Xi'an, Shaanxi, 710004, China; Department of Neural and Pain Sciences, School of Dentistry, The UM Center to Advance Chronic Pain Research, University of Maryland Baltimore, 650 West Baltimore Street, Baltimore, MD, 21201, USA.
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Yakkaphan P, Lambru G, Renton T. Impact of migraine and fibromyalgia on temporomandibular disorder: A retrospective study on pain, psychological factors and quality of life. J Oral Rehabil 2024. [PMID: 38965737 DOI: 10.1111/joor.13789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 05/18/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES This study assessed the impact of migraine and fibromyalgia (FM) in TMD patients, focusing on pain, anxiety, depression, and quality of life (QoL). Additionally, we investigated how these variables relate to the total number of comorbidities to gain insights into their interactions. METHODS A retrospective data collection was conducted during January 2016 to December 2022, involving 409 adult TMD patients. TMD patients were categorised into four groups: those without comorbidity (TMD-only) and those with comorbid migraine and/or fibromyalgia (TMD + MG, TMD + FM and TMD + MG + FM). Quantitative variables were compared among them. Linear regression was used to analyse the associations between these variables. RESULTS Most of study population were women (79%) with a mean age of 44.43 years. TMD + MG patients reported longer pain duration, higher pain scores and greater pain interference compared with TMD-only patients. Similarly, TMD + FM patients had higher pain intensity than patients with TMD only. Both the TMD + MG and TMD + FM groups had higher levels of anxiety, depression, and health impairment compared with patients with TMD only. Patients with all three pain conditions (TMD + MG + FM) experienced the longest pain duration, highest pain intensity, psychological distress, and impaired QoL. The result showed positive associations between pain outcomes, psychological measures, pain's impact on QoL, and the number of comorbidities and a negative association between overall health states and the number of comorbidities. CONCLUSIONS These findings underscore the importance of considering the presence of comorbidities and addressing physical and psychological aspects in the management of TMD patients.
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Affiliation(s)
- Pankaew Yakkaphan
- Faculty of Dentistry, Oral & Craniofacial Science, King's College London, London, UK
- Faculty of Dentistry, Prince of Songkla University, Songkhla, Thailand
| | - Giorgio Lambru
- The Headache and Facial Pain Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tara Renton
- Faculty of Dentistry, Oral & Craniofacial Science, King's College London, London, UK
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Zheng Y, Chen Y, Li Y, Zheng S, Yang S. Diaphragm dysfunction is found in patients with chronic painful temporomandibular disorder: A case-control study. Heliyon 2024; 10:e32872. [PMID: 39022095 PMCID: PMC11253231 DOI: 10.1016/j.heliyon.2024.e32872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
Aim To determine whether patients with chronic painful temporomandibular disorder (TMD) had abnormal diaphragm function compared to healthy controls and to explore the correlation between diaphragm contractility, psychological status, and pain characteristics. Methods A single-blinded, case-control study was conducted involving 23 chronic painful TMD patients and 22 healthy volunteers. The examination and diagnosis were performed according to the Diagnostic Criteria for Temporomandibular Disorders, and questionnaires were used to evaluate pain, depression, anxiety, and physical symptoms status. B-mode ultrasound was used to measure diaphragm thickness and contractility. The sonographer responsible for measuring the diaphragm was blinded to group membership. Results 1. Depression, anxiety, and physical symptoms scores were significantly higher in the patients than in the controls (p < 0.05). 2. The Interference Score of pain was significantly correlated with depression and physical symptoms (p < 0.01). 3. Bilateral diaphragm contractility was significantly smaller in the patients than in the controls (right: P = 0.003; left: P = 0.001). 3. There was no correlation between diaphragm contractility on the left and right sides in the patients (r = -0.112, P = 0.611), while there was a positive correlation in the control group (r = 0.638, P = 0.001). 4. No correlation was found between the degree of diaphragm contractility, psychological status, and pain scores. Conclusions 1. Patients with chronic painful TMD have worse psychological status, including depression, anxiety, and physical symptoms. 2. Patients with chronic painful TMD have a smaller degree of bilateral diaphragm contractility and more significant left-right incongruity, which indicated that diaphragm dysfunction may be correlated with chronic painful temporomandibular disorder.
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Affiliation(s)
- Yaqing Zheng
- Department of Stomatology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
- Department of Stomatology, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, 361015, China
| | - Yonghui Chen
- Department of Stomatology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Yifeng Li
- Department of Stomatology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Sijing Zheng
- Department of Stomatology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Shuping Yang
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
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Voß LC, Basedau H, Svensson P, May A. Bruxism, temporomandibular disorders, and headache-a narrative review of correlations and causalities. Pain 2024:00006396-990000000-00628. [PMID: 38888745 DOI: 10.1097/j.pain.0000000000003277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/01/2024] [Indexed: 06/20/2024]
Abstract
ABSTRACT The co-occurrence of bruxism, temporomandibular disorders (TMDs), and headache is common in patients. However, there is conflicting evidence regarding whether this association is simply a result of their high prevalence or whether there are indeed causal relationships. This review provides an overview of the current state of research while taking into account the controversies surrounding research methods, particularly in definitions and diagnostic standards. Bruxism-defined as repetitive jaw muscle activity during sleep or wakefulness-is not a painful disorder but may-particularly in co-occurrence with TMD-worsen pre-existing headache. It seems important to differentiate between sleep and awake bruxism because of different impact on pathophysiological processes in different primary headache disorders such as migraine and tension-type headache. Temporomandibular disorder is a heterogenous entity with both myofascial and arthrogenous types of pain in addition to nonpainful disorders. Research suggests a correlation between TMD pain and migraine, as well as between awake bruxism and tension-type headache. However, psychosocial factors may act as confounders in these relationships. Determining causality is challenging because of the limited number of experimental and clinical studies conducted on this topic. The main finding is an apparent lack of consensus on the definition and assessment criteria for bruxism. Treatment wise, it is important to differentiate all 3 conditions because treatment of one condition may have an effect on the other 2 without proving causality. For future research, it is crucial to establish greater consistency and applicability in diagnostic procedures and definitions. In addition, more experimental and clinical studies investigating the question of causality are needed.
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Affiliation(s)
- Leonie Caroline Voß
- Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hauke Basedau
- Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Arne May
- Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Bof de Andrade F, Teixeira DSDC, Moreira RDS, de Oliveira C. Prevalence and associations of temporomandibular disorders in older Brazilian adults. Gerodontology 2024; 41:263-268. [PMID: 37386718 DOI: 10.1111/ger.12701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The objective of the study was to estimate the prevalence of temporomandibular disorders (TMD) and describe associations in a representative sample of community-dwelling older Brazilian adults. BACKGROUND TMD cause recurrent or chronic pain and dysfunction with substantial impacts on quality of life, but little is known of their occurrence and associated factors among older adults. MATERIALS AND METHODS This was a cross-sectional study using data from the second wave of the Brazilian Longitudinal Study of Aging, a nationally representative sample of older Brazilian adults aged 50 or older. The presence of temporomandibular disorder symptoms was measured by the Fonseca Anamnestic Index. Independent variables included sociodemographic characteristics, general health conditions and self-reported oral health measures. The association between the independent variables and TMD symptoms was evaluated using logistic regression models. RESULTS Complete information for the variables of interest was available for 9391 individuals. The overall prevalence of TMD symptoms was 18.0% (95% CI 14.4-22.1). Relative to older adults aged 50-59 those in all age categories had lower odds of TMD symptoms. Individuals with depression, pain, sleep problems and self-reported poor general health had higher odds of reporting TMD symptoms. None of the oral health measures were related to TMD. CONCLUSION The prevalence of TMD symptoms among Brazilian older adults is associated with demographic and general health conditions, but not with dentition status.
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Affiliation(s)
| | | | - Rafael da Silveira Moreira
- Instituto Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, Brazil
- Center for Medical Science, Federal University of Pernambuco, Recife, Brazil
| | - Cesar de Oliveira
- Epidemiology and Public Health Department, University College London, London, UK
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Ujin Yap A, Kurniawan F, Pragustine Y, Marpaung C. Temporomandibular disorder and somatic symptoms: Relations to 'fear of missing out' and other negative emotional states. Acta Odontol Scand 2024; 83:340-347. [PMID: 38804261 PMCID: PMC11302401 DOI: 10.2340/aos.v83.40776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE The association between the 'fear of missing out (FOMO)' and physical symptoms has not been widely explored. This study aimed to investigate the relationship between FOMO and other negative emotions with Temporomandibular disorder (TMD) and somatic symptoms in young adults. The correlations between the various physical and emotional variables were also established. MATERIAL AND METHODS TMD and somatic symptoms were appraised with the Short-form Fonseca Anamnestic Index, quintessential five TMD symptoms of the Diagnostic Criteria (DC)/TMD, and Patient Health Questionnaire-15. FOMO and other negative emotional states were assessed with the FOMO Scale and Depression, Anxiety, Stress Scales-21 (DASS-21). Data were evaluated using non-parametric tests/correlation and regression analysis (α = 0.05). RESULTS While only negative affectivity (total DASS), anxiety, and stress differed significantly between those without and with TMDs, significant variances in FOMO and all DASS-21 constructs were discerned between individuals without and with somatization. Conclusions: Individuals with orofacial pain and more severe somatic symptoms have higher levels of negative emotions including FOMO. While somatization increased the prospect of TMDs, being female, presence of TMDs, and negative affectivity were risk factors for somatization in young adults. CLINICAL RELEVANCE Asian young adults appear to be disposed to somatization, and TMDs may be a form of functional somatic syndromes. Recognition of somatic symptoms and emotional distress, including FOMO, is essential for person-centric TMD care.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore; National Dental Research Institute Singapore, National Dental Center Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore, Singapore; Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Florencia Kurniawan
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Yenny Pragustine
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Carolina Marpaung
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia.
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Yap AU, Dewi NL, Marpaung C. Comorbidities between temporomandibular disorders and somatization in young adults: exploring links with personality, emotional, and sleep disturbances. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:493-500. [PMID: 38480071 DOI: 10.1016/j.oooo.2024.01.017] [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: 09/18/2023] [Revised: 12/07/2023] [Accepted: 01/28/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The comorbidities between temporomandibular disorders (TMDs) and somatization and their associations with personality traits, emotional disorders, and sleep disturbances were investigated. STUDY DESIGN Adults aged 18 to 24 years completed an electronic survey encompassing TMD symptoms (5Ts), Patient Health Questionnaire-15, Big Five Personality Inventory-10, Depression Anxiety Stress Scales-21, and Pittsburgh Sleep Quality Index. Data were assessed using non-parametric tests/correlation analysis and logistic regression analysis (α = 0.05). RESULTS The sample comprised 365 participants, of whom 22.2% and 19.5% were 5Ts-negative without and with somatization, respectively, and 18.1% and 40.3% were 5Ts-positive without and with somatization, respectively. Significant differences in neuroticism, distress, depression, anxiety, stress, and sleep quality were observed between 5Ts-negative participants with somatization and 5Ts-positive participants with somatization compared with 5Ts-negative participants without somatization and 5Ts-positive participants without somatization. Distress, anxiety, stress, and sleep were moderately correlated with somatic but not TMD symptoms (rs = 0.45-0.52). CONCLUSIONS Irrespective of whether they had TMDs, participants with somatization exhibited heightened levels of neuroticism and emotional and sleep disturbances.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia; Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore; National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, SingHealth, Singapore
| | - Ni Luh Dewi
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Carolina Marpaung
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia.
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12
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Chamani G, Zarei MR, Rad M, Mafi S. Comparison of low-level laser therapy and standard treatment for temporomandibular disorders: An assessment of therapeutic and placebo effects. J Oral Rehabil 2024; 51:657-665. [PMID: 38012102 DOI: 10.1111/joor.13634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Despite extensive research on the use of low-power lasers for TMD treatment, the extent of their effectiveness remains uncertain. OBJECTIVE This study aimed to investigate the therapeutic or placebo effect of LLLT for TMD, and to compare it with standard treatment methods. A unique aspect of this study was the inclusion of a control group that received only standard treatment, allowing for an assessment of the placebo effect of LLLT. METHODS A total of 42 patients with TMD were referred to Kerman Dental School Pain Clinic and were randomly assigned to three groups: group A received LLLT, group B was a placebo group and group C was a control group that received only standard treatment. The laser groups received gallium-aluminium-arsenide laser treatment twice a week for 10 sessions. Patients' jaw movement rate indicators and VAS index were evaluated at the start of treatment, and indicators were re-recorded every week for 5 weeks. SPSS 21 was used for statistical analysis, including ANOVA and Tukey's post hoc tests for inter-group comparisons. The repeated measurement test was used to analyse the data. RESULTS All groups showed significant improvement in VAS indicators (p = .0001), lateral jaw movements (p = .0001), forward jaw movement (p = .007) but not for maximum mouth opening. No significant difference was observed between the groups at the end of the study (p = .000). CONCLUSION Our study provides insights into LLLT's effectiveness for TMD, suggesting it cannot replace standard treatment alone. These findings contribute to the literature and emphasise the importance of including a control group in future studies to assess the placebo effect of LLLT.
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Affiliation(s)
- Goli Chamani
- FAAOP Diplomat, American Board of Orofacial Pain Professor of Oral Medicine and Orofacial Pain Division of Oral Diagnostics and Rehabilitation Department of Dental Medicine, Karolinska Institute Scandinavian Center for Orofacial Neuroscience (SCON) Huddinge, Huddinge, Sweden
| | - Mohammad Reza Zarei
- Oral Medicine Department, Orofacial Pain Clinic, Kerman School of Dentistry, Kerman, Iran
| | - Maryam Rad
- Oral Medicine specialist, PhD by research in Epidemiology, Kerman, Iran
| | - Sahar Mafi
- Department of Oral Medicine, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University of Tehran, Tehran, Iran
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13
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Gadd M, Attard A, Green J, Elledge ROC. Comorbid psychiatric conditions with temporomandibular disorders (TMD) in a tertiary referral clinic. Br J Oral Maxillofac Surg 2024; 62:318-323. [PMID: 38355385 DOI: 10.1016/j.bjoms.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 02/16/2024]
Abstract
Patients with chronic pain have a higher prevalence of mood disorders with depression and anxiety contributing to higher pain intensity, emotional allodynia, and neuro-anatomical changes. We sought to quantify the prevalence of psychiatric comorbidities (PCs) in a tertiary referral clinic for temporomandibular disorders (TMDs). Medical records of all patients attending clinics run by three tertiary temporomandibular joint (TMJ) surgeons for the period January to April 2022 inclusive were audited for the prevalence of concomitant psychiatric conditions. A total of 166 patients were identified with a female to male ratio of 5:1 and mean (SD) age of 45.1 (15.2) years. A total of 124 (89.9%) patients were tertiary referrals and 72 (43.4%) patients had concomitant psychiatric diagnoses, with 58 (34.9%) being on some form of psychotropic medication (PM) (patients on anticonvulsants for neuropathic pain were not included). A majority of 136 (81.9%) patients had some form of intervention (including Dysport® and minimally invasive surgery) which appeared more common in patients with co-existing psychiatric issues (p < 0.05). A higher proportion of mental health issues exist among TMD patients in a tertiary referral clinic than would be expected in the general population. We suggest a holistic approach to patients with multidisciplinary care taking into account this prevalence to ensure decision-making that contextualises the patient and not simply the pathology.
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Affiliation(s)
- Madeleine Gadd
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Alan Attard
- Consultant Oral and Maxillofacial Surgeon, University Hospitals Birmingham NHS Foundation Trust, UK.
| | - Jason Green
- Consultant Oral and Maxillofacial Surgeon, University Hospitals Birmingham NHS Foundation Trust, UK.
| | - Ross O C Elledge
- Consultant Oral and Maxillofacial Surgeon, University Hospitals Birmingham NHS Foundation Trust, UK; Consultant Oral and Maxillofacial Surgeon / Honorary Senior Clinical Lecturer, University Hospitals Birmingham NHS Foundation Trust, UK.
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14
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Yakkaphan P, Elias LA, Ravindranath PT, Renton T. Is painful temporomandibular disorder a real headache for many patients? Br Dent J 2024; 236:475-482. [PMID: 38519684 PMCID: PMC10959744 DOI: 10.1038/s41415-024-7178-1] [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: 03/07/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 03/25/2024]
Abstract
Temporomandibular disorders (TMDs) and primary headaches are common pain conditions and often co-exist. TMD classification includes the term 'headache secondary to TMD' but this term does not acknowledge the likelihood that primary headache pathophysiology underpins headache causing painful TMD signs and symptoms in many patients. The two disorders have a complex link and we do not fully understand their interrelationship. However, growing evidence shows a significant association between the two disorders. This article reviews the possible connection between temporomandibular disorders and primary headaches, specifically migraine, both anatomically and pathogenetically.
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Affiliation(s)
- Pankaew Yakkaphan
- Faculty of Dentistry, Oral and Craniofacial Science, King´s College London, London, UK; Faculty of Dentistry, Prince of Songkla University, Songkhla, Thailand.
| | - Leigh-Ann Elias
- Orofacial Pain Service, Department of Oral Surgery, King´s College Hospital NHS Foundation Trust, London, UK
| | - Priya Thimma Ravindranath
- Faculty of Dentistry, Oral and Craniofacial Science, King´s College London, London, UK; Orofacial Pain Service, Department of Oral Surgery, King´s College Hospital NHS Foundation Trust, London, UK
| | - Tara Renton
- Faculty of Dentistry, Oral and Craniofacial Science, King´s College London, London, UK; Orofacial Pain Service, Department of Oral Surgery, King´s College Hospital NHS Foundation Trust, London, UK
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15
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Yap AU, Wee KK, Loh JY, Marpaung C, Natu VP. Temporomandibular disorder pain in older adolescents-young adults: Interrelationship with somatic burden, mental ill-being, and well-being. Cranio 2024:1-11. [PMID: 38415618 DOI: 10.1080/08869634.2024.2322595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES The associations of Temporomandibular disorder (TMD) pain with somatic symptoms, mental ill-being/distress, and well-being were explored, along with the mental correlates of TMD (TS) and somatic symptom (SS) burden in older adolescents-young adults. METHODS TMD/somatic symptoms were appraised with the five quintessential symptoms (5Ts) of the DC/TMD/Somatic Symptom Scale-8, whereas mental distress/well-being was assessed with the Depression, Anxiety, Stress Scales-21/Scales of Psychological Well-being-18. Data were examined using Chi-square/non-parametric tests and multivariate analyses (α = .05). RESULTS Among the 366 participants, 51.4%, 28.1%, 6.8%, and 13.7% had no TMD (NT), TMD pain (TP), TMD dysfunction (TD), and combined TMD (CT) respectively. Though mental distress varied substantially (CT, TP>NT, TD), no significant differences in well-being were discerned. SS burden, but not TS burden, was moderately correlated to distress. CONCLUSIONS The prospect of TMD pain was increased by being female, depressed, and anxious but reduced by "positive relations with others" and "self-acceptance".
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore
- National Dental Research Institute Singapore, National Dental Center Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore
| | - Kai Kee Wee
- School of Health and Social Sciences, Nanyang Polytechnic, Singapore
| | - Jia Yu Loh
- School of Health and Social Sciences, Nanyang Polytechnic, Singapore
| | - Carolina Marpaung
- Department of Prosthodontics, Faculty of Dentistry, Trisakti University, Jakarta, Indonesia
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16
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Justribó-Manion C, Mesa-Jiménez J, Bara-Casaus J, Zuil-Escobar JC, Wachowska K, Álvarez-Bustins G. Additional effects of therapeutic exercise and education on manual therapy for chronic temporomandibular disorders treatment: a randomized clinical trial. Physiother Theory Pract 2024:1-16. [PMID: 38353484 DOI: 10.1080/09593985.2024.2316305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/25/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Previous studies have evaluated the implementation of behavioral approaches in individuals with chronic temporomandibular disorders (TMDs). OBJECTIVE To evaluate the benefits of a behavioral approach to craniofacial pain. Second, we assessed the benefits of kinesiophobia, catastrophizing, mouth opening without pain, and forward head posture. METHODS Individuals with chronic TMDs were treated for five weeks. The intervention group (n = 17) underwent pain neuroscience education, manual therapy, and therapeutic exercise, whereas the control group (n = 17) underwent manual therapy only. Outcomes were evaluated immediately, at seven and 19 weeks follow-up. The assessment tools used were the Craniofacial Pain Disability Inventory, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Mandibular Range of Motion Scale, and Cervical Range of Motion Tool. RESULTS The interventions did not influence the differences in the improvements between the groups observed for craniofacial pain disability (inter-subject p 0.4). The intervention had a moderate influence on the improvement of kinesiophobia and catastrophizing (Inter-subject p 0.09 and 0.1 respectively) with a clinically significant effect size (Estimated mean (EM) -8.6 standard deviation (SD) ±3.48 p 0.019; and EM -7.6 SD ± 5.11 p 0.15 respectively). CONCLUSION The behavioral approach improved catastrophizing and kinesiophobia outcomes in individuals with chronic TMDs.
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Affiliation(s)
- Cristian Justribó-Manion
- Escuela Internacional de Doctorado (CEINDO), Universitat Abat Oliva CEU, CEU Universities, Barcelona, Spain
- Spain National Centre, Foundation COME Collaboration, Barcelona, Spain
- Craniofacial Disorder Academy, Barcelona, Spain
| | - Juan Mesa-Jiménez
- Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, Spain
- Integrative Craniofacial Therapy (Incraft Lab), Madrid, Spain
| | - Javier Bara-Casaus
- Group Quiron Salud, Sagrado Corazón University Hospital, Barcelona, Spain
| | - Juan-Carlos Zuil-Escobar
- Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, Spain
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17
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Justribó-Manion C, Mesa-Jiménez J, Caballero-Ruiz-de-la-Hermosa C, Zuil Escobar JC, Armijo-Olivo S. Is low back pain a risk/prognostic factor for the development and/or progression of temporomandibular disorders? A systematic review with meta-analysis. J Oral Rehabil 2024; 51:427-454. [PMID: 37743593 DOI: 10.1111/joor.13601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 06/01/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES To evaluate the association between low back pain (LBP) and painful temporomandibular disorders (TMDs). METHODS Systematic review of observational studies. Searches were conducted using OVID MEDLINE, CINHAL, Web of Science and PUBMED databases up to 21 October 2022. Qualitative and quantitative analyses were performed. Risk of bias (RoB) was assessed using the Quality in Prognosis Studies tool (QUIPS). RESULTS Eight studies were included in the present review with meta-analysis. The first onset of TMDs was more likely in patients with previous chronic LBP (hazard ratio (HR) 1.53 [95% confidence interval (CI): 1.28; 1.83, p < .00001]). In addition, patients with chronic LBP had 3.25 times the odds (OR) [95% CI: 1.94; 5.43, p < .00001] of having chronic TMDs than those who did not have chronic LBP. In addition, the higher the exposure to chronic LBP, the higher the risk of developing a first onset of TMDs. CONCLUSIONS Chronic LBP can be considered a risk/contributing factor for painful TMDs. Although there is a high certainty in the evidence linking chronic LBP with the risk of a first onset of TMDs, there are insufficient studies to draw definitive conclusions. Furthermore, while an association between chronic LBP and chronic TMDs and a dose-effect was observed between these two conditions, a limited number of studies and evidence exist to support these findings. Future studies are needed to increase the body of evidence.
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Affiliation(s)
- C Justribó-Manion
- Universidad Abat Oliba - CEU, CEU Universities, Barcelona, Spain
- Spain National Centre, Foundation COME Collaboration, Barcelona, Spain
| | - J Mesa-Jiménez
- Universidad San Pablo - CEU, CEU Universities, Madrid, Spain
| | | | | | - S Armijo-Olivo
- Faculty of Economics and Social Sciences, University of Applied Sciences Osnabrück, Osnabrück, Germany
- Faculties of Rehabilitation Medicine and Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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18
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Yap AU, Kim S, Lee BM, Jo JH, Park JW. Correlates of jaw functional limitation, somatization and psychological distress among different temporomandibular disorder diagnostic subtypes. J Oral Rehabil 2024; 51:287-295. [PMID: 37849410 DOI: 10.1111/joor.13606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/11/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES This study investigated the jaw functional status and severity of somatic/psychological symptoms in different Diagnostic Criteria for temporomandibular disorders (DC/TMD) diagnostic subtypes and established the correlates between jaw functional limitation, somatization, depression and anxiety. METHODS Data were accrued from consecutive 'first-visit' patients seeking TMD treatment at a university-based oral medicine/diagnosis clinic. Axis I physical TMD diagnoses were derived using the DC/TMD methodology and patients were categorized into pain-related (PT), intra-articular (IT) and combined (CT) TMD groups. Axis II measures were also administered and included the Jaw Functional Limitation Scale-20 (JFLS-20), Patient Health Questionnaire-15 and 9 (PHQ-15 and PHQ-9) and General Anxiety Disorder Scale-7 (GAD-7). Chi-square/Kruskal-Wallis tests and Spearman's correlation were employed for statistical evaluations (α = .05). RESULTS The final dataset consisted of 772 TMD patients (mean age of 37.7 ± 15.9 years; 70.2% females). The prevalence of PT, IT and CT was 11.9%, 15.7% and 72.4%, respectively. Significant differences in functional jaw limitations, somatization, depression (CT, PT > IT) and anxiety (CT > PT, IT) were observed. Moderate-to-severe somatization, depression and anxiety were detected in 12.6%-15.7% of patients. For all three TMD groups, JFLS global scale/subscale scores were weakly associated with somatization, depression and anxiety scores (rs < 0.4). Moderate-to-strong correlations were noted between somatization, depression and anxiety (rs = 0.50-0.74). CONCLUSIONS Functional jaw limitations were associated with painful TMDs but appear to be unrelated to somatization and psychological distress. Somatization and depression/anxiety were moderately correlated, underscoring the importance of somatic symptom screening when managing TMD patients.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore, Singapore
| | - Sunghae Kim
- Dental Research Institute, Seoul National University, Seoul, Korea
- Center for Future Dentistry, Seoul National University School of Dentistry, Seoul, Korea
| | - Byeong-Min Lee
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea
| | - Jung Hwan Jo
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea
- Department of Oral Medicine & Oral Diagnosis, Seoul National University School of Dentistry, Seoul, Korea
| | - Ji Woon Park
- Dental Research Institute, Seoul National University, Seoul, Korea
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea
- Department of Oral Medicine & Oral Diagnosis, Seoul National University School of Dentistry, Seoul, Korea
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19
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Yap AU, Dewi NL, Marpaung C. Psychological characteristics of young adults with temporomandibular disorders, somatization and combined conditions: A multidimensional evaluation. J Oral Rehabil 2023; 50:1382-1392. [PMID: 37605293 DOI: 10.1111/joor.13570] [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: 05/09/2023] [Revised: 07/01/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Temporomandibular disorders and somatization have shown interrelation in many studies. The physical and psychological factors which contributed to the occurrence and relation of both conditions are yet to be determined. OBJECTIVES The personality traits, coping styles and psychological distress of young adults with temporomandibular disorder (TMD) and somatic symptoms were characterized together with the determination of psychological risk factors for TMDs, somatization and combined conditions. METHODS Participants were recruited from university-attending young adults. TMD and somatic symptoms were appraised with the short-form Fonseca Anamnestic Index and Patient Health Questionnaire-15. Psychological variables were assessed with the Big Five Personality Inventory-10, Brief-COPE Inventory and Depression, Anxiety, and Stress Scales-21. Data were evaluated using chi-squared/non-parametric tests and logistic regression analyses (α = .05). RESULTS Among the 507 participants (mean age 22.2 ± 1.5 years), 46.4% reported no TMD/somatic symptoms (NS) while 7.5%, 34.5% and 11.6% had TMDs only (TS), somatization only (SS) and combined TMDs-somatization (CS), respectively. Significant differences in conscientiousness (NS > SS), agreeableness (NS, TS > CS; NS > SS), dysfunctional coping, general distress, depression, anxiety and stress (CS ≥ SS > NS) were discerned. Multivariate analyses indicated that the odds of TS were increased by anxiety (OR = 1.10; 95% CI = 1.01-1.21), while the odds of SS/CS were affected by anxiety (OR = 1.15; 95% CI = 1.06-1.25/OR = 1.34; 95% CI = 0.19-1.52) and problem-focused coping (OR = 0.71; 95% CI = 0.56-0.89/OR = 0.55; 95% CI = 0.39-0.78). CONCLUSION Though individuals with TMDs and somatization have dissimilar psychological profiles, anxiety constantly increased their likelihood. Problem-focused coping strategies may help alleviate psychosocial and physical stressors associated with TMDs and somatization.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore, Singapore
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Ni Luh Dewi
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
| | - Carolina Marpaung
- Department of Prosthodontics, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia
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20
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Holmström AK, Vallin S, Wänman A, Lövgren A, Stålnacke BM. Effect on orofacial pain in patients with chronic pain participating in a multimodal rehabilitation programme - a pilot study. Scand J Pain 2023; 23:656-661. [PMID: 37327054 DOI: 10.1515/sjpain-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Orofacial pain in patients taking part in a multimodal rehabilitation programme (MMRP) due to chronic bodily pain is common but it is not known whether such a rehabilitation programme can also have an effect on the presence of orofacial pain. The first aim of this study was to evaluate the effect of an MMRP on orofacial pain frequency. The second aim was to evaluate differences in the effect on quality of life and on psychosocial factors related to chronic pain. METHODS MMRP was evaluated through validated questionnaires from the Swedish Quality Registry for Pain Rehabilitation (SQRP). Fifty-nine patients participating in MMRP filled out the two screening questions for orofacial pain in addition to the SQRP questionnaires before and after participation in MMRP during the period August 2016 to March 2018. RESULTS Pain intensity decreased significantly after the MMRP (p=0.005). Fifty patients (69.4 %) reported orofacial pain before MMRP and no significant decrease after the programme (p=0.228). Among individuals with orofacial pain, the self-reported level of depression decreased after participation in the programme (p=0.004). CONCLUSIONS Even though orofacial pain is common among patients with chronic bodily pain, participation in a multimodal pain programme was not enough to reduce frequent orofacial pain. This finding implies that specific orofacial pain management including information about jaw physiology could be a justified component of patient assessment prior to a multimodal rehabilitation programme for chronic bodily pain.
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Affiliation(s)
- Anna-Karin Holmström
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, UmeåSweden
| | - Simon Vallin
- Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden
| | - Anders Wänman
- Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden
| | - Anna Lövgren
- Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, UmeåSweden
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21
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Yap AU, Lee DZR. Painful temporomandibular disorders in Confucian-heritage cultures: Their inter-relationship with bodily pain, psychological well-being and distress. J Oral Rehabil 2023; 50:948-957. [PMID: 37246585 DOI: 10.1111/joor.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/10/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Temporomandibular disorders (TMDs) are common and affect individuals negatively. OBJECTIVES This study investigated the inter-relationship of painful TMDs with bodily pain, psychological well-being and distress in young people from a Confucian-heritage culture (CHC). METHODS Adolescents/young adults were recruited from a polytechnic in Singapore. While the presence/severity of painful TMDs and bodily pain were established with the DC/TMD Pain Screener (TPS) and Maciel's Pain Inventory, psychological well-being and distress were evaluated with the Scales of Psychological Well-being-18 (SPWB-18) and Patient Health Questionnaire-4 (PHQ-4). Statistical explorations were conducted using chi-square/Mann-Whitney U tests, Spearman's correlation and logistic regression analyses (α = .05). RESULTS Among the 225 participants (mean age 20.1 ± 3.9 years) examined, 11.6% had painful TMDs and 68.9% experienced multisite bodily pain. Though painful TMDs were accompanied by a higher occurrence of multisite bodily pain, the overall/discrete number of bodily pain sites did not differ substantially between the 'no TMD pain' (NT) and 'with TMD pain' (WT) groups. Besides ear pain, differences in overall/discrete bodily pain scores were also insignificant. However, significant differences in environmental mastery, overall psychological distress, depression and anxiety subscale scores were discerned between the NT and WT groups. Psychological well-being and distress were moderately and negatively correlated (rs = -.56). Multivariate analysis indicated that ear pain and psychological distress increased the prospect of painful TMDs. CONCLUSION The prevalence of multi-site bodily pain was high in young people from CHCs irrespective of the painful TMDs' presence of painful TMDs. Enhancing environmental mastery and relieving depression/anxiety may help manage TMD pain.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore City, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore City, Singapore
| | - Darren Zong Ru Lee
- School of Health & Social Sciences, Nanyang Polytechnic, Singapore City, Singapore
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22
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Romero-Reyes M, Klasser G, Akerman S. An Update on Temporomandibular Disorders (TMDs) and Headache. Curr Neurol Neurosci Rep 2023; 23:561-570. [PMID: 37581857 DOI: 10.1007/s11910-023-01291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE OF REVIEW To provide an overview and highlight recent updates in temporomandibular disorders (TMDs) and their comorbidity with headache disorders regarding pathophysiology and management. RECENT FINDINGS In the last decade, there have been great advancements in the understanding of TMDs and their relationship with neurovascular pains such as headaches. Understanding of TMDs is necessary for the context of its comorbidity with primary headache disorders. The literature regarding management of these comorbidities is scarce but points to combination therapy including pharmacological and non-pharmacological approaches to optimize management. The use of CGRP receptor-targeted monoclonal antibodies or CGRP receptor antagonists should be explored for the management of chronic TMDs. It could also be used as a novel monotherapy or in combination with non-pharmacological approaches for TMDs' comorbidity with headache, particularly migraine. Research is needed to support evidence-based management protocols. A team involving neurology (headache medicine) and dentistry (orofacial pain) is critical for optimal management.
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Affiliation(s)
- Marcela Romero-Reyes
- Brotman Facial Pain Clinic, School of Dentistry, University of Maryland, Baltimore, MD, USA.
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th floor, Baltimore, MD, 21201, USA.
| | - Gary Klasser
- Department of Diagnostic Sciences, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans, LA, USA
| | - Simon Akerman
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th floor, Baltimore, MD, 21201, USA
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23
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Romero-Reyes M, Arman S, Teruel A, Kumar S, Hawkins J, Akerman S. Pharmacological Management of Orofacial Pain. Drugs 2023; 83:1269-1292. [PMID: 37632671 DOI: 10.1007/s40265-023-01927-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
Orofacial pain is a category of complex disorders, including musculoskeletal, neuropathic and neurovascular disorders, that greatly affect the quality of life of the patient. These disorders are within the fields of dentistry and medicine and management can be challenging, requiring a referral to an orofacial pain specialist, essential for adequate evaluation, diagnosis, and care. Management is specific to the diagnosis and a treatment plan is developed with diverse pharmacological and non-pharmacological modalities. The pharmacological management of orofacial pain encompasses a vast array of medication classes and approaches. This includes anti-inflammatory drugs, muscle relaxants, anticonvulsants, antidepressants, and anesthetics. In addition, as adjunct therapy, different injections can be integrated into the management plan depending on the diagnosis and needs. These include trigger point injections, temporomandibular joint (TMJ) injections, and neurotoxin injections with botulinum toxin and nerve blocks. Multidisciplinary management is key for optimal care. New and safer therapeutic targets exclusively for the management of orofacial pain disorders are needed to offer better care for this patient population.
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Affiliation(s)
- Marcela Romero-Reyes
- Brotman Facial Pain Clinic, School of Dentistry, University of Maryland, 650 W. Baltimore St, 1st Floor, Baltimore, MD, 21201, USA.
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th Floor, Baltimore, MD, 21201, USA.
| | - Sherwin Arman
- Orofacial Pain Program, Section of Oral Medicine, Oral Pathology and Orofacial Pain, University of California, Los Angeles, School of Dentistry, Los Angeles, CA, USA
| | | | - Satish Kumar
- Department of Periodontics, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, AZ, USA
| | - James Hawkins
- Naval Postgraduate Dental School, Naval Medical Leader and Professional Development Command, Uniformed Services University of the Health Sciences Postgraduate Dental College, Baltimore, MD, USA
| | - Simon Akerman
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th Floor, Baltimore, MD, 21201, USA
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Yap AU, Lei J, Fu KY, Kim SH, Lee BM, Park JW. DC/TMD Axis I diagnostic subtypes in TMD patients from Confucian heritage cultures: a stratified reporting framework. Clin Oral Investig 2023; 27:4459-4470. [PMID: 37243820 DOI: 10.1007/s00784-023-05067-2] [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: 09/25/2022] [Accepted: 05/07/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES This study proposed a conceptual framework for reporting Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I conditions and investigated the prevalence of TMD subtypes/categories in patients from Confucian heritage cultures. Variances in gender, age, and TMD chronicity between Chinese (CN) and Korean (KR) patients were also explored. MATERIALS AND METHODS Subjects were recruited from consecutive patients seeking care at two University-based centers in Beijing and Seoul. Eligible patients completed a demographic survey as well as the DC/TMD Symptom Questionnaire and were clinically examined according to the DC/TMD methodology. Axis I diagnoses were subsequently rendered with the DC/TMD algorithms and documented using the stratified reporting framework. Statistical evaluations were performed with chi-square, Mann-Whitney U tests, and logistic regression analysis (α = 0.05). RESULTS Data of 2008 TMD patients (mean age 34.8 ± 16.2 years) were appraised. Substantial differences in female-to-male ratio (CN > KR), age (KR > CN), and TMD duration (KR > CN) were observed. Ranked frequencies of the most common Axis I diagnoses were: CN - disc displacements (69.7%) > arthralgia (39.9%) > degenerative joint disease (36.7%); KR - disc displacements (81.0%) > myalgia (60.2%) > arthralgia (56.1%). Concerning TMD categories, notable differences in the prevalence of intra-articular (CN 55.1% > KR 15.4%) and combined (KR 71.8% > CN 33.4%) TMDs were discerned. CONCLUSIONS Though culturally similar, the two countries require disparate TMD care planning/prioritization. While TMJ disorders in children/adolescents and young adults should be emphasized in China, the focus in Korea would be on TMD pain in young and middle-aged adults. CLINICAL RELEVANCE Besides culture, other variables including socioeconomic, environmental, and psychosocial factors can influence the clinical presentation of TMDs. Chinese and Korean TMD patients exhibited significantly more intra-articular and combined TMDs respectively.
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Affiliation(s)
- Adrian Ujin Yap
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, Singapore, Singapore
| | - Jie Lei
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Kai Yan Fu
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Seong Hae Kim
- Department of Dental Biomaterials Science, Seoul National University School of Dentistry, Seoul, Korea
- Dental Research Institute, Seoul National University, Seoul, Korea
| | - Byeong-Min Lee
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea
| | - Ji Woon Park
- Dental Research Institute, Seoul National University, Seoul, Korea.
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea.
- Department of Oral Medicine & Oral Diagnosis, Seoul National University School of Dentistry, 101 Daehak-Ro, Jongno-Gu, Seoul, Korea.
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25
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Asquini G, Devecchi V, Edoardo Bianchi A, Borromeo G, Tessera P, Falla D. External validation of a clinical prediction tool for the use of manual therapy for patients with temporomandibular disorders: a protocol for a prospective observational study. BMJ Open 2023; 13:e069327. [PMID: 37451727 PMCID: PMC10351239 DOI: 10.1136/bmjopen-2022-069327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Clinical guidelines recommend conservative treatment for the management of temporomandibular disorders (TMD), and manual therapy directed to temporomandibular structures is commonly applied to reduce pain and improve function. In a recent prospective study, we developed a clinical prediction tool based on an array of predictors to identify people with TMD who are likely to experience significant pain relief and functional improvements following a programme of manual therapies (MTP) applied to temporomandibular structures. The purpose of this study is to externally validate in a different sample (temporal validation) the prediction model obtained in the initial study. METHODS/ANALYSIS This observational prospective study will recruit a cohort of 120 adults with TMD from a Dental Hospital in Italy. The intervention will be an MTP consisting of four sessions (once per week) of manual therapy applied to temporomandibular structures. Candidate predictors included in the predictive model will be pain intensity during mouth opening, treatment expectations, number of pain locations, central sensitisation, TMD pain duration and maximal mouth opening. Outcome measures (i.e., pain intensity, functional improvement) will be collected before starting the MTP, after the last session and after 1 month (2 months from baseline). A reduction of pain intensity by at least 30% will be considered a good outcome. External validity of the prediction model will be evaluated after the last session by measuring its calibration, discrimination and overall fit. Additionally, the performance of the model will be evaluated considering the clinical outcomes collected 1 month after the last MTP session. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethics Committee of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy. The results will be submitted for publication in a peer-reviewed journal, and the prediction model will be implemented in a web-based calculator to facilitate its use by clinicians. TRIAL REGISTRATION NUMBER NCT03990662.
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Affiliation(s)
- Giacomo Asquini
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Craniomandibular Physiotherapy Service, Istituto Stomatologico Italiano, Milano, Italy
| | - Valter Devecchi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Andrea Edoardo Bianchi
- Craniomandibular Physiotherapy Service, Istituto Stomatologico Italiano, Milano, Italy
- Saint Camillus International University of Health Sciences, UniCamillus, Via di Sant'Alessandro 8, 00131 Rome, Italy, Italy
| | - Giulia Borromeo
- Craniomandibular Physiotherapy Service, Istituto Stomatologico Italiano, Milano, Italy
| | - Paola Tessera
- Craniomandibular Physiotherapy Service, Istituto Stomatologico Italiano, Milano, Italy
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Marino S, Jassar H, Kim DJ, Lim M, Nascimento TD, Dinov ID, Koeppe RA, DaSilva AF. Classifying migraine using PET compressive big data analytics of brain's μ-opioid and D2/D3 dopamine neurotransmission. Front Pharmacol 2023; 14:1173596. [PMID: 37383727 PMCID: PMC10294712 DOI: 10.3389/fphar.2023.1173596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/26/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction: Migraine is a common and debilitating pain disorder associated with dysfunction of the central nervous system. Advanced magnetic resonance imaging (MRI) studies have reported relevant pathophysiologic states in migraine. However, its molecular mechanistic processes are still poorly understood in vivo. This study examined migraine patients with a novel machine learning (ML) method based on their central μ-opioid and dopamine D2/D3 profiles, the most critical neurotransmitters in the brain for pain perception and its cognitive-motivational interface. Methods: We employed compressive Big Data Analytics (CBDA) to identify migraineurs and healthy controls (HC) in a large positron emission tomography (PET) dataset. 198 PET volumes were obtained from 38 migraineurs and 23 HC during rest and thermal pain challenge. 61 subjects were scanned with the selective μ-opioid receptor (μOR) radiotracer [11C]Carfentanil, and 22 with the selective dopamine D2/D3 receptor (DOR) radiotracer [11C]Raclopride. PET scans were recast into a 1D array of 510,340 voxels with spatial and intensity filtering of non-displaceable binding potential (BPND), representing the receptor availability level. We then performed data reduction and CBDA to power rank the predictive brain voxels. Results: CBDA classified migraineurs from HC with accuracy, sensitivity, and specificity above 90% for whole-brain and region-of-interest (ROI) analyses. The most predictive ROIs for μOR were the insula (anterior), thalamus (pulvinar, medial-dorsal, and ventral lateral/posterior nuclei), and the putamen. The latter, putamen (anterior), was also the most predictive for migraine regarding DOR D2/D3 BPND levels. Discussion: CBDA of endogenous μ-opioid and D2/D3 dopamine dysfunctions in the brain can accurately identify a migraine patient based on their receptor availability across key sensory, motor, and motivational processing regions. Our ML-based findings in the migraineur's brain neurotransmission partly explain the severe impact of migraine suffering and associated neuropsychiatric comorbidities.
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Affiliation(s)
- Simeone Marino
- Statistics Online Computational Resource, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, United States
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, United States
| | - Hassan Jassar
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Dajung J. Kim
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Manyoel Lim
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Thiago D. Nascimento
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Ivo D. Dinov
- Statistics Online Computational Resource, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, United States
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, United States
| | - Robert A. Koeppe
- Department of Radiology, Division of Nuclear Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Alexandre F. DaSilva
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
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Thomas DC, Khan J, Manfredini D, Ailani J. Temporomandibular Joint Disorder Comorbidities. Dent Clin North Am 2023; 67:379-392. [PMID: 36965938 DOI: 10.1016/j.cden.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Comorbidity is a distinct additional condition that either existed or exists during the clinical course of a patient afflicted by the condition/entity in question. The clinician attempting to manage temporomandibular joint disorder (TMD) and TMD pain must realize that recognition and management of the comorbidities are essential to the successful management of the same with optimal pain control. When TMD presents with multiple comorbidities, the task for the clinician becomes more complex. It is the hope of the authors that this condensed version of TMD-associated comorbidities acts as a primer for understanding the significance of the same in pain management.
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Affiliation(s)
- Davis C Thomas
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ 07103, USA; Eastman Institute of Oral Health, Rochester, NY, USA.
| | - Junad Khan
- Department of Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, 2400 South Clinton Avenue, Building H, Suite #125, Rochester, NY 14618, USA
| | - Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Viale Bracci - 53100 Siena, Italy
| | - Jessica Ailani
- Georgetown Headache Center, Strategic Planning Neurology, Medstar Georgetown University Hospital 3800 Reservoir Road. NW, Washington, DC 20007, USA
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28
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Orzeszek S, Waliszewska-Prosol M, Ettlin D, Seweryn P, Straburzynski M, Martelletti P, Jenca A, Wieckiewicz M. Efficiency of occlusal splint therapy on orofacial muscle pain reduction: a systematic review. BMC Oral Health 2023; 23:180. [PMID: 36978070 PMCID: PMC10053140 DOI: 10.1186/s12903-023-02897-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND This systematic review aims to examine the existing original studies to determine the effectiveness of occlusal splints (OSs) in the management of orofacial myalgia and myofascial pain (MP) in comparison with no treatment or other interventions. MATERIALS AND METHODS Based on the inclusion and exclusion criteria of this systematic review, randomized controlled trials were qualified, in which the effectiveness of occlusal splint therapy in the management of muscle pain was examined in comparison with no treatment or other interventions. This systematic review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. The authors searched three databases (PubMed, CINAHL (The Cumulative Index to Nursing and Allied Health Literature) and Scopus) for English publications published between January 1, 2010, and June 1, 2022. The last database search was carried out on June 4, 2022. Data were extracted from the included studies and assessed for risk of bias using the revised Cochrane risk-of-bias tool for randomized trials. RESULTS Thirteen studies were identified for inclusion in this review. In total, 589 patients were diagnosed with orofacial muscle pain who underwent education and various forms of therapy including different types of OSs, light emitting diode therapy, acupuncture, low-level laser therapy, device-supported sensorimotor training, Kinesio Taping, myofunctional therapy, and physical therapy. All studies included demonstrated a high risk of bias. CONCLUSIONS There is insufficient evidence regarding whether OS therapy in the treatment of orofacial myalgia and MP offers an advantage over other forms of interventions or no treatment. Further reliable clinical studies in this area are needed to improve the quality of research, which should be performed with larger groups of blinded respondents and controls. CLINICAL RELEVANCE Due to the large-scale nature of orofacial muscle pain, it is assumed that each dental clinician will meet patients with orofacial muscle pain repeatedly in daily practice; hence, the review of the effectiveness of OSs in the management of orofacial myalgia and MP is necessary.
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Affiliation(s)
- Sylwia Orzeszek
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | | | - Dominik Ettlin
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Piotr Seweryn
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Straburzynski
- Department of Family Medicine and Infectious Diseases, University of Warmia and Mazury, Olsztyn, Poland
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Andrej Jenca
- Clinic of Stomatology and Maxillofacial Surgery, Faculty of Medicine, University Pavol Josef Safarik and Akademia Kosice, Kosice, Slovakia
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland.
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29
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Posttraumatic Stress Disorder and the Role of Psychosocial Comorbidities in Chronic Orofacial Pain. Dent Clin North Am 2023; 67:141-155. [PMID: 36404075 DOI: 10.1016/j.cden.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article presents the case of a patient with persistent right-sided jaw pain with a history of multiple temporomandibular joint surgeries in the setting of persistent widespread body pain, the causes of which were fibromyalgia and osteoarthritis with multiple joint replacements, as well as psychological diagnoses of PTSD and depression. Despite extensive treatment from her orofacial pain team in combination with neurology and neurosurgery, her severe pain persisted, likely due to the consequences of untreated PTSD and depression, which led to avoidance of activities that would exacerbate her pain and thus to further disability and emotional deterioration.
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30
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Hitti M, Welte-Jzyk C, Pröbster L, Erbe C. CMD und Kieferorthopädie. INFORMATIONEN AUS ORTHODONTIE & KIEFERORTHOPÄDIE 2022. [DOI: 10.1055/a-1925-4606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
ZusammenfassungDie Craniomandibuläre Dysfunktion (CMD) ist mit einer Prävalenz
von über 30% die häufigste chronische Schmerzerkrankung
im Kiefer- Gesichtsbereich. Die Therapie erfordert einen
interdisziplinären, individuell angepassten Behandlungsansatz. Diese
Fallvorstellung soll einen Einblick über das Behandlungskonzept eines
posterior-lateralen Zwangsbisses mit Oberkiefer- Okklusionsschiene und
OK/UK Alignern (Invisalign) geben.
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Affiliation(s)
- Mirette Hitti
- Poliklinik für Kieferorthopädie der
Universitätsmedizin Mainz
| | | | | | - Christina Erbe
- Poliklinik für Kieferorthopädie der
Universitätsmedizin Mainz
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31
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Henningsen P, Hausteiner-Wiehle C, Häuser W. Migraine in the context of chronic primary pain, chronic overlapping pain disorders, and functional somatic disorders: A narrative review. Headache 2022; 62:1272-1280. [PMID: 36373821 DOI: 10.1111/head.14419] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To contextualize migraine as the most common primary headache disorder in relation to other chronic primary pain and non-pain functional somatic and mental conditions. BACKGROUND Migraine is increasingly understood as a sensory processing disorder within a broader spectrum of symptom disorders. This has implications for diagnosis and treatment. METHOD Narrative review based on a search of the literature of the last 15 years on the overlap of migraine with other symptom disorders. RESULTS Migraine as the prototypical primary headache disorder not only comprises many non-headache symptoms in itself, it also shows high comorbidity with other chronic pain and non-pain conditions (e.g., fibromyalgia syndrome, irritable bowel syndrome, functional non-epileptic seizures, depression, anxiety, and posttraumatic stress disorder). Such "symptom disorders" share several etiological factors (e.g., female preponderance, psychological vulnerability) and psychophysiological mechanisms (e.g., altered sensory processing, pain expectancy). These facts are acknowledged by several recent integrative conceptualizations such as chronic primary pain, chronic overlapping pain conditions, or functional somatic disorders. Accordingly, migraine management increasingly addresses the total symptom burden and individual contributors to symptom experience, and thus incorporates centrally acting pharmacological and non-pharmacological, that is, psychological and behavioral, treatment approaches. CONCLUSIONS Migraine and also other primary headache disorders should be seen as particular phenotypes within a broader spectrum of symptom perception and processing disorders that require integrative diagnostics and treatment. A harmonization of classifications and better interdisciplinary collaboration are desirable.
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Affiliation(s)
- Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Constanze Hausteiner-Wiehle
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany.,Department of Neurology, BG Trauma Center Murnau, Murnau, Germany
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany.,Department of Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany
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32
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Chen H, Comnick C, Norman GJ, Caplan DJ, Jin XX, Fillingim RB. Triad Multisystem Phenotype with High-risk for Developing Temporomandibular Disorders- Characteristics and Potential Pathophysiology Results from the OPPERA Dataset. Pain 2022; 164:1027-1038. [PMID: 36661844 DOI: 10.1097/j.pain.0000000000002797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/20/2022] [Indexed: 01/21/2023]
Abstract
ABSTRACT A multisystem phenotype with the Triad of bodily pain, psychological distress, and sleep disturbance was found to have high risk for developing initial onset of painful temporomandibular disorders (TMDs) in the multicenter Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) dataset. In this study, we systemically examined phenotypic characteristics and explored potential pathophysiology in quantitative sensory testing (QST) and autonomic nervous system (ANS) domains in this multisystem Triad phenotype. Secondary analysis was performed on 1199 non-Triad and 154 Triad TMD-free OPPERA enrollees at baseline. Results indicate that prior to developing TMDs, the Triad phenotype demonstrated both orofacial and systemic signs and symptoms that can only be captured through multisystem assessment. In addition, we found significantly lower resting heart rate variability and higher resting heart rate in the Triad phenotype as compared to the non-Triad group. However, pain sensitivity measured by QST was not different between groups. These findings highlight the importance of whole-person multisystem assessment at the stage prior to developing complex pain conditions such as TMDs, and suggest that, in addition to a "tissue damage monitor", pain should be considered in a broader context, such as a component within a "distress monitoring system" at the whole-person level when multisystem issues co-present. Therefore, the presence or absence of multisystem issues may carry critical information when searching for disease mechanisms and developing mechanism-based intervention and prevention strategies for TMDs and related pain conditions. Cardiovascular autonomic function should be further researched when multisystem issues co-present prior to developing TMDs.
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Affiliation(s)
- Hong Chen
- the University of Iowa College of Dentistry, Department of Preventive and Community Dentistry
| | - Carissa Comnick
- University of Iowa College of Dentistry, Division of Biostatistics & Computational Biology and University of Iowa College of Public Health, Department of Biostatistics
| | | | - Daniel J Caplan
- the University of Iowa College of Dentistry, Department of Preventive and Community Dentistry
| | - Xie Xian Jin
- University of Iowa College of Dentistry, Division of Biostatistics & Computational Biology and University of Iowa College of Public Health, Department of Biostatistics
| | - Roger B Fillingim
- University of Florida College of Dentistry, Department of Community Dentistry and Behavioral Science
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33
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Differential Sensitization of Muscle versus Fascia in Individuals with Low Back Pain. Bioengineering (Basel) 2022; 9:bioengineering9090440. [PMID: 36134986 PMCID: PMC9495767 DOI: 10.3390/bioengineering9090440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/21/2022] Open
Abstract
Muscles and the deep fascia surrounding them have been suggested to play an important role in various musculoskeletal pain conditions including low back pain. Both have been shown to host rich nociceptive innervation and to undergo changes in individuals with chronic pain. However, evidence for the respective contribution of muscle and fascia sensitization in humans with myofascial pain syndrome is lacking. Here, we studied the sensitization of muscle and fascia in individuals with myofascial low back pain. Twenty individuals with acute (5) and chronic (15) myofascial low back pain of the quadratus lumborum muscle and a matched control group of twenty healthy individuals were recruited and clinically evaluated. All participants underwent ultrasound-guided needling of their subcutaneous tissue, deep fascia and quadratus lumborum muscle. Reported pain intensity and episodes of muscle twitching were recorded and analyzed. Among pain patients, both muscles and deep fascia demonstrated pain hypersensitivity, but muscles were significantly more sensitized than the deep fascia. No difference between acute- or chronic-pain patients was observed. Results of this study suggest that while both deep fascia and muscle show pain sensitization in both early and chronic stages of low back pain, muscles are more sensitized than fascia.
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34
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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.
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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
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