Exploring the Role of Negative Cognitions in the Relationship Between Ethnicity, Sleep, and Pain in Women With Temporomandibular Joint Disorder

Visual psychosocial profiling of Chinese temporomandibular disorder pain patients and correlations with somatosensory function

BACKGROUND

Psychosocial function of Chinese temporomandibular disorders (TMD) pain patients and the correlation with somatosensory function has not been sufficiently studied.

OBJECTIVE

The study aims at assessing the psychosocial function of Chinese TMD pain patients by visualisation method and evaluating the correlations with somatosensory function quantitatively.

METHODS

The Symptom Checklist 90 (SCL-90) questionnaire and standardised quantitative sensory testing (QST) were administered to 70 Chinese TMD pain patients and age- and gender-matched healthy controls (HCs). Of these, 40 TMD arthralgia patients received QST before and after medication. Psychosocial and somatosensory parameters were transformed into standardised scores. Differences within groups were assessed through t tests. Correlations between psychosocial and somatosensory profiles were explored through correlation analyses with Bonferroni correction for multiple comparisons.

RESULTS

100% of the Chinese TMD pain patients exhibited psychosocial distress in contrast to HCs. Anger and hostility showed negative correlation with the thermal nonnociceptive parameter (thermal sensory limen, p =.002) and nociceptive parameters (cold pain threshold and pain pressure threshold, p<.001). Correlation analysis indicated that cold detection threshold was negatively correlated with somatization and mechanical pain sensitivity had a negative correlation with anger and hostility through medical treatment (p <.001).

CONCLUSIONS

Visual psychosocial profiles provided an easy overview of psychosocial function in Chinese TMD pain patients. Anger and hostility was associated with increased thermal nonnociceptive and nociceptive sensitivity to stimuli. Psychosocial distress might be negatively associated with TMD treatment response which indicated a possible need for psychological intervention during treatment.

Is low dose of botulinum toxin effective in controlling chronic pain in sleep bruxism, awake bruxism, and temporomandibular disorder?

OBJECTIVE

To evaluate the effects of low doses of botulinum toxin type A (BoNT-A) to control pain in patients with sleep bruxism (SB), awake bruxism (AB), and temporomandibular disorder (TMD) during 180 days.

METHODS

Overall sample of thirty-five patients with chronic pain related to TMD, SB, and AB received a single dose of 20 U of BoNT-A in masseter and temporalis muscles. The pain was assessed with a visual analog scale (VAS) before and after 15, 30, 60, 90, and 180 days of the application.

RESULTS

The three clinical conditions experienced decrease in pain after 15 days of treatment (p < 0.0001); the maximum pain relief persisted for up to 90 days after BoNT-A application in patients with SB and AB and 15 days for patients with TMD.

CONCLUSION

A low dose of BoNT-A may be effective for controlling chronic pain related to SB and AB, but TMD pain reduction was short-lived.

Influence of botulinum toxin A in pain perception and condyle-fossa relationship after the management of temporomandibular dysfunction: a randomized controlled clinical trial

OBJECTIVES

To investigate the pain perception (PP) and condyle-fossa relationship (CFR) after botulinum toxin A (BoNTA) injection in the masseter muscles of painful muscular temporomandibular dysfunction (TMD) patients.

MATERIALS AND METHODS

Fourteen women (aged 29.7 ± 5.4 years) diagnosed with myogenic TMD were randomized in the BoNTA-treated group (TG) and control group (CG). TG masseter muscles (n = 7) were bilaterally injected with 30 U. The CG (n = 7) were injected with saline injections. Condyle-fossa relationship (CFR) spaces were measured in sagittal (SP) and frontal planes (FP) of images of cone-beam computed tomography (CBCT) done before (T0) and after 30 days' interventions (T1). Visual analogue scale (VAS) measured the patients' TMD pain perception (PP). Data were compared by generalized linear models considering the results over time (α = .05).

RESULTS

There were no statistical differences in CFR in the SP or FP for TG and CG over time (p ˃ .05), except for frontal lateral space CFR (p < .05). In both groups, the condyle was positioned medially after interventions. Frontal lateral space increased in TG for both, left and right sides, over time (p < .05), as well as PP decreased over time (p < .05) for TG and CG.

CONCLUSIONS

The results depicted that there was no significant association with BoNTA injection in TMD masseter muscles in PP and CFR, except considering the frontal lateral space of CFR.

CLINICAL RELEVANCE

BoNTA injection in the masseter muscles may not promote clinically significant shifts in the condyle-fossa relationships of muscular TMD patients.

Individual Dimensions of Pain Catastrophizing Do Not Mediate the Effect of Sociodemographic and Psychological Factors on Chronic Orofacial Pain Severity, Interference, and Jaw Limitation: A Structural Equation Modeling Approach

Pain catastrophization (PC), involving rumination, magnification, and helplessness, can be viewed as a coping strategy associated with chronic pain. PC is considered a driving force in mediating pain-related outcomes, but it is still unclear whether PC mediates the relationship between psychological and sociodemographic factors with chronic pain when considered in a single model. Using baseline data from a parent study, this study examined the effect of positive and negative psychological and sociodemographic factors on pain severity, interference, and jaw limitation mediated by the PC dimensions in a sample of 397 temporomandibular disorder (TMD) participants using structural equation modeling (SEM). SEM revealed that pain severity regressed on age, sex, education, and income; interference regressed on positive and negative psychological factors, education, and income; and jaw limitation regressed on age. The PC dimensions did not individually mediate these relationships. Although they jointly mediated the relationships between negative psychological factors and pain severity and between age and pain interference, the effect size was small, suggesting that PC is not a critical factor in mediating TMD pain outcomes. Reducing negative cognitions, not just PC, may be of greatest benefit to the most vulnerable TMD populations. PERSPECTIVE: This study examines sociodemographic and psychological factors that affect orofacial pain, finding that the pain catastrophizing dimensions do not mediate these relationships. Understanding which factors most strongly affect pain outcomes will help identify targets for intervention to produce the greatest benefit for the most vulnerable persons suffering from pain.

Sleep disorders in chronic pain and its neurochemical mechanisms: a narrative review

Chronic pain (CP) is a prevalent problem, and more than half of patients with CP have sleep disorders. CP comorbidity with sleep disorders imposes immense suffering and seriously affects the patient's quality of life, which is a challenging issue encountered by clinicians. Although the reciprocal interactions between pain and sleep have been studied to some degree, there is still a lack of awareness and comprehensive description of CP comorbidity with sleep disorders. In this narrative review article, we summarize the current knowledge about the present estimates of the prevalence of comorbid sleep disorders in CP patients, sleep detection methods, sleep characterization in CP, and the effect of sleep disorders on CP and current therapies. We also summarize current knowledge of the neurochemical mechanisms of CP comorbidity with sleep disorders. In conclusion, insufficient attention has been paid to the role of sleep disorders in CP patients, and CP patients should be screened for sleep disorders in the clinic. Special attention should be given to a possible risk of drug-drug interaction when using two types of drugs targeting pain and sleep simultaneously. The current insight into the neurobiological mechanisms underlying CP comorbidity with sleep disorders is still rather limited.

Association between depression and temporomandibular dysfunction in adults - a systematic review

OBJECTIVE

To critically evaluate the literature and answer the question: "Is there an association between depression and temporomandibular disorder (TMD) in adults?"

METHODS

The personalized search strategy was applied to PubMed, Embase, Web of Science, and Scopus databases. Articles were selected in two stages according to the eligibility criteria. The Joanna Briggs Institute (JBI) tool was used to analyze the risk of bias according to the type of study.

RESULTS

The included articles presented a moderate risk of bias. Based on the studies, individuals with TMD have higher levels of depression compared to the control group. There is also a direct association in that individuals with depression are more susceptible to developing TMD.

CONCLUSION

There is a probable association between depression and TMD in adults. However, more studies with high methodological quality are needed to confirm this finding.

Catastrophizing and Hypervigilance Influence Subjective Sleep Quality in Painful TMD Patients

Aims: To determine sleep quality and associated factors in a group of patients with painful TMDs. Methods: The medical records of 80 patients with arthralgia and/or myofascial pain were reviewed and compared to a healthy control group. Data about sex, age, subjective pain, physical activity, social activity, subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI]), pain vigilance (Pain Vigilance and Awareness Questionnaire [PVAQ]), and pain catastrophizing (Pain Catastrophizing Scale [PCS]) were collected. Relationships between PSQI, age, pain intensity, PVAQ, and PCS in the TMD group were also analyzed. Data from the control group were used to transform the PSQI results into T-scores, which were then used to divide the TMD group into two subgroups: normal and impaired sleep. Results: TMD patients presented a significantly higher (P < .001) PSQI score than the control group. Also, in the TMD group, there was a low to moderate correlation between PSQI and pain intensity and a significant correlation between PVAQ and PCS. The impaired sleep group presented a significantly higher (P < .001) PSQI T-score than the normal sleep group. Univariate analysis showed that subjective pain, social activity, and the PCS total and subscale scores differed significantly between the different PSQI T-score groups. The comparison between TMD pain patients and control subjects showed a significantly higher prevalence of T-score discordance in almost all PSQI components in TMD patients with impaired sleep. Conclusion: Subjective sleep quality in painful TMD patients could be associated with and influenced by psychosocial factors (catastrophizing and hypervigilance), social activity, and pain intensity.

Lavage Volume of Arthrocentesis in the Management of Temporomandibular Disorders: A Systematic Review and Meta-Analysis

The aim of this study was to investigate the most effective lavage volume of arthrocentesis in the management of temporomandibular disorders. A comprehensive electronic search, based on the PRISMA guidelines, was performed, which included a computer search with specific keywords, a reference list search and a manual search. The inclusion criteria were the following: a randomized controlled trial, at least 20 subjects who underwent arthrocentesis, mention of the irrigation materials used for the arthrocentesis, mention of the irrigation volumes used for the arthrocentesis, MMO and pain measured as VAS or NRS, were reported as outcome figures, mention of a specific diagnosis or signs and symptoms, and inclusion of the data on the MMO or VAS/NRS at 6-month follow-up. Sixteen publications were enrolled in the meta-analysis, comparing arthrocentesis with a lavage volume <150 mL and arthrocentesis with a lavage volume ≥150 mL, in the efficacy of the improvement in the mouth opening and pain reduction. The results revealed the group with a lavage volume <150 mL had a greater improvement in the mouth opening and pain reduction. However, results are to be interpreted with caution, due to the paucity of the randomized controlled literature and other confounding factors. Further high-quality studies are required to provide a better conclusion to the treatment outcomes of the different lavage volumes.

Women’s oral health-related quality of life as a risk factor for TMD symptoms. A case-control study

OBJECTIVE

To investigate the association between temporomandibular disorder (TMD) symptoms and women's oral health-related quality of life (OHRQoL).Methods: An observational case-control study was performed with 765 adult women aged 21.5 years on average. Oral Health Impact Profile (OHIP-14) assessed OHRQoL and determined the selection of cases and controls matched by age and marital status at a ratio of 1:4 (153 cases: 612 controls). American Academy of Orofacial Pain's self-explanatory questionnaire assessed the TMD symptoms. The TMD symptoms' impact on OHRQoL was analyzed, estimating the odds ratio with a 95% confidence interval.

RESULTS

Of the women, 86.9% in the case group, and 69.6% in the control group presented some TMD symptoms (p< 0.05). Women with an impacted OHRQoL are 2.95 (95% CI:1.79-4.86) times more likely to report some TMD symptoms (p< 0.05).

DISCUSSION

Women with a negative impact on OHRQoL are more likely to report TMD symptoms.

Pain relief for osteoarthritis through combined treatment (PROACT): Protocol for a randomized controlled trial of mindfulness meditation combined with transcranial direct current stimulation in non-Hispanic black and white adults with knee osteoarthritis

Knee osteoarthritis (OA) is a leading cause of late life pain and disability, and non-Hispanic black (NHB) adults experience greater OA-related pain and disability than non-Hispanic whites (NHWs). Recent evidence implicates psychosocial stress, cognitive-attentional processes, and altered central pain processing as contributors to greater OA-related pain and disability among NHBs. To address these ethnic/race disparities, this clinical trial will test whether a mindfulness intervention (Breathing and Attention Training, BAT) combined with transcranial direct current stimulation (tDCS) will enhance pain modulatory balance and pain-related brain function, reduce clinical pain, and attenuate ethnic differences therein, among NHBs and NHWs with knee OA. Participants will complete assessments of clinical pain, function, psychosocial measures, and quantitative sensory testing (QST), including mechanical temporal summation and conditioned pain modulation. Neuroimaging will be performed to examine pain-related brain structure and function. Then, participants will be randomized to one of four groups created by crossing two BAT conditions (Real vs. Sham) with two tDCS conditions (Real vs. Sham). Participants will then undergo five treatment sessions during which the assigned BAT and tDCS interventions will be delivered concurrently for 20 min over one week. After the fifth intervention session, participants will undergo assessments of clinical pain and function, QST and neuroimaging identical to the pretreatment measures, and monthly follow-up assessments of pain will be conducted for three months. This will be the first study to determine whether mindfulness and tDCS treatments will show additive or synergistic effects when combined, and whether treatment effects differ across ethnic/race groups.

Association between oxidative stress and temporomandibular joint dysfunction: A narrative review

BACKGROUND

The role of oxidative stress in temporomandibular disorders (TMDs) has been studied using synovial fluid, to evaluate oxidative stress (im)balance and its potential role in the onset and/or progression of the disease.

OBJECTIVE

This review aimed to evaluate the association between oxidative stress markers and the etiopathogenesis of TMJ dysfunction by means of synovial fluid analysis.

METHODS

Two independent reviewers searched the electronic databases from inception to March 2019: PubMed/MEDLINE, LILACS, SciELO, EMBASE, TRIPDATABASE, SCOPUS, and Google Scholar. The following key search terms were used: Temporomandibular Joint Disorders OR Temporomandibular Joint Disc OR Temporomandibular Joint Dysfunction Syndrome OR Temporomandibular Joint OR Facial Pain AND Free Radicals OR Oxidative Stress. Data were extracted from the selected articles, including study design, sample profile, TMJ disease reported, diagnostic method, reactive oxygen and nitrogen species evaluated, enzymatic and non-enzymatic antioxidants evaluated, and techniques used to measure free radicals and antioxidants.

RESULTS

After title and abstract screening of 6974 results, and full-text reading, 19 studies were included. All selected articles were cross-sectional observational studies. Enzymatic and non-enzymatic antioxidant defences appeared to be reduced in these patients, resulting in the establishment of the oxidative stress process. In addition, the studies showed a positive correlation between the severity of the intra-articular TMD and the increase in oxidative damage.

CONCLUSION

The establishment of oxidative stress, whether by an increase in reactive oxygen/nitrogen species or by a decrease in antioxidant defences, or a combination of both, may be associated with the establishment and maintenance of intra-articular damage.

Insomnia Symptoms among African-American Older Adults in Economically Disadvantaged Areas of South Los Angeles

BACKGROUND

Although psychosocial and health factors impact insomnia symptoms, less is known about these effects in economically disadvantaged African-American older adults.

AIMS

This study investigated social and health determinants of insomnia symptoms among economically disadvantaged African-American older adults.

METHODS

This survey enrolled 398 African-American older adults (age ≥ 65 years) from economically disadvantaged areas of South Los Angeles. Gender, age, educational attainment, financial difficulty, number of chronic diseases, self-rated health, pain intensity, and depression were covariates. Total insomnia, insomnia symptoms, and insomnia impact were our outcomes. Linear regression was applied for data analysis.

RESULTS

Based on linear regression, higher financial difficulty (B = 0.48, 95% CI = 0.35-0.61), smoking status (B = 1.64, 95% CI = 0.13-3.16), higher pain intensity (B = 0.39, 95% CI = 0.11-0.67), higher number of chronic diseases (B = 0.34, 95% CI = 0.05-0.64), and more depressive symptoms (B = 0.35, 95% CI = 0.12-0.57) were associated with a higher frequency of insomnia symptoms. Based on a logistic regression model, lower age (B = 0.91, 95% CI = 0.91-1.00) and high financial difficulty (OR = 1.15, 95% CI = 1.08-1.24), pain (OR = 2.08, 95% CI = 1.14-3.80), chronic disease (OR = 1.27, 95% CI = 1.07-1.51) and depression (OR = 2.38, 95% CI = 1.22-4.65) were associated with higher odds of possible clinical insomnia. We also found specific predictors for insomnia symptoms and insomnia impact.

CONCLUSIONS

Among African-American older adults in economically disadvantaged areas of South Los Angeles, insomnia symptoms co-occur with other economic, physical, and mental health challenges such as financial difficulty, smoking, multimorbidity, pain, and depression. There is a need to address sleep as a component of care of economically disadvantaged African-American older adults who have multiple social and health challenges.