Local Vibrotactile and Pain Sensitivities Are Negatively Related in Temporomandibular Disorders

Neurobiology of estrogen status in deep craniofacial pain

Pain in the temporomandibular joint (TMJ) region often occurs with no overt signs of injury or inflammation. Although the etiology of TMJ-related pain may involve multiple factors, one likely risk factor is female gender or estrogen status. Evidence is reviewed from human and animal studies, supporting the proposition that estrogen status acts peripherally or centrally to influence TMJ nociceptive processing. A new model termed the "TMJ pain matrix" is proposed as critical for the initial integration of TMJ-related sensory signals in the lower brainstem that is both modified by estrogen status, and closely linked to endogenous pain and autonomic control pathways.

Nociceptive afferent activity alters the SI RA neuron response to mechanical skin stimulation

Procedures that reliably evoke cutaneous pain in humans (i.e., 5-7 s skin contact with a 47-51 °C probe, intradermal algogen injection) are shown to decrease the mean spike firing rate (MFR) and degree to which the rapidly adapting (RA) neurons in areas 3b/1 of squirrel monkey primary somatosensory cortex (SI) entrain to a 25-Hz stimulus to the receptive field center (RF(center)) when stimulus amplitude is "near-threshold" (i.e., 10-50 μm). In contrast, RA neuron MFR and entrainment are either unaffected or enhanced by 47-51 °C contact or intradermal algogen injection when the amplitude of 25-Hz stimulation is 100-200 μm (suprathreshold). The results are attributed to an "activity dependence" of γ-aminobutyric acid (GABA) action on the GABA(A) receptors of RA neurons. The nociceptive afferent drive triggered by skin contact with a 47-51 °C probe or intradermal algogen is proposed to activate nociresponsive neurons in area 3a which, via corticocortical connections, leads to the release of GABA in areas 3b/1. It is hypothesized that GABA is hyperpolarizing/inhibitory and suppresses stimulus-evoked RA neuron MFR and entrainment whenever RA neuron activity is low (as when the RF(center) stimulus is weak/near-threshold) but is depolarizing/excitatory and augments MFR and entrainment when RA neuron activity is high (when the stimulus is strong/suprathreshold).

Amino acid release at the spinomedullary junction after inflammation of the TMJ region in male and female rats

Temporomandibular joint (TMJ) disorders are painful conditions that are more prevalent in women than men. This study tested the hypothesis that acute inflammation of the TMJ region evoked sex-related changes in amino acid transmitter concentrations at the trigeminal subnucleus/upper cervical cord (Vc/C2) junction, the major terminal zone for TMJ sensory afferents. Microdialysis samples were collected in male, intact and ovariectomized (OvX) female rats after injection of mustard oil into the TMJ region (TMJ-MO) under barbiturate anesthesia. Males displayed increases in glutamate, aspartate and serine at 5 min and secondary increases 40-45 min after TMJ-MO. Intact and OvX females given low dose estrogen (LE2) displayed increases in glutamate, aspartate and serine at 5 min but no secondary increase at 40 min, while OvX females given high dose estrogen (HE2) revealed no increases after TMJ-MO. Glycine increased 20 min after TMJ-MO in males and cycling females, but not in OvX rats. Perfusion of high potassium through the probe evoked similar increases in glutamate, aspartate and glycine in all groups. In separate experiments, perfusion of the glutamate-aspartate reuptake inhibitor, L-trans-2,4-pyrrolidine dicarboxylate (PDC), through the probe caused a prompt elevation in glutamate that was significantly greater in HE2 than LE2 females or males. These results suggested sex hormone status affects glutamatergic neurotransmission at the Vc/C2 junction by acting, in part, through modulation of glutamate reuptake. Altered amino acid transmitter release and/or availability at the Vc/C2 junction may contribute to differential processing of sensory input from the TMJ region in males and females.

Reduction of TMD pain by high-frequency vibration: a spatial and temporal analysis

Under some conditions, vibration delivered to the skin can reduce pain (vibratory analgesia). Previous studies of this phenomenon in a clinical context have been somewhat variable in terms of stimulus control, and have not examined the way in which the spatial distribution of pain is affected. In the present study, we used rigorously controlled conditions to examine vibratory analgesia in participants (N=17) with painful temporomandibular disorders (TMD). Results of 20- and 100-Hz vibration were compared with data from a no-vibration control condition. The results document for the first time that vibratory analgesia occurs in TMD chronic pain conditions. We measured its time course using continuous visual analog scale (VAS) recording, and its spatial aspects by asking subjects to indicate painful regions on standardized drawings. VAS ratings and drawings both showed that pain is reduced by 100-Hz, but not by 20-Hz, vibration. The effectiveness of the high-frequency vibration cannot be attributed to a mechanism involving Pacinian corpuscles, since these receptors are lacking in the skin of the orofacial region. Spatial analyses revealed that ipsilateral and contralateral effects of vibration were statistically equivalent, suggesting that vibratory analgesia relies at least in part on central nervous system processes rather than local mechanisms.