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Salbego RS, Conti PCR, Soares FFC, Ferreira DMAO, Herreira-Ferreira M, de Lima-Netto BA, Costa YM, Bonjardim LR. Central sensitization inventory is associated with psychological functioning but not with psychophysical assessment of pain amplification. Eur J Pain 2024. [PMID: 39120067 DOI: 10.1002/ejp.4713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 07/02/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The central sensitization inventory (CSI) is a questionnaire that has been widely used as a tool for assessing symptoms associated with sensitization. However, its ability to identify individuals with this phenomenon has recently been questioned. The aim of this study was to assess the correlation of CSI with psychosocial and psychophysical factors in patients with painful TMD diagnosed according to diagnostic criteria for temporomandibular disorders (DC/TMD) and asymptomatic controls, as well as to determine the influence of these variables on the CSI scores variations. METHODS This cross-sectional study with 77 patients diagnosed with painful TMD according to DC/TMD and 101 asymptomatic controls realized correlations between CSI, WUR, PPT, CPM and psychosocial questionnaires (HADS, PSQI, PCS and PSS). In cases where significant correlations existed, the potential influence of these variables on CSI variation was explored through linear regression analysis. RESULTS It has been found that the CSI correlates with psychosocial variables (anxiety, depression, catastrophizing, sleep and stress) (p < 0.0006) regardless of the presence of TMD, and that 68.9% of the variation in CSI scores can be influenced by all these variables (except stress). On the contrary, the CSI does not correlate with psychophysical parameters indicative of pain amplification (wind-up ratio and conditioned pain modulation) (p > 0.320). CONCLUSION CSI is more associated with psychosocial factors than with more robust indicators of probable central sensitization (CS), thus limiting its utility in detecting this phenomenon both in TMD patients and healthy individuals. SIGNIFICANCE STATEMENT The research highlights a noteworthy relationship between the central sensitization inventory and psychological factors, emphasizing their substantial influence on inventory values. This correlation offers crucial insights into mental health markers within the questionnaire. Additionally, the lack of connection with pain amplification implies a necessary re-evaluation of the inventory's diagnostic suitability, especially in cases of painful temporomandibular disorders. Thus, caution is urged in its application for identifying CS in these individuals.
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Affiliation(s)
- Rafaela Stocker Salbego
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Paulo César Rodrigues Conti
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | | | - Matheus Herreira-Ferreira
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | - Yuri Martins Costa
- Department of Biosciences, Piracicaba School of Dentistry, University of Campinas, Piracicaba, Brazil
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Van Oosterwijck S, Meeus M, van Der Wekken J, Dhondt E, Billens A, Van Oosterwijck J. Physical activity is predictive of conditioned pain modulation in healthy individuals: a cross-sectional study. THE JOURNAL OF PAIN 2024:104639. [PMID: 39029881 DOI: 10.1016/j.jpain.2024.104639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 07/04/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
Even in healthy populations, conditioned pain modulation (CPM) magnitude varies. This may be accounted for by (non-)modifiable factors, including physical activity. Yet, little research has thoroughly examined physical activity and its relation with CPM magnitude in a representative sample. Therefore, the present study investigated the predictive effect of physical activity on CPM magnitude in 105 healthy adults. Physical activity was assessed during seven consecutive days by self-report using the International Physical Activity Questionnaire and by monitored-based accelerometry. CPM was examined using a heterotopic noxious conditioning stimulation protocol during which the effect of a hot water conditioning stimulus on pressure pain thresholds was evaluated. Comparative, correlation, and hierarchical linear regression analyses were performed. Report-based walking predicts 4.8% of variance in pain modulatory capacity, moderate physical activity predicts 10.2% of variance in pain modulatory capacity, and report-based time spent on total physical activity predicts 7.0% of variance in pain modulatory capacity. More MET-minutes/week spent on total physical activity, including walking and moderate physical activity is associated with greater pain modulatory capacity. The findings of this study add to the limited evidence on the predictive effect of physical activity on CPM. It urges to consider physical activity a confounding factor when examining CPM. The current study provides evidence that a physically active lifestyle benefits endogenous pain modulation in healthy adults. Given its potential, walking and moderate-intensity physical activity might be achievable treatment strategies for pain patients known to have impaired CPM. PERSPECTIVE: The results of this article show that a physically active lifestyle including larger amounts of walking and moderate activity predict greater pain modulatory capacity. TRIAL REGISTRATION: This study has not been preregistered.
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Affiliation(s)
- Sophie Van Oosterwijck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Pain in Motion international research group, www.paininmotion.be; Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Mira Meeus
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Pain in Motion international research group, www.paininmotion.be; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jacob van Der Wekken
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Evy Dhondt
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Pain in Motion international research group, www.paininmotion.be
| | - Amber Billens
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Pain in Motion international research group, www.paininmotion.be
| | - Jessica Van Oosterwijck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Pain in Motion international research group, www.paininmotion.be; Research Foundation - Flanders (FWO), Brussels, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
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Dos Santos Proença J, Baad-Hansen L, do Vale Braido GV, Campi LB, de Godoi Gonçalves DA. Clinical features of chronic primary pain in individuals presenting painful temporomandibular disorder and comorbidities. J Oral Rehabil 2024; 51:255-265. [PMID: 37727030 DOI: 10.1111/joor.13598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/16/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The diagnosis of chronic primary pain (CPP), according to the recently released International Classification of Disease (ICD-11) criteria, refers to conditions with complex aetiologies. CPP is characterized by specific clinical features such as generalized sensory hypersensitivity and widespread pain, and is associated with functional disability and emotional distress. OBJECTIVE This study investigated clinical features of CPP in individuals with painful temporomandibular disorders (TMD) and comorbidities (fibromyalgia, migraine and/or tension-type headache). METHODS This cross-sectional study was conducted with a sample of 129 individuals. Painful TMD, fibromyalgia and primary headaches were evaluated based on well-established international criteria. Generalized sensory hypersensitivity was assessed using psychophysical tests. Symptoms of anxiety and depression were assessed by the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. The Central Sensitization Inventory was applied to assess central sensitization-related symptoms and the Pittsburg Sleep Quality Index to evaluate the quality of sleep. The presence of widespread pain was assessed using a body map. The sample was stratified into three groups: control (n = 25), TMD-painful TMD only (n = 35) and TMD + Cm-painful TMD and comorbidities (n = 69). Statistical analysis was performed using one-way ANOVA, chi-squared test and ANCOVA, considering gender as a covariate (α = .05). RESULTS Compared to controls, individuals presenting painful TMD and comorbidities showed lower pressure pain thresholds in all evaluated areas (p ≤ .012) and a higher number of painful areas in the body (p = .001). They presented more symptoms of anxiety (p = .040) and depression (p = .018), and a higher score in the Central Sensitization Inventory (p ≤ .006) than the other groups. CONCLUSION Individuals with painful TMD and comorbidities presented more clinical features of CPP compared to those affected by TMD only.
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Affiliation(s)
- Juliana Dos Santos Proença
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil
| | - Lene Baad-Hansen
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | | | - Letícia Bueno Campi
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil
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Mercante FG, Fernandes G, Braido GVDV, Proença JDS, Andersen ML, Hachul H, Gonçalves DADG. Insomnia is associated with symptoms of central sensitization in patients with painful temporomandibular disorders. J Am Dent Assoc 2023; 154:1024-1031. [PMID: 37086253 DOI: 10.1016/j.adaj.2023.02.017] [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: 08/25/2022] [Revised: 01/17/2023] [Accepted: 02/07/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Central sensitization (CS) and temporomandibular disorder (TMD) are both associated with insomnia. Therefore, the authors aimed to investigate whether insomnia was associated with more symptoms of CS in patients with TMD. METHODS In 82 volunteers with TMD, insomnia was clinically assessed, allowing sample stratification according to its presence. The Central Sensitization Inventory questionnaire was self-applied to assess the clinical symptoms of CS. RESULTS Participants with insomnia had significantly higher mean (SD) scores of CS according to the Central Sensitization Inventory than participants without insomnia (43.10 [12.57] vs 26.59 [13.66]; P = < .001). CONCLUSIONS Insomnia was associated with higher scores of CS symptoms in patients with TMD. PRACTICAL IMPLICATIONS Insomnia influences TMD as well as its relationship with CS, and, therefore, it is critical to the clinical management of TMD.
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Vale Braido GVD, Svensson P, Dos Santos Proença J, Mercante FG, Fernandes G, de Godoi Gonçalves DA. Are central sensitization symptoms and psychosocial alterations interfering in the association between painful TMD, migraine, and headache attributed to TMD? Clin Oral Investig 2023; 27:681-690. [PMID: 36383296 DOI: 10.1007/s00784-022-04783-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine if somatosensory function and symptoms related to central sensitization (CS) differed in individuals with painful temporomandibular disorders (TMD) according to the presence of migraine (MIG) or MIG + headache attributed to TMD (HAT). MATERIALS AND METHODS This study evaluated 92 adults (20-65 years), presenting painful TMD. Standard diagnostic criteria were applied to classification of painful TMD, MIG, and HAT. CS was assessed through the central sensitization inventory (CSI), wind-up ratio (WUR), pressure pain thresholds (PPT), and the conditioned pain modulation test (CPM). Psychosocial factors were evaluated by validated instruments. RESULTS There was a significant difference regarding gender, with more women in the group TMD + MIG + HAT (p = 0.028). TMD + MIG and TMD + MIG + HAT had significantly lower PPTs than the TMD group. No group differences were found for the WUR, CPM, or CSI. TMD + MIG + HAT had higher chronic pain intensity (p = 0.001), disability points (p = 0.045), graded chronic pain scale (p = 0.007), and higher somatization (NSPS) scores (p = 0.012), compared to the other groups. CONCLUSION Mechanical hyperalgesia was more pronounced in the group with the highest pain and somatization scores, while CPM and WUR did not differ between groups. Altered somatosensory function and CS may partially underlie the pathophysiology of overlapping TMD pain conditions, pointing towards additive effects of comorbid head pains. CLINICAL RELEVANCE Our results demonstrate the importance of considering the association of primary and secondary headaches during TMD assessment and its implications for maintaining the signs and symptoms of CS. This can influence the conduct of treatment, which must be multidisciplinary, and must include management of mechanisms related to CS.
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Affiliation(s)
- Guilherme Vinícius do Vale Braido
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil.
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Faculty of Odontology, Malmø University, Malmö, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Juliana Dos Santos Proença
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
| | - Fernanda Gruninger Mercante
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
| | - Giovana Fernandes
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
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Nuwailati R, Bobos P, Drangsholt M, Curatolo M. Reliability of conditioned pain modulation in healthy individuals and chronic pain patients: a systematic review and meta-analysis. Scand J Pain 2022; 22:262-278. [PMID: 35142147 DOI: 10.1515/sjpain-2021-0149] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/21/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Conditioned pain modulation (CPM) is a psychophysical parameter that is used to reflect the efficacy of endogenous pain inhibition. CPM reliability is important for research and potential clinical applications. The aim of this systematic review and meta-analysis was to evaluate the reliability of CPM tests in healthy individuals and chronic pain patients. METHODS We searched three databases for peer-reviewed studies published from inception to October 2020: EMBASE, Web of Science and NCBI. Risk of bias and the quality of the included studies were assessed. A meta-analysis with a random effects model was conducted to estimate intraclass correlation coefficients (ICCs). RESULTS Meta-analysis was performed on 25 papers that examined healthy participants (k=21) or chronic pain patients (k=4). The highest CPM intra-session reliability was with pressure as test stimulus (TS) and ischemic pressure (IP) or cold pressor test (CPT) as conditioning stimulus (CS) in healthy individuals (ICC 0.64, 95% CI 0.45-0.77), and pressure as TS with CPT as CS in patients (ICC 0.77, 95% CI 0.70-0.82). The highest inter-session ICC was with IP as TS and IP or CPT as CS (ICC 0.51, 95% CI 0.42-0.59) in healthy subjects. The only data available in patients for inter-session reliability were with pressure as TS and CPT as CS (ICC 0.44, 95% CI 0.11-0.69). Quality ranged from very good to excellent using the QACMRR checklist. The majority of the studies (24 out of 25) scored inadequate in Kappa coefficient reporting item of the COSMIN-ROB checklist. CONCLUSIONS Pressure and CPT were the TS and CS most consistently associated with good to excellent intra-session reliability in healthy volunteers and chronic pain patients. The inter-session reliability was fair or less for all modalities, both in healthy volunteers and chronic pain patients.
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Affiliation(s)
- Rania Nuwailati
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
- Department of Oral Medicine, University of Washington, Seattle, WA, USA
| | - Pavlos Bobos
- Applied Health Research Centre (AHRC), The HUB, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Clinical Epidemiology and Health Care Research, Dalla Lana School of Public Health, Institute of Healthy Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mark Drangsholt
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
- Department of Oral Medicine, University of Washington, Seattle, WA, USA
| | - Michele Curatolo
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
- CLEAR Research Center for Musculoskeletal Disorders, Seattle, WA, USA
- Department of Health Science and Technology, Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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Ferreira DMAO, Costa YM, Bonjardim LR, Conti PCR. Effects of acute mental stress on conditioned pain modulation in temporomandibular disorders patients and healthy individuals. J Appl Oral Sci 2021; 29:e20200952. [PMID: 34105694 PMCID: PMC8232930 DOI: 10.1590/1678-7757-2020-0952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/18/2021] [Indexed: 12/15/2022] Open
Abstract
Stress is a contributing factor to painful temporomandibular disorders (TMD). Nevertheless, the underpinnings of this relationship are not fully understood.
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Affiliation(s)
| | - Yuri Martins Costa
- Universidade de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Biociências, Piracicaba, Brasil
| | - Leonardo Rigoldi Bonjardim
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ciências Biológicas, Bauru, Brasil
| | - Paulo César Rodrigues Conti
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Prótese e Periodontia, Bauru, Brasil
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Weckwerth GM, Dionísio TJ, Costa YM, Zupelari-Gonçalves P, Oliveira GM, Torres EA, Bonjardim LR, Faria FAC, Calvo AM, Moore T, Absher DM, Santos CF. Multifocal Analysis of Acute Pain After Third Molar Removal. Front Pharmacol 2021; 12:643874. [PMID: 33935738 PMCID: PMC8082138 DOI: 10.3389/fphar.2021.643874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To analyze the pain modulation capacity profile in a Brazilian population, the relationship between opioid receptor (OPRM1) and Catechol-O-methyltransferase (COMT) 1polymorphisms and pain modulation capacity was determined through preoperative pain modulation tests and acute postoperative pain control evaluation, swelling, and trismus in 200 volunteers undergoing lower third molar removal. Methods: Psychologic and clinical parameters were measured. Patient DNA was sequenced for single nucleotide polymorphisms in OPRM1 and COMT, and the salivary concentration of interleukin (IL)-2 (IL)-6, interferon (IFN)-γ and tumor necrosis factor (TNF)-α was evaluated. Primary outcomes were the influence of all predictors on the fluctuation of pain intensity using a visual analogue scale (VAS), and swelling and trismus on the 2nd and 7th postoperative days. Preoperative pain modulation capacity (CPM), pain catastrophizing scale (PCS), body mass index (BMI), and surgery duration and difficulty were evaluated. Results: Salivary concentration of IFN-γ and IL-2 as well as the duration of surgery influenced the fluctuation of postoperative pain in the VAS, and in the sum of the differences in pain intensity test at 8, 48, and 96 h. BMI influenced swelling, while both BMI and COMT haplotype influenced trismus on the 2nd postoperative day. Conclusion: Polymorphisms in COMT, salivary concentrations of IL-2 and IFN-γ, BMI, and duration of surgery were predictors for pain fluctuation, swelling, and trismus on the 2nd day after lower third molar extraction. This therapy was effective in controlling inflammatory symptomatology after lower third molar extraction and ibuprofen was well tolerated by patients. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03169127.
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Affiliation(s)
- Giovana Maria Weckwerth
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Thiago José Dionísio
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Yuri Martins Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Paulo Zupelari-Gonçalves
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Gabriela Moraes Oliveira
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Elza Araújo Torres
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | | | - Adriana Maria Calvo
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Troy Moore
- Kailos Genetics Inc., HudsonAlpha Institute for Biotechnology, Huntsville, AL, United States
| | | | - Carlos Ferreira Santos
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Proença JDS, Baad-Hansen L, Braido GVDV, Mercante FG, Campi LB, Gonçalves DADG. Lack of correlation between central sensitization inventory and psychophysical measures of central sensitization in individuals with painful temporomandibular disorder. Arch Oral Biol 2021; 124:105063. [PMID: 33529837 DOI: 10.1016/j.archoralbio.2021.105063] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the correlation between the Central Sensitization Inventory (CSI) scores and the results of psychophysical tests and psychosocial questionnaires according to the presence of painful temporomandibular disorder (TMD). DESIGN It was a cross-sectional study involving 146 participants, aged 20-65 years. Painful TMD was classified using the Research Diagnostic Criteria for Temporomandibular Disorders. CSI was applied to assess "central sensitization-related symptoms", as has been suggested. Wind-up ratio, pressure pain threshold and conditioned pain modulation were used as psychophysical tests to evaluate signs and symptoms of central sensitization. Psychosocial factors were assessed by the presence of non-specific physical symptoms, depressive and anxiety symptoms. The sample was divided into two groups: Control (n = 31); Painful TMD (n = 115). Descriptive statistics characterized the sample. Correlation analysis were performed using Pearson's and Spearman's correlation coefficients (α = 5%). RESULTS Of the total sample, 78.8 % presented painful TMD, and the mean (standard deviation) age was 37.4 (±11.5) years. Anxiety symptoms (p = 0.028) and non-specific physical symptoms (p < 0.001) were more frequent in the painful TMD group than in controls. Painful TMD patients presented higher scores of the CSI (p < 0.001) and lower pressure pain thresholds (p ≤ 0.020) compared to controls. CSI scores were significantly correlated with psychosocial measures (p < 0.001) but not with psychophysical tests (p ≥ 0.089). CONCLUSION The CSI scores did not correlate with psychophysical measures of central sensitization but were positively correlated with the results of psychosocial questionnaires.
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Affiliation(s)
- Juliana Dos Santos Proença
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil.
| | - Lene Baad-Hansen
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Guilherme Vinícius do Vale Braido
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
| | - Fernanda Gruninger Mercante
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
| | - Letícia Bueno Campi
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
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Fiedler LS, Machado LA, Costa YM, Conti PCR, Bonjardim LR. Influence of self-reported physical activity and sleep quality on conditioned pain modulation in the orofacial region. Clin Oral Investig 2020; 25:1195-1202. [PMID: 32643089 DOI: 10.1007/s00784-020-03424-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 06/19/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the influence of self-reported physical activity and sleep quality on conditioned pain modulation (CPM) in the orofacial region. MATERIALS AND METHODS Ninety healthy participants aged 18-50 years old were evenly distributed according to the level of physical activity into low, moderate, and high level. The classification of physical activity was based on modified criteria of the International Physical Activity Questionnaire (IPAQ), considering intensity, duration, and frequency of physical activity. The Pittsburgh Sleep Quality Index (PSQI) assessed sleep quality and the individuals were then classified as good or poor sleepers. CPM was assessed using the pressure pain threshold (PPT) of the anterior temporalis as test stimulus and hand immersion in hot water as conditioning stimulus. ANOVA was applied to the data and Tukey's posttest was applied when the main effects or interactions were significant (p < 0.050). RESULTS There was no significant main effect of neither physical activity nor sleep quality on pain modulation. However, individuals who reported high level of physical activity and good quality of sleep had a greater pain modulation (- 0.60 ± 0.34) when compared with those who reported moderate (- 0.10 ± 0.25) and low level of physical activity (- 0.10 ± 0.52) and good sleep quality (p < 0.028). CONCLUSIONS Pain modulation seems to be more efficient in individuals who report a good sleep quality and a high level of physical activity. CLINICAL RELEVANCE Conditioned pain modulation is highly variable in healthy people. Therefore, a multifactorial approach should be taken into consideration in the evaluation of the efficacy of endogenous analgesia.
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Affiliation(s)
- Leticia Soares Fiedler
- Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Laila Aguiar Machado
- Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Yuri Martins Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | - Leonardo Rigoldi Bonjardim
- Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo, Al. Octávio Pinheiro Brizolla 9-75 CEP Vila Universitária, Bauru, SP, 17012-901, Brazil.
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11
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Nuwailati R, Curatolo M, LeResche L, Ramsay DS, Spiekerman C, Drangsholt M. Reliability of the conditioned pain modulation paradigm across three anatomical sites. Scand J Pain 2020; 20:283-296. [PMID: 31812949 DOI: 10.1515/sjpain-2019-0080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 10/24/2019] [Indexed: 01/08/2023]
Abstract
Background and aims Conditioned Pain Modulation (CPM) is a measure of pain inhibition-facilitation in humans that may elucidate pain mechanisms and potentially serve as a diagnostic test. In laboratory settings, the difference between two pain measures [painful test stimulus (TS) without and with the conditioning stimulus (CS) application] reflects the CPM magnitude. Before the CPM test can be used as a diagnostic tool, its reliability on the same day (intra-session) and across multiple days (inter-session) needs to be known. Furthermore, it is important to determine the most reliable anatomical sites for both the TS and the CS. This study aimed to measure the intra-session and inter-session reliability of the CPM test paradigm in healthy subjects with the TS (pressure pain threshold-PPT) applied to three test sites: the face, hand, and dorsum of the foot, and the CS (cold pressor test-CPT) applied to the contralateral hand. Methods Sixty healthy participants aged 18-65 were tested by the same examiner on 3 separate days, with an interval of 2-7 days. On each day, testing was comprised of two identical experimental sessions in which the PPT test was performed on each of the three dominant anatomical sites in randomized order followed by the CPM test (repeating the PPT with CPT on the non-dominant hand). CPM magnitude was calculated as the percent change in PPT. The Intraclass Correlation Coefficient (ICC), Coefficient of Variation (CV), and Bland-Altman analyses were used to assess reliability. Results PPT relative reliability ranged from good to excellent at all three sites; the hand showed an intra-session ICC of 0.90 (0.84, 0.94) before CPT and ICC of 0.89 (0.83, 0.92) during CPT. The PPT absolute reliability was also high, showing a low bias and small variability when performed on all three sites; for example, CV of the hand intra-session was 8.0 before CPT and 8.1 during CPT. The relative reliability of the CPM test, although only fair, was most reliable when performed during the intra-session visits on the hand; ICC of 0.57 (0.37, 0.71) vs. 0.20 (0.03, 0.39) for the face, and 0.22 (0.01, 0.46) for the foot. The inter-session reliability was lower in all three anatomical sites, with the best reliability on the hand with an ICC of 0.40 (0.23, 0.55). The pattern of absolute reliability of CPM was similar to the relative reliability findings, with the reliability best on the hand, showing lower intra-session and inter-session variability (CV% = 43.5 and 51.5, vs. 70.1 and 73.1 for the face, and 75.9 and 78.9 for the foot). The CPM test was more reliable in women than in men, and in older vs. younger participants. Discussion The CPM test was most reliable when the TS was applied to the dominant hand and CS performed on the contralateral hand. These data indicate that using the CS and TS in the same but contralateral dermatome in CPM testing may create the most reliable results.
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Affiliation(s)
- Rania Nuwailati
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Michele Curatolo
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA.,Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Linda LeResche
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA.,Department of Oral Medicine, University of Washington, Seattle, WA, USA
| | - Douglas S Ramsay
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA.,Department of Orthodontics, University of Washington, Seattle, WA, USA.,Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA
| | - Charles Spiekerman
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA.,Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Mark Drangsholt
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA.,Department of Oral Medicine, University of Washington, Seattle, WA, USA
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12
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Costa YM, Ferreira DMAO, Conti PCR, Baad‐Hansen L, Svensson P, Bonjardim LR. Topical anaesthesia degree is reduced in temporomandibular disorders patients: A novel approach to assess underlying mechanisms of the somatosensory alterations. J Oral Rehabil 2019; 47:113-122. [DOI: 10.1111/joor.12874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/16/2019] [Accepted: 08/07/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Yuri Martins Costa
- Section of Head and Face Physiology Department of Biological Sciences Bauru School of Dentistry University of Sao Paulo Bauru Brazil
- Bauru Orofacial Pain Group Bauru Brazil
| | - Dyna Mara A. O. Ferreira
- Bauru Orofacial Pain Group Bauru Brazil
- Department of Prosthodontics Bauru School of Dentistry University of Sao Paulo Bauru Brazil
| | - Paulo César R. Conti
- Bauru Orofacial Pain Group Bauru Brazil
- Department of Prosthodontics Bauru School of Dentistry University of Sao Paulo Bauru Brazil
| | - Lene Baad‐Hansen
- Scandinavian Center for Orofacial Neurosciences (SCON) Aarhus Denmark
- Section of Orofacial Pain and Jaw Function Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
| | - Peter Svensson
- Scandinavian Center for Orofacial Neurosciences (SCON) Aarhus Denmark
- Section of Orofacial Pain and Jaw Function Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
- Department of Dental Medicine Karolinska Institutet Huddinge Sweden
| | - Leonardo R. Bonjardim
- Section of Head and Face Physiology Department of Biological Sciences Bauru School of Dentistry University of Sao Paulo Bauru Brazil
- Bauru Orofacial Pain Group Bauru Brazil
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13
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Sampaio FA, Sampaio CRA, Cunha CO, Costa YM, Alencar PNB, Bonjardim LR, Garib D, Garlet GP, Eliav E, Conti PCR. The effect of orthodontic separator and short-term fixed orthodontic appliance on inflammatory mediators and somatosensory function. J Oral Rehabil 2018; 46:257-267. [PMID: 30378703 DOI: 10.1111/joor.12742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 08/18/2018] [Accepted: 09/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although inflammation can alter cytokines release and nerve function, it is not yet fully established if orthodontic-induced inflammation can cause significant extraoral trigeminal somatosensory alterations and release of inflammatory chemical mediators. OBJECTIVE The primary aim of this study was to investigate the impact of orthodontic separator and short-term fixed orthodontic appliance on the extraoral trigeminal somatosensory function and concentrations of cytokines in the gingival crevicular fluid (GCF). METHODS Twenty-two female patients were evaluated as follow: baseline, 24 hour-after elastomeric separator (-aES), 24 hour- and 1 month-after bonding brackets (-aBB) at both arches. The outcome variables were as follows: self-reported pain (Visual Analog Scale), QSTs (current perception threshold-CPT, cold detection threshold-CDT, warm detection threshold-WDT, mechanical detection threshold-MDT, mechanical suprathreshold-MST and wind-up ratio-WUR. All QSTs were performed at infra-orbital and mental nerve entry zone at patient`s dominant side. In addition, GCF samples in order to assess cytokines profile (IL-1β,IL-8,IL-6 and TNF-α) were collected. ANOVA and Tukey's post hoc analyses were performed (a = 5%). RESULTS Patients reported higher pain intensity 24 hour-aBB compared to baseline and 24 hour-aES (P < 0.050). Patients were less sensitive to pin-prick pain (MST) at 24 hour-aBB and 1 month-aBB compared to baseline (P < 0.006). Significant increases in IL-6 levels were observed 24 hour-aBB (P < 0.001). Multiple comparison analysis showed significant increase in IL-1β levels (P < 0.001) and TNF-α (P < 0.001) 1 month-aBB compared to baseline. CONCLUSION Elastomeric separators only induced mild pain and were not able to significantly increase proinflammatory cytokines level in the GCF. In addition, orthodontic fixed appliance may induce only minor somatosensory changes at extraoral trigeminal locations.
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Affiliation(s)
- Fernanda A Sampaio
- Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.,Department of Prosthodontics, University Center Christus, Fortaleza, Brazil
| | | | - Carolina O Cunha
- Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.,Health Science Center, Sacred Heart University, Bauru, Brazil
| | - Yuri M Costa
- Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.,Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.,Department of Physiological Sciences, Piracicaba Dental School, University of Campinas (FOP/UNICAMP), Piracicaba, São Paulo, Brazil
| | | | - Leonardo R Bonjardim
- Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.,Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil
| | - Gustavo P Garlet
- Department of Biological Sciences, School of Dentistry of Bauru, University of São Paulo (FOB/USP), Bauru, São Paulo, Brazil
| | - Eli Eliav
- Eastman Institute of Oral Health, University of Rochester Medical Center, Rochester, New York
| | - Paulo C R Conti
- Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.,Department of Prosthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil
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14
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Costa Y, Araújo‐Júnior E, Fiedler LS, de Souza P, Silva L, Ferreira D, Conti P, Bonjardim L. Reproducibility of quantitative sensory testing applied to musculoskeletal orofacial region: Site and sex differences. Eur J Pain 2018; 23:81-90. [DOI: 10.1002/ejp.1287] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Y.M. Costa
- Section of Head and Face Physiology Department of Biological Sciences Bauru School of Dentistry University of São Paulo Bauru Brazil
- Bauru Orofacial Pain Group Bauru Brazil
| | - E.N.S. Araújo‐Júnior
- Section of Head and Face Physiology Department of Biological Sciences Bauru School of Dentistry University of São Paulo Bauru Brazil
- Bauru Orofacial Pain Group Bauru Brazil
| | - L. S. Fiedler
- Bauru Orofacial Pain Group Bauru Brazil
- Department of Prosthodontics Bauru School of Dentistry University of São Paulo Bauru Brazil
| | - P.R.J. de Souza
- Section of Head and Face Physiology Department of Biological Sciences Bauru School of Dentistry University of São Paulo Bauru Brazil
| | - L.L.C.P. Silva
- Section of Head and Face Physiology Department of Biological Sciences Bauru School of Dentistry University of São Paulo Bauru Brazil
| | - D.M.A.O. Ferreira
- Bauru Orofacial Pain Group Bauru Brazil
- Department of Prosthodontics Bauru School of Dentistry University of São Paulo Bauru Brazil
| | - P.C.R. Conti
- Bauru Orofacial Pain Group Bauru Brazil
- Department of Prosthodontics Bauru School of Dentistry University of São Paulo Bauru Brazil
| | - L.R. Bonjardim
- Section of Head and Face Physiology Department of Biological Sciences Bauru School of Dentistry University of São Paulo Bauru Brazil
- Bauru Orofacial Pain Group Bauru Brazil
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15
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A tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulus. Pain Rep 2017; 2:e626. [PMID: 29392240 PMCID: PMC5741326 DOI: 10.1097/pr9.0000000000000626] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/15/2017] [Accepted: 09/13/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction The interest in conditioned pain modulation (CPM) as a clinical tool for measuring endogenously induced analgesia is increasing. There is, however, large variation in the CPM methodology, hindering comparison of results across studies. Research comparing different CPM protocols is needed in order to obtain a standardized test paradigm. Objectives The aim of the study was to assess whether a protocol with phasic heat stimuli as test-stimulus is preferable to a protocol with tonic heat stimulus as test-stimulus. Methods In this experimental crossover study, we compared 2 CPM protocols with different test-stimulus; one with tonic test-stimulus (constant heat stimulus of 120-second duration) and one with phasic test-stimuli (3 heat stimulations of 5 seconds duration separated by 10 seconds). Conditioning stimulus was a 7°C water bath in parallel with the test-stimulus. Twenty-four healthy volunteers were assessed on 2 occasions with minimum 1 week apart. Differences in the magnitude and test-retest reliability of the CPM effect in the 2 protocols were investigated with repeated-measures analysis of variance and by relative and absolute reliability indices. Results The protocol with tonic test-stimulus induced a significantly larger CPM effect compared to the protocol with phasic test-stimuli (P < 0.001). Fair and good relative reliability was found with the phasic and tonic test-stimuli, respectively. Absolute reliability indices showed large intraindividual variability from session to session in both protocols. Conclusion The present study shows that a CPM protocol with a tonic test-stimulus is preferable to a protocol with phasic test-stimuli. However, we emphasize that one should be cautious to use the CPM effect as biomarker or in clinical decision making on an individual level due to large intraindividual variability.
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