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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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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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Bartley EJ, Alappattu MJ, Manko K, Lewis H, Vasilopoulos T, Lamvu G. Presence of endometriosis and chronic overlapping pain conditions negatively impacts the pain experience in women with chronic pelvic-abdominal pain: A cross-sectional survey. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241248017. [PMID: 38682290 PMCID: PMC11057341 DOI: 10.1177/17455057241248017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/06/2024] [Accepted: 04/02/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Evidence of overlap between endometriosis and chronic pain conditions is emerging; however, little is known about how the pain experience differs based on the presence or absence of endometriosis. OBJECTIVES In a sample of women reporting chronic pelvic-abdominal pain (CPP), the aim of this study was to characterize differences in pain symptomatology between women with and without endometriosis and to examine the influence of chronic overlapping pain conditions (COPCs) on pain among these two groups. DESIGN This was a cross-sectional study, based on an online survey. METHODS Participants (aged 18+ years) completed a survey collecting pain diagnoses and symptoms assessing pelvic pain severity, pain interference, and pain impact. Independent sample t-tests, chi-square, and multiple linear regression models were employed to analyze group differences in pain symptomatology and COPCs. RESULTS Of the 525 respondents with CPP, 25% (n = 133) reported having endometriosis. Women with endometriosis were younger at the onset of pelvic pain, relative to women without endometriosis (p = 0.04). There were no differences in age, race, ethnicity, or duration of pelvic pain between women with and without endometriosis. Women with endometriosis reported higher pelvic pain severity (+0.8, 95% CI = 0.4-1.1), pain interference (+5.9, 95% CI = 2.4-9.3), and pain impact (+1.9, 95% CI = 0.8-2.9). Endometriosis was associated with a higher number of COPCs (p = 0.003), with 25% (n = 33) of women reporting ⩾3 overlapping pain conditions compared with 12% (n = 45) of those without endometriosis. Women with endometriosis had a higher frequency of fibromyalgia (p < 0.001), chronic fatigue syndrome (p < 0.001), and temporomandibular disorder (p = 0.001). The number of COPCs was associated with higher pain severity, interference, and impact, independently of endometriosis. CONCLUSION Women with endometriosis experienced higher levels of pain-related burden and COPCs compared with those without endometriosis. Pain intensity, interference, and impact increased with a higher number of pain conditions regardless of endometriosis presence.
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Affiliation(s)
- Emily J Bartley
- College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Meryl J Alappattu
- College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Kelsey Manko
- College of Medicine, University of Central Florida, Gainesville, FL, USA
| | - Hannah Lewis
- Gynecology Section, Division of Surgery, Orlando Veterans Affairs Healthcare System, Orlando, FL, USA
| | | | - Georgine Lamvu
- College of Medicine, University of Central Florida, Gainesville, FL, USA
- Gynecology Section, Division of Surgery, Orlando Veterans Affairs Healthcare System, Orlando, FL, USA
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Hernández-Nuño de la Rosa MF, Guerrero P, Alturki SA, Scrivani SJ. Masticatory Myofascial Pain Disorders. Dent Clin North Am 2023; 67:1-11. [PMID: 36404071 DOI: 10.1016/j.cden.2022.07.001] [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
Masticatory myofascial pain disorders (MMPD) are a common group of orofacial pain conditions affecting the muscles of mastication, with headache and cervical disorders as well as chronic widespread pain and psychosocial disorders being common comorbid conditions. As their pathophysiology is multifactorial in nature, a multimodal and interdisciplinary approach should be considered. Overall treatment goals include decreasing pain and disability, increasing mandibular range of motion, and improving quality of life. This article describes a complex case exhibiting common characteristics of MMPD while additionally reviewing the literature on classification, pathophysiology, and evidence-based treatment planning.
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Affiliation(s)
| | - Patricia Guerrero
- Department of Diagnostics Sciences, Craniofacial Pain Center, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA
| | - Shuruq A Alturki
- Department of Diagnostics Sciences, Craniofacial Pain Center, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA
| | - Steven J Scrivani
- Department of Diagnostics Sciences, Craniofacial Pain Center, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA
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Chronic temporomandibular disorders are associated with higher propensity to develop central sensitization: a case-control study. Pain 2022; 164:e251-e258. [PMID: 36251966 DOI: 10.1097/j.pain.0000000000002803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/30/2022] [Indexed: 01/09/2023]
Abstract
ABSTRACT Temporomandibular disorders (TMD) include a group of musculoskeletal disorders that may involve increased responsiveness of nociceptive neurons in the central nervous system (ie, central sensitization). To test this hypothesis further, this study examined whether, as compared with healthy subjects, patients with chronic TMD have a greater propensity to develop secondary mechanical hyperalgesia-a phenomenon that can be confidently attributed to central sensitization. In this case-control study, we assessed the area of secondary mechanical hyperalgesia induced experimentally by delivering high-frequency electrical stimulation (HFS) to the volar forearm skin in 20 participants with chronic TMD and 20 matched healthy controls. High-frequency electrical stimulation consisted in 12 trains of constant-current electrical pulses (5 mA) delivered at 42 Hz. The area of secondary mechanical hyperalgesia was evaluated 30 minutes after applying HFS. The area of secondary mechanical hyperalgesia induced by HFS was on average 76% larger in the chronic TMD group (M = 67.7 cm 2 , SD = 28.2) than in the healthy control group (M = 38.4 cm 2 , SD = 14.9; P = 0.0003). Regarding secondary outcomes, there was no group difference in the intensity of secondary mechanical hyperalgesia, but allodynia to cotton after HFS was more frequent in the chronic TMD group. To the best of our knowledge, this is the first study to show that individuals with chronic TMD have an increased propensity to develop secondary hyperalgesia in a site innervated extratrigeminally. Our results contribute to a better understanding of the pathophysiology of chronic TMD.
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Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review. Int J Mol Sci 2022; 23:ijms232012164. [PMID: 36293017 PMCID: PMC9602546 DOI: 10.3390/ijms232012164] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open
Abstract
Temporomandibular disorders (TMD) are a group of musculoskeletal diseases affecting masticatory muscles and temporomandibular joints (TMJ). In this context, the chronic TMD could be considered as a condition with chronic primary orofacial pain, presenting as myofascial TMD pain or TMJ arthralgia. In this context, myogenous TMD may present overlapping features with other disorders, such as fibromyalgia and primary headaches, characterized by chronic primary pain related to dysfunction of the central nervous system (CNS), probably through the central sensitization. This phenomenon could be defined as an amplified response of the CNS to sensory stimuli and peripheral nociceptive, characterized by hyperexcitability in the dorsal horn neurons in the spinal cord, which ascend through the spinothalamic tract. The main objectives of the management of TMD patients are: decreasing pain, increasing TMJ function, and reducing the reflex masticatory muscle spasm/pain. The first-line treatments are physical therapy, pharmacological drugs, occlusal splints, laser therapy, extracorporeal shockwave therapy, transcutaneous electrical nerve stimulation, and oxygen–ozone therapy. Although all these therapeutic approaches were shown to have a positive impact on the central sensitization of TMD pain, there is still no agreement on this topic in the scientific literature. Thus, in this comprehensive review, we aimed at evaluating the evidence on pain management and rehabilitation for the central sensitization in TMD patients.
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Lee YH, Auh QS. Clinical factors affecting depression in patients with painful temporomandibular disorders during the COVID-19 pandemic. Sci Rep 2022; 12:14667. [PMID: 36038574 PMCID: PMC9421627 DOI: 10.1038/s41598-022-18745-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 08/18/2022] [Indexed: 01/16/2023] Open
Abstract
Temporomandibular disorders (TMD) are a multifactorial condition associated with both physical and psychological factors. Stress has been known to trigger or worsens TMD. We aimed to investigate whether the novel coronavirus disease-2019 (COVID-19) pandemic aggravates depression in patients with painful TMD, and the factors that affect their level of depression. We included 112 patients with painful TMD (74 females, 38 males; mean age: 35.90 ± 17.60 years; myalgia [n = 38], arthralgia [n = 43], mixed joint-muscle TMD pain [n = 31]). TMD was diagnosed based on the Diagnostic Criteria for TMD Axis I. Physical pain intensity was recorded using the visual analog scale (VAS); psycho-emotional status (depression: Beck Depression Inventory [BDI], anxiety: Beck Anxiety Inventory [BAI], and generalized stress related to COVID19: Global Assessment of Recent Stress [GARS]) was investigated twice (before [BC] and after COVID-19 [AC]). Additionally, factors affecting BDI-AC were investigated. BDI (p < 0.001), BAI (p < 0.001), GARS (p < 0.001), and VAS (p < 0.01) scores were significantly increased at AC than BC. The depression, anxiety, and stress levels were significantly positively correlated, and the AC and BC values of each factor showed a high correlation. In the mixed TMD group, BDI-AC was positively correlated with VAS-AC (p < 0.001). In the multiple regression analysis, clenching habit was the strongest predictor of an increase in the BDI scores from moderate to severe, followed by psychological distress, muscle stiffness, female sex, BAI-AC, and TMJ sounds. COVID-19 has negatively affected the psycho-emotional state of patients with painful TMD, and several clinical factors, including female sex and clenching habits, have influenced depression.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine Kyung Hee University Dental Hospital, Kyung Hee University, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Q-Schick Auh
- Department of Orofacial Pain and Oral Medicine Kyung Hee University Dental Hospital, Kyung Hee University, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, South Korea
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Werkman DF, Carver KZ, Harper DE, Troost JP, Aronovich S. Are outcomes of TMJ arthroscopy influenced by central sensitization? J Oral Maxillofac Surg 2022; 80:980-988. [DOI: 10.1016/j.joms.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/15/2022]
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Is Irritable Bowel Syndrome Considered as Comorbidity in Clinical Trials of Physical Therapy Interventions in Fibromyalgia? A Scoping Review. J Clin Med 2021; 10:jcm10204776. [PMID: 34682899 PMCID: PMC8541581 DOI: 10.3390/jcm10204776] [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: 09/21/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Abstract
Evidence supports the presence of comorbid conditions, e.g., irritable bowel syndrome (IBS), in individuals with fibromyalgia (FM). Physical therapy plays an essential role in the treatment of FM; however, it is not currently known whether the IBS comorbidity is considered in the selection criteria for clinical trials evaluating physiotherapy in FM. Thus, the aim of the review was to identify whether the presence of IBS was considered in the selection criteria for study subjects for those clinical trials that have been highly cited or published in the high-impact journals investigating the effects of physical therapy in FM. A literature search in the Web of Science database for clinical trials that were highly cited or published in high-impact journals, i.e., first second quartile (Q1) of any category of the Journal Citation Report (JCR), investigating the effects of physical therapy in FM was conducted. The methodological quality of the selected trials was assessed with the Physiotherapy Evidence Database (PEDro) scale. Authors, affiliations, number of citations, objectives, sex/gender, age, and eligibility criteria of each article were extracted and analyzed independently by two authors. From a total of the 412 identified articles, 20 and 61 clinical trials were included according to the citation criterion or JCR criterion, respectively. The PEDro score ranged from 2 to 8 (mean: 5.9, SD: 0.1). The comorbidity between FM and IBS was not considered within the eligibility criteria of the participants in any of the clinical trials. The improvement of the eligibility criteria is required in clinical trials on physical therapy that include FM patients to avoid selection bias.
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Sebastiani AM, Gerber JT, Bergamaschi IP, Petinati MF, Meger MN, Costa DJD, Brancher JA, Küchler EC, Scariot R. Individuals requiring orthognathic surgery have more depression and pain than controls. Braz Oral Res 2021; 35:e091. [PMID: 34378762 DOI: 10.1590/1807-3107bor-2021.vol35.0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 10/03/2020] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to evaluate if individuals with dentofacial deformities (DFD) who require orthognathic surgery are affected more by depression and pain. A case-control study was performed with 195 individuals. In the DFD group, 145 individuals with Class II and III malocclusion requiring orthognathic surgery were selected. The control group was composed of 50 individuals with no DFD. All patients were diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Data were analyzed with a significance level of 0.05. The DFD group more often presented severe depression (p = 0.020) and chronic pain (p = 0.017). They also presented higher prevalence of Nonspecific Physical Symptoms Including Pain (P = 0.002) and Nonspecific Physical Symptoms Excluding Pain (p = 0.002). Concerning TMD symptoms, the DFD group had more myofascial (p = 0.002) and articular pain (p = 0.041). Therefore, the results of this study suggest that depression and pain are more common in individuals with DFD requiring orthognathic surgery compared with individuals without DFD.
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Affiliation(s)
| | - Jennifer Tsi Gerber
- Universidade Positivo, School of Health and Biological Sciences, Curitiba, PR, Brazil
| | | | | | | | - Delson João da Costa
- Universidade Federal do Paraná - UFPR, Department of Stomatology, Curitiba, PR, Brazil
| | - João Armando Brancher
- Universidade Positivo, School of Health and Biological Sciences, Curitiba, PR, Brazil
| | - Erika Calvano Küchler
- Universidade de São Paulo - USP, Ribeirão Preto Dental School, Department of Pediatric Dentistry, Ribeirão Preto, SP, Brazil
| | - Rafaela Scariot
- Universidade Federal do Paraná - UFPR, Department of Stomatology, Curitiba, PR, Brazil
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Harper DE, Sayre K, Schrepf A, Clauw DJ, Aronovich S. Impact of Fibromyalgia Phenotype in Temporomandibular Disorders. PAIN MEDICINE 2021; 22:2050-2056. [PMID: 33674851 DOI: 10.1093/pm/pnab077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Mounting evidence suggests that central nervous system amplification, similar to that seen in fibromyalgia (FM), contributes to the pain experience in a subset of patients with temporomandibular disorders (TMD). METHODS In this prospective observational study, patients with TMD completed the 2011 FM survey questionnaire, a surrogate measure of "centralized" pain. The influence of centralized pain on TMD pain, dysfunction, and disability was assessed dichotomously by determining the incidence of FM-positive cases in the sample and by using FM survey scores as a continuous measure of "fibromyalgia-ness" ("FM-ness"). RESULTS The patients meeting criteria for FM diagnosis (17 of 89) had significantly more disease burden on numerous measures. FM-ness was positively associated with pain at rest, negative mood, tenderness to palpation, perceived jaw functional limitation, and pain-related disability, and it was negatively associated with comfortable pain-free jaw opening. The impact of FM-ness on perceived jaw functional limitation and disability was mediated by levels of spontaneous, ongoing pain in the orofacial region. Importantly, this pattern of findings was still present even in those not meeting the criteria for FM diagnosis. CONCLUSION Together, these results imply that higher FM-ness increases TMD patient burden by amplifying spontaneous pain and further hampering painless jaw function, even in patients who do not meet criteria for FM diagnosis. These results are highly relevant for the clinical management of TMD, as they imply that targeting the central nervous system in the treatment of patients with TMD with evidence of pain centralization may help ameliorate both pain and jaw dysfunction.
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Affiliation(s)
- Daniel E Harper
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology.,Department of Anesthesiology, Emory University, Atlanta, Georgia, USA
| | - Kelly Sayre
- Department of Oral and Maxillofacial Surgery and Hospital Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery and Hospital Dentistry, University of Michigan, Ann Arbor, Michigan
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Asquini G, Bianchi AE, Borromeo G, Locatelli M, Falla D. The impact of Covid-19-related distress on general health, oral behaviour, psychosocial features, disability and pain intensity in a cohort of Italian patients with temporomandibular disorders. PLoS One 2021; 16:e0245999. [PMID: 33529226 PMCID: PMC7853459 DOI: 10.1371/journal.pone.0245999] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/12/2021] [Indexed: 12/22/2022] Open
Abstract
This study aimed to understand the impact of COVID-19 distress on psychological status, features of central sensitization and facial pain severity in people with temporomandibular disorders (TMDs). In this prospective cohort study, 45 adults (19 chronic, 26 acute/subacute TMD) were recruited prior to the COVID-19 outbreak. Baseline assessment took place before the outbreak while a follow-up was performed immediately after the lockdown period. Multiple variables were investigated including age, gender, perceived life quality, sleep quality, anxiety and depression, coping strategies, central sensitization, pain intensity, pain-related disability and oral behaviour. COVID Stress Scales (CSS) were applied at follow-up to measure the extent of COVID-related distress. CSS were significantly higher in those with chronic TMDs compared to those with acute/subacute TMDs (p<0.05). In people with chronic TMD, the variation in anxiety and depression from baseline to follow-up was significantly correlated with scores on the CSS (r = 0.72; p = 0.002). Variations of the central sensitization inventory (r = 0.57; p = 0.020) and graded chronic pain scale (r = 0.59; p = 0.017) were significantly correlated with scores on the CSS. These initial findings indicate that people with chronic TMD were more susceptible to COVID-19 distress with deterioration of psychological status, worsening features of central sensitization and increased chronic facial pain severity. These findings reinforce the role of stress as a possible amplifier of central sensitization, anxiety, depression, chronic pain and pain-related disability in people with TMDs. Trial Registration: ClinicalTrials.gov ID: 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, United Kingdom
- Craniomandibular Physiotherapy Service, Italian Stomatologic Institute, Milan, Italy
| | | | - Giulia Borromeo
- Craniomandibular Physiotherapy Service, Italian Stomatologic Institute, Milan, 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, United Kingdom
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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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Bai B, Bai X, Wang C. Mapping research trends of temporomandibular disorders from 2010 to 2019: A bibliometric analysis. J Oral Rehabil 2021; 48:517-530. [PMID: 33386626 DOI: 10.1111/joor.13143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Because of various clinical manifestations and complicated courses, temporomandibular disorders (TMDs) are difficult to treat. Current knowledge about this disease remains insufficient for precise treatment after diagnosis. OBJECTIVES The objective of this study is to obtain and map the overall literature trends and most cited keywords in TMDs research. METHODS Many indicators, including annual number of publications, country distribution, global cooperations, author contributions, original journals, cited references and keywords, were calculated and evaluated using VOSviewer v.1.6.13, which visualised many results, from the WoSCC database. RESULTS A total of 3121 papers on TMDs research were retrieved from 2010 to 2019. The United States produced the most articles published, but the most productive institution was the University of Sao Paulo (Brazil). Researchers and institutions conducting TMDs research have shown a very widespread and close connection. TMDs have been studied worldwide by many research centres. Professor Svensson P was the most published researcher in TMDs research and the Journal of Oral Rehabilitation published the most TMDs research articles. The top cited references mainly presented diagnostic criteria of TMDs. The most cited keywords formed clusters: (a) Anatomical factor of TMDs, (b) Symptoms of TMDs and (c) RDC/TMD, the risk factors, biopsychosocial factors and epidemiology of TMDs. CONCLUSIONS The research results provide very valuable data for a thorough understanding of the research status of TMDs and demonstrated international cooperation.
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Affiliation(s)
- Bing Bai
- Department of Prosthodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Xiaofeng Bai
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Chunxia Wang
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Key Lens Research Laboratory of Liaoning Province, Shenyang, China
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Rodrigues-de-Souza DP, Paz-Vega J, Fernández-de-las-Peñas C, Cleland JA, Alburquerque-Sendín F. Is Irritable Bowel Syndrome Considered in Clinical Trials on Physical Therapy Applied to Patients with Temporo-Mandibular Disorders? A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228533. [PMID: 33213056 PMCID: PMC7698821 DOI: 10.3390/ijerph17228533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Abstract
The aim of the current scoping review was to identify if the presence of irritable bowel syndrome was included as eligibility criteria of participants included in clinical trials investigating the effects of physical therapy in individuals with temporomandibular pain disorders (TMDs). A systematic electronic literature search in the Web of Science database was conducted. Scientifically relevant, randomized clinical trials (those cited in other studies at least 5 times, or clinical trials published in high-impact journals, i.e., first and second quartiles (Q1-Q2) of any category of the Journal Citation Report (JCR)) evaluating the effects of any physical therapy intervention in patients with TMDs were included. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of the selected trials. Authors affiliated to a clinical or non-clinical institution, total number of citations, objective, sex/gender, age, and eligibility criteria in each article were extracted and analyzed independently by two authors. From a total of 98 identified articles, 12 and 19 clinical trials were included according to the journal citation criterion or JCR criterion, respectively. After removing duplicates, a total of 23 trials were included. The PEDro score ranged from 4 to 8 (mean: 6.26, SD: 1.48). Based on the eligibility criteria of the trials systematically reviewed, none considered the presence of comorbid irritable bowel syndrome in patients with TMDs. The comorbidity between TMDs and irritable bowel syndrome is not considered within the eligibility criteria of participants in highly cited clinical trials, or published in a high-impact journal, investigating the effects of physical therapy in TMDs.
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Affiliation(s)
- Daiana P. Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (D.P.R.-d.-S.); (J.P.-V.); (F.A.-S.)
| | - Javier Paz-Vega
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (D.P.R.-d.-S.); (J.P.-V.); (F.A.-S.)
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Correspondence: ; Tel.: +34-914-888-884
| | - Joshua A. Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02155, USA;
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (D.P.R.-d.-S.); (J.P.-V.); (F.A.-S.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain
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Cuenca-Martínez F, Herranz-Gómez A, Madroñero-Miguel B, Reina-Varona Á, La Touche R, Angulo-Díaz-Parreño S, Pardo-Montero J, del Corral T, López-de-Uralde-Villanueva I. Craniocervical and Cervical Spine Features of Patients with Temporomandibular Disorders: A Systematic Review and Meta-Analysis of Observational Studies. J Clin Med 2020; 9:E2806. [PMID: 32872670 PMCID: PMC7565821 DOI: 10.3390/jcm9092806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 01/22/2023] Open
Abstract
To assess neck disability with respect to jaw disability, craniocervical position, cervical alignment, and sensorimotor impairments in patients with temporomandibular disorders (TMD), a systematic review and meta-analysis of observational studies trials were conducted. The meta-analysis showed statistically significant differences in the association between neck disability and jaw disability (standardized mean difference (SMD), 0.72 (0.56-0.82)). However, results showed no significant differences for cervical alignment (SMD, 0.02 (-0.31-0.36)) or for the craniocervical position (SMD, -0.09 (-0.27-0.09)). There was moderate evidence for lower pressure pain thresholds (PPT) and for limited cervical range of motion (ROM). There was limited evidence for equal values for maximal strength between the patients with TMD and controls. There was also limited evidence for reduced cervical endurance and conflicting evidence for abnormal electromyographic (EMG) activity and motor control in TMD patients. Results showed a clinically relevant association between cervical and mandibular disability in patients with TMD. Regarding sensory-motor alterations, the most conclusive findings were observed in the reduction of PPT and cervical ROM, with moderate evidence of their presence in the patients with TMD. Lastly, the evidence on impaired motor control and cervical EMG activity in patients with TMD was conflicting.
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Affiliation(s)
- Ferran Cuenca-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (F.C.-M.); (A.H.-G.); (B.M.-M.); (Á.R.-V.); (J.P.-M.); (T.d.C.)
- Motion in Brains Research Group, Institute of Neurosciences and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (S.A.-D.-P.); (I.L.-d.-U.-V.)
| | - Aida Herranz-Gómez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (F.C.-M.); (A.H.-G.); (B.M.-M.); (Á.R.-V.); (J.P.-M.); (T.d.C.)
| | - Beatriz Madroñero-Miguel
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (F.C.-M.); (A.H.-G.); (B.M.-M.); (Á.R.-V.); (J.P.-M.); (T.d.C.)
| | - Álvaro Reina-Varona
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (F.C.-M.); (A.H.-G.); (B.M.-M.); (Á.R.-V.); (J.P.-M.); (T.d.C.)
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (F.C.-M.); (A.H.-G.); (B.M.-M.); (Á.R.-V.); (J.P.-M.); (T.d.C.)
- Motion in Brains Research Group, Institute of Neurosciences and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (S.A.-D.-P.); (I.L.-d.-U.-V.)
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), 28008 Madrid, Spain
| | - Santiago Angulo-Díaz-Parreño
- Motion in Brains Research Group, Institute of Neurosciences and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (S.A.-D.-P.); (I.L.-d.-U.-V.)
- Facultad de Medicina, Universidad CEU San Pablo, 28003 Madrid, Spain
| | - Joaquín Pardo-Montero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (F.C.-M.); (A.H.-G.); (B.M.-M.); (Á.R.-V.); (J.P.-M.); (T.d.C.)
- Motion in Brains Research Group, Institute of Neurosciences and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (S.A.-D.-P.); (I.L.-d.-U.-V.)
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), 28008 Madrid, Spain
| | - Tamara del Corral
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (F.C.-M.); (A.H.-G.); (B.M.-M.); (Á.R.-V.); (J.P.-M.); (T.d.C.)
- Motion in Brains Research Group, Institute of Neurosciences and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (S.A.-D.-P.); (I.L.-d.-U.-V.)
| | - Ibai López-de-Uralde-Villanueva
- Motion in Brains Research Group, Institute of Neurosciences and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (S.A.-D.-P.); (I.L.-d.-U.-V.)
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain
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Li JH, Yang JL, Wei SQ, Li ZL, Collins AA, Zou M, Wei F, Cao DY. Contribution of central sensitization to stress-induced spreading hyperalgesia in rats with orofacial inflammation. Mol Brain 2020; 13:106. [PMID: 32723345 PMCID: PMC7385893 DOI: 10.1186/s13041-020-00645-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022] Open
Abstract
Temporomandibular disorder (TMD) is commonly comorbid with fibromyalgia syndrome (FMS). The incidence of these pain conditions is prevalent in women and prone to mental stress. Chronic pain symptoms in patients with FMS and myofascial TMD (mTMD) are severe and debilitating. In the present study, we developed a new animal model to mimic the comorbidity of TMD and FMS. In ovariectomized female rats, repeated forced swim (FS) stress induced mechanical allodynia and thermal hyperalgesia in the hindpaws of the 17β-estradiol (E2) treated rats with orofacial inflammation. Subcutaneous injection of E2, injection of complete Freund’s adjuvant (CFA) into masseter muscles or FS alone did not induce somatic hyperalgesia. We also found that the somatic hyperalgesia was accompanied by upregulation of GluN1 receptor and serotonin (5-hydroxytryptamine, 5-HT)3A receptor expression in the dorsal horn of spinal cord at L4-L5 segments. Intrathecal injection of N-methyl-D-aspartic acid receptor (NMDAR) antagonist 2-amino-5-phosphonovaleric acid (APV) or 5-HT3 receptor antagonist Y-25130 blocked stress-induced wide-spreading hyperalgesia. These results suggest that NMDAR-dependent central sensitization in the spinal dorsal horn and 5-HT-dependent descending facilitation contribute to the development of wide-spreading hyperalgesia in this comorbid pain model.
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Affiliation(s)
- Jia-Heng Li
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Research Center of Stomatology, Xi'an Jiaotong University College of Stomatology, 98 West 5th Road, Xi'an, Shaanxi, 710004, People's Republic of China.,Department of Orthodontics, Xi'an Jiaotong University College of Stomatology, 98 West 5th Road, Xi'an, Shaanxi, 710004, People's Republic of China.,Department of Neural and Pain Sciences, University of Maryland School of Dentistry; the UM Center to Advance Chronic Pain Research, 650 West Baltimore Street, Baltimore, MD, 21201, USA
| | - Jia-Le Yang
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry; the UM Center to Advance Chronic Pain Research, 650 West Baltimore Street, Baltimore, MD, 21201, USA
| | - Si-Qi Wei
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Research Center of Stomatology, Xi'an Jiaotong University College of Stomatology, 98 West 5th Road, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Zhuo-Lin Li
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Research Center of Stomatology, Xi'an Jiaotong University College of Stomatology, 98 West 5th Road, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Anna A Collins
- Department of Orthodontics, Xi'an Jiaotong University College of Stomatology, 98 West 5th Road, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Min Zou
- Department of Orthodontics, Xi'an Jiaotong University College of Stomatology, 98 West 5th Road, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Feng Wei
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry; the UM Center to Advance Chronic Pain Research, 650 West Baltimore Street, Baltimore, MD, 21201, USA.
| | - Dong-Yuan Cao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Research Center of Stomatology, Xi'an Jiaotong University College of Stomatology, 98 West 5th Road, Xi'an, Shaanxi, 710004, People's Republic of China.
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18
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Jessri M, Sultan AS, Tavares T, Schug S. Central mechanisms of pain in orofacial pain patients: Implications for management. J Oral Pathol Med 2020; 49:476-483. [PMID: 32539196 DOI: 10.1111/jop.13062] [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: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Central sensitization (CS) is a form of neuroplasticity characterized by changes in the neural sensitivity, responsiveness, and/or output that are not contingent on peripheral input nor activity-dependent. CS is characterized by activation of unmyelinated C-fibers resulting in a cascade of events at molecular and cellular levels which eventuate into generation of synaptic currents at rest. CS, therefore, contributes to heightened generalized pain sensitivity, further complicates the process of reaching a diagnosis, and increases the possibility of treatment failure. BODY: Trigeminal nerve is the main sensory supplier of the anterior part of the head, including the intraoral structures. Primary afferent nociceptors of the trigeminal nerve and low threshold mechanoreceptors synapse with wide dynamic range (WDR) neurons in the pons. This multifaceted network of nerve interactions which is further complicated by the modulatory circuits that can suppress or heighten the activity of WDR neurons is one of the main contributors to CS. The importance of CS in orofacial pain disorders is emphasized in the context of chronic pain development. As for all chronic pain conditions, it is crucial to consider the biopsychosocial aspects of chronic orofacial pain in managing this diverse group of conditions. This review highlights current understanding of the biopsychosocial model and central mechanisms contributing to the pathogenesis of chronic orofacial pain.
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Affiliation(s)
- Maryam Jessri
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Ahmed S Sultan
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Tiffany Tavares
- Department of Oral Pathology, Radiology, and Medicine, University of Missouri, Kansas City, MO, USA
| | - Stephan Schug
- Anaesthesiology and Pain Medicine, UWA Medical School, University of Western Australia, Nedlands, WA, Australia
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19
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Standard Correction of Vision Worsens EMG Activity of Pericranial Muscles in Chronic TMD Subjects. Pain Res Manag 2020; 2020:3932476. [PMID: 32351638 PMCID: PMC7178530 DOI: 10.1155/2020/3932476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/15/2020] [Accepted: 02/17/2020] [Indexed: 12/16/2022]
Abstract
Recent studies showed an evident correlation between the stomatognathic system and the visual system. These results suggest that subjects who are affected by both temporomandibular (TMD) disorders and refractive disorders present with altered control of pericranial musculature tone and higher open-eye electromyographic (EMG) values. The objective of this work was to evaluate the effects of standard vision correction on EMG in subjects suffering from TMD compared with application of the same vision treatments to non-TMD subjects. 40 subjects were enrolled in this study. The test group included 20 myopic subjects and also included patients with TMD. The control group included 20 healthy myopic subjects. All of the participants underwent a complete ocular examination and a sEMG analysis. The results showed that TMD subjects with vision disorders that are corrected with standard glasses present EMG values that are significantly higher than those presented by non-TMD subjects with vision disorders and standard glasses. Infact, in TMD subjects, eye correction did not have a positive effect on the stomatognathic or pericranial musculature.
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20
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Temporal Summation in Chronic Pelvic Pain. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:556-560. [DOI: 10.1016/j.jogc.2019.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 01/09/2023]
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21
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Faccio PF, Tavares RB, Asano NMJ, Asano AGC, Coriolano MDGWDS, Lins CCDSA. Chronic pain and depression as factors associated with temporomandibular dysfunction in older adults with Parkinson's disease. REVISTA CEFAC 2020. [DOI: 10.1590/1982-0216/20202247719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to investigate whether chronic pain and depression are factors associated with temporomandibular dysfunction (TMD) in older adults with Parkinson's disease. Methods: a cross-sectional study using the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire. The clinical variables studied were chronic pain, depression, nonspecific physical symptoms including and excluding items of pain, and dentures use. The associations between the dependent and independent variables were evaluated by the chi-square odds ratio, with a 95% confidence interval. Results: a total of 81 older adults met the eligibility criteria - 67% were males, 74% were married or had a partner, 43% reported earning 1 to 2 minimum wages, and 47% were in the moderate stage of Parkinson's disease. TMD was identified in 22% of the sample, 12% reporting chronic pain. The statistical analysis showed an association between TMD and chronic pain (p = 0.001, OR = inf, 95% CI = 12.13 - inf) and between TMD and moderate-to-severe depression (p = 0.014, OR = 4.8, 95% CI = 1.14 - 23.51). Conclusion: it was verified that chronic pain and moderate-to-severe depression were the factors associated with TMD in older adults presented with Parkinson's disease.
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22
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Kalatakis-dos-Santos AE, Fidelis-de-Paula-Gomes CA, Bassi-Dibai D, Gonçalves MC, Martins-de-Sousa PH, Pires FDO, Almeida MQG, Dibai-Filho AV. Correlation Between Habitual Physical Activity and Central Sensitization, Pain Intensity, Kinesiophobia, Catastrophizing, and the Severity of Myogenous Temporomandibular Disorder. J Chiropr Med 2019; 18:299-304. [PMID: 32952475 PMCID: PMC7486466 DOI: 10.1016/j.jcm.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We sought to correlate habitual physical activity with central sensitization, pain intensity, kinesiophobia, catastrophizing, and the severity of chronic myogenous temporomandibular disorder (TMD). METHODS This was an observational study. Fifty-five individuals, male and female, aged 18 to 45 years, with pain for at least 3 months (chronic) related to myogenous TMD were included in the study. Myogenous TMD was evaluated by means of the Numerical Rating Scale, Catastrophic Thoughts on Pain Scale, Tampa Scale for Kinesiophobia, Fonseca Anamnestic Index, Central Sensitization Inventory, and habitual physical activity by means of the Baecke Questionnaire (BQ). The Spearman correlation coefficient (r s) was applied to verify the association of the BQ score with the pain variables. RESULTS No significant correlations (P > .05) were observed in the total or mean BQ scores (both r s = -0.17 to -0.04), nor in the analyses performed on the occupational (r s = -0.03 to 0.14), sport (r s = -0.16 to 0.01), and leisure domains (r s = -0.16 to -0.02). CONCLUSION Habitual physical activity as measured by the BQ is not associated with pain intensity, catastrophizing, kinesiophobia, central sensitization, or the severity of chronic myogenous TMD.
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Affiliation(s)
| | | | - Daniela Bassi-Dibai
- Postgraduate Program in Programs Management and Health Services, Ceuma University, São Luís, MA, Brazil
| | | | | | | | | | - Almir Vieira Dibai-Filho
- Postgraduate Program in Physical Education, Federal University of Maranhão, São Luís, MA, Brazil
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Koneru SN, Staelin R, Rawe IM. Chronic pain intervention using pulsed shortwave therapy: the relationship between pain demographics and central sensitization inventory. Pain Manag 2019; 9:283-296. [PMID: 31140929 DOI: 10.2217/pmt-2018-0032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: The central sensitization inventory (CSI) is a validated, patient-reported questionnaire that quantifies symptoms of hypersensitivity disorders such as chronic pain, for which central sensitization (CS) may be the etiology. Objective: To investigate the analgesic effectiveness of ActiPatch and analyze the relationship between baseline CSI scores and demographics of chronic pain sufferers. Methods: Upon completing a 7-day ActiPatch trial, baseline CSI scores along with other assessment measures were obtained via e-mail from 174 chronic pain sufferers. Conclusion: CSI scores were positively correlated with gender (higher for women), baseline visual analog scale scores and pain duration. ActiPatch was found to be effective in reducing baseline pain for all subjects by an average of 4.3 visual analog scale points.
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Affiliation(s)
- Sree N Koneru
- Clinical Research Division, BioElectronics Corporation, Frederick, MD 13905, USA
| | - Richard Staelin
- Fuqua School of Business, Duke University, Durham, NC 27708, USA
| | - Ian M Rawe
- Clinical Research Division, BioElectronics Corporation, Frederick, MD 13905, USA
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Osiewicz M, Manfredini D, Biesiada G, Czepiel J, Garlicki A, Pytko-Polończyk J, Lobbezoo F. Differences between palpation and static/dynamic tests to diagnose painful temporomandibular disorders in patients with Lyme disease. Clin Oral Investig 2019; 23:4411-4416. [PMID: 30982182 DOI: 10.1007/s00784-019-02890-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 04/02/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The aim was to determine the frequency of Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD)-based pain diagnoses and dynamic/static tests-based pain diagnoses, and to assess the agreement of palpation tests with static/dynamic tests. MATERIALS AND METHODS Eighty-six (N = 86) adult patients with Lyme disease (mean age 57.0 ± 14.3 years; male/female ratio was 42/44) were examined according to techniques described in the RDC/TMD. Additionally, dynamic/static tests were performed. For RDC/TMD-based pain diagnoses and dynamic/static tests-based pain diagnoses, descriptive frequencies were calculated. Differences between the frequency of palpation-based diagnoses and of dynamic/static-based diagnoses as well as the agreement between pain diagnoses established with the two diagnostic approaches were assessed. RESULTS RDC/TMD-based pain diagnoses were made in 61 patients for myofascial pain and in 11 patients for arthralgia and/or osteoarthritis. Based on dynamic/static tests, mainly myogenous pain was diagnosed in 6 patients, and a mainly arthrogenous pain in 5. The agreement of palpation tests with static/dynamic tests in Lyme disease population was poor. CONCLUSION A high prevalence of TMD symptoms was found in patients with Lyme disease. The results suggest that using palpation tests alone could overestimate primary TMDs when comorbid conditions are present. CLINICAL RELEVANCE Dynamic/static tests should be used as part of the routine TMD assessment. In case of Lyme disease as the actual cause of the facial pain, while the dentist might be suspecting TMD when dynamic/static TMD tests are negative, referral to an appropriate specialist for the diagnosis and treatment of Lyme disease needs to be made.
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Affiliation(s)
- Magdalena Osiewicz
- Department of Integrated Dentistry, Dental Institute, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
| | | | - Grażyna Biesiada
- Department of Infectious and Tropical Diseases, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Czepiel
- Department of Infectious and Tropical Diseases, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Aleksander Garlicki
- Department of Infectious and Tropical Diseases, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jolanta Pytko-Polończyk
- Department of Integrated Dentistry, Dental Institute, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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De Souza Tesch R, Fernandes FS, Favilla EE, De Goffredo Filho GS, De Queiroz Faria Goes CP. Differences in non-specific physical symptom levels and pressure pain thresholds between patients with masticatory myofascial pain and arthralgia. Cranio 2018; 38:389-395. [DOI: 10.1080/08869634.2018.1531207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Welte-Jzyk C, Pfau DB, Hartmann A, Daubländer M. Somatosensory profiles of patients with chronic myogenic temporomandibular disorders in relation to their painDETECT score. BMC Oral Health 2018; 18:138. [PMID: 30092795 PMCID: PMC6085668 DOI: 10.1186/s12903-018-0601-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to characterize patients with chronic temporomandibular disorders (TMD) in terms of existing hyperalgesia against cold, heat and pressure. METHODS The extent of hyperalgesia for pressure and thermal sensation in TMD patients was determined by the use of the painDETECT questionnaire ("Is cold or heat in this area occasionally painful?" "Does slight pressure in this area, e.g., with a finger, trigger pain?") and experimental somatosensory testing against thermal and pressure stimuli (Quantitative Sensory Testing; QST). In addition, we explored psychological comorbidity among the chronic TMD patients (hospital anxiety and depression scale, HADS-D and coping strategies questionnaire, CSQ). RESULTS Nineteen patients with chronic TMD and 38 healthy subjects participated in the study. N = 12 patients had a painDETECT score ≤ 12, n = 3 patients had a painDETECT score of 13-18 and n = 4 patients had a painDETECT score ≥ 19. TMD patients with painDETECT scores ≥19 had moderately, strong or very strong enhancement of thermal and pressure pain perception, whereas patients with painDETECT scores 13-18 and ≤ 12 responded these questions with "never", "hardly noticed" or "slightly painful" (p < 0.05-0.01). With increasing painDETECT scores we found increased hyperalgesia for pressure (p < 0.01) and thermal stimuli (p < 0.05) in QST. The patients with a painDETECT score ≥ 19 showed increased signs of anxiety (p < 0.05), depression (p < 0.01), praying and hoping (p < 0.05). CONCLUSION The present study has shown that the PainDETECT questionnaire can be a helpful additional diagnostic tool. Together with QST, the PainDETECT questionnaire detected hyperalgesia for pressure and thermal sensation. Therefore the PainDETECT questionnaire is helpful to decide which TMD patients should undergo QST.
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Affiliation(s)
- C Welte-Jzyk
- Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany.
| | - D B Pfau
- Mannheim Institute of Public Health (MIPH), Social and Preventive Medicine, University of Heidelberg, Heidelberg, Germany.,Department of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim (CBTM), University of Heidelberg, Heidelberg, Germany
| | - A Hartmann
- Private Practice Dr. Seiler and colleagues, Filderstadt, Germany
| | - M Daubländer
- Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
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Casado PL, Quinelato V, Cataldo P, Prazeres J, Campello M, Bonato LL, Aguiar T. Dental genetics in Brazil: Where we are. Mol Genet Genomic Med 2018; 6:689-701. [PMID: 30078197 PMCID: PMC6160708 DOI: 10.1002/mgg3.457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022] Open
Abstract
Dentistry constitutes the basic nucleus of professionals of higher level of health in Brazil with one of the largest concentrations of dentists per capita in the world. However, the genetic in dentistry in Brazil is explored, basically, in research field. Future actions need to be performed in order to deep the whole knowledge about diagnosis and treatment of diseases with genetic basis in dentistry, in Brazil.
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Affiliation(s)
| | | | | | | | | | | | - Telma Aguiar
- Universidade Federal Fluminense, Niterói, Brazil
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Pagé MG, Fortier M, Ware MA, Choinière M. As if one pain problem was not enough: prevalence and patterns of coexisting chronic pain conditions and their impact on treatment outcomes. J Pain Res 2018; 11:237-254. [PMID: 29416373 PMCID: PMC5790081 DOI: 10.2147/jpr.s149262] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The presence of multiple coexisting chronic pain (CP) conditions (eg, low-back pain and migraines) within patients has received little attention in literature. The goals of this observational longitudinal study were to determine the prevalence of coexisting CP conditions, identify the most frequent ones and patterns of coexistence, investigate the relationships among patients' biopsychosocial characteristics and number of CP conditions, and determine the impact of coexisting CP conditions on treatment response. PATIENTS AND METHODS A total of 3,966 patients attending multidisciplinary pain-treatment centers who were enrolled in the Quebec Pain Registry were included. Patients completed self-report and nurse-administered questionnaires before their first visit and 6 months later. Results were analyzed using descriptive statistics, factor and cluster analyses, negative binomials with log-link generalized linear models, and linear mixed-effect models. RESULTS A third of patients reported coexisting CP conditions. No specific patterns of comorbidities emerged. The presence of coexisting CP conditions was associated with longer pain duration, older age, being female, and poorer quality of life. The presence of more than one CP condition did not have a clinically significant impact on treatment responses. DISCUSSION The novelty of the study results relate to the heterogeneity that was found in the patterns of coexistence of CP conditions and the fact that having multiple CP conditions did not clinically impact treatment response. These results highlight the need for future research that examines causes of coexistence among CP conditions across the spectrum of CP, as opposed to focusing on specific conditions, and to examine whether multiple CP conditions impact on additional domains, such as treatment satisfaction. These results highlight the importance of studying the pathophysiological mechanisms underlying the development of coexisting CP conditions, in order eventually to prevent/minimize their occurrence and/or develop optimal treatment and management approaches.
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Affiliation(s)
- M Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal
| | - Maude Fortier
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)
| | - Mark A Ware
- Department of Family Medicine
- Department of Anesthesia, Faculty of Medicine
- Alan Edwards Centre for Research on Pain, McGill University
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)
- Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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Gasperi M, Krieger JN, Forsberg C, Goldberg J, Buchwald D, Afari N. Chronic prostatitis and comorbid non-urological overlapping pain conditions: A co-twin control study. J Psychosom Res 2017; 102:29-33. [PMID: 28992894 PMCID: PMC5683425 DOI: 10.1016/j.jpsychores.2017.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by pain and voiding symptoms in the absence of an obvious infection or other cause. CP/CPPS frequently occurs with non-urological chronic overlapping pain conditions (COPCs) of unknown etiology. We conducted a co-twin control study in men discordant for chronic prostatitis (CP), an overarching diagnosis of which approximately 90% is CP/CPPS. The primary aim was to investigate the contribution of familial factors, including shared genetic and common environmental factors, to the comorbidity of CP and COPCs. METHODS Data from 6824 male twins in the Vietnam Era Twin Registry were examined to evaluate the association between self-reported lifetime physician diagnosis of CP with COPCs including fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, temporomandibular disorder, tension headaches, and migraine headaches. Random effects logistic regression models were used and within-pair analyses evaluated confounding effects of familial factors on the associations. RESULTS There were significant associations between CP and all 6 examined COPCs. After adjusting for shared familial influences in within twin pair analyses, the associations for all COPCs diminished but remained significant. Familial confounding was strongest for the association of CP with fibromyalgia and temporomandibular disorder and smallest for irritable bowel syndrome. CONCLUSIONS CP and COPCs are highly comorbid. These associations can be partially explained by familial factors. The mechanisms underlying these relationships are likely diverse and multifactorial. Future longitudinal research can help to further elucidate specific genetic and environmental mechanisms and determine potentially causal relationships between CP and its comorbidities.
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Affiliation(s)
- Marianna Gasperi
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | | | | | - Jack Goldberg
- University of Washington, Seattle, WA, USA,Vietnam Era Twin Registry, Seattle, WA, USA
| | - Dedra Buchwald
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Niloofar Afari
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.
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Muñoz-García D, López-de-Uralde-Villanueva I, Beltrán-Alacreu H, La Touche R, Fernández-Carnero J. Patients with Concomitant Chronic Neck Pain and Myofascial Pain in Masticatory Muscles Have More Widespread Pain and Distal Hyperalgesia than Patients with Only Chronic Neck Pain. PAIN MEDICINE 2017; 18:526-537. [PMID: 28034980 DOI: 10.1093/pm/pnw274] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Insufficient evidence exists to compare widespread pain (WP), pain sensibility, and psychological factors that occur in patients presenting with chronic neck pain (CNP) or a combination of temporomandibular disorder (TMD) and other complaints. The present study compared the pain sensibility and psychological factors of subjects with CNP with those with TMD + CNP. Design Cross-sectional study. Setting Local community. Subjects A nonprobabilistic convenience sample of 86 persons with CNP or TMD was recruited into three groups: CNP, TMD with myofascial pain in masticatory muscles with cocomitant CNP (TMD + CNP), and asymptomatic control groups consisted of 27, 29, and 30 participants, respectively. Methods Participants underwent a clinical examination to evaluate WP with computerized assessment based on the pain drawing, pressure pain thresholds (PPT), and psychological factors, which were evaluated using the pain catastrophizing scale (PCS) and the state-trait anxiety inventory (STAI). Results Statistically significant differences were observed between participants with CNP and TMD + CNP for WP (t = -2.80, P < 0.01, d = -1.06). Post hoc analyses only revealed significant differences between TMD + CNP participants and asymptomatic controls for PPT at extratrigeminal areas. Pearson correlation analyses showed a moderate positive association between symptomatic groups within the WP and STAI ( P < 0.05) and a moderate negative association between PCS and PPT ( P < 0.05) at the right tibialis muscle. Conclusion TMD + CNP participants had more areas of pain and also showed widespread pain hyperalgesia. Both groups of participants had psychological factors positively associated with STAI and WP; further, PCS and the PPT at the extratrigeminal region were negatively associated with each other in both groups, except for the left tibialis in the TMD + CNP group.
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Affiliation(s)
- Daniel Muñoz-García
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Aravaca, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Aravaca, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Héctor Beltrán-Alacreu
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Aravaca, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Aravaca, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Central Sensitization-Based Classification for Temporomandibular Disorders: A Pathogenetic Hypothesis. Pain Res Manag 2017; 2017:5957076. [PMID: 28932132 PMCID: PMC5592418 DOI: 10.1155/2017/5957076] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/03/2017] [Accepted: 07/09/2017] [Indexed: 12/15/2022]
Abstract
Dysregulation of Autonomic Nervous System (ANS) and central pain pathways in temporomandibular disorders (TMD) is a growing evidence. Authors include some forms of TMD among central sensitization syndromes (CSS), a group of pathologies characterized by central morphofunctional alterations. Central Sensitization Inventory (CSI) is useful for clinical diagnosis. Clinical examination and CSI cannot identify the central site(s) affected in these diseases. Ultralow frequency transcutaneous electrical nerve stimulation (ULFTENS) is extensively used in TMD and in dental clinical practice, because of its effects on descending pain modulation pathways. The Diagnostic Criteria for TMD (DC/TMD) are the most accurate tool for diagnosis and classification of TMD. However, it includes CSI to investigate central aspects of TMD. Preliminary data on sensory ULFTENS show it is a reliable tool for the study of central and autonomic pathways in TMD. An alternative classification based on the presence of Central Sensitization and on individual response to sensory ULFTENS is proposed. TMD may be classified into 4 groups: (a) TMD with Central Sensitization ULFTENS Responders; (b) TMD with Central Sensitization ULFTENS Nonresponders; (c) TMD without Central Sensitization ULFTENS Responders; (d) TMD without Central Sensitization ULFTENS Nonresponders. This pathogenic classification of TMD may help to differentiate therapy and aetiology.
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La Touche R, Paris-Alemany A, Hidalgo-Pérez A, López-de-Uralde-Villanueva I, Angulo-Diaz-Parreño S, Muñoz-García D. Evidence for Central Sensitization in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis of Observational Studies. Pain Pract 2017; 18:388-409. [DOI: 10.1111/papr.12604] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 05/25/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Roy La Touche
- Department of Physiotherapy; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Motion in Brains Research Group; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Institute of Neuroscience and Craniofacial Pain (INDCRAN); Madrid Spain
- Hospital La Paz Institute for Health Research; IdiPAZ; Madrid Spain
| | - Alba Paris-Alemany
- Department of Physiotherapy; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Motion in Brains Research Group; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Institute of Neuroscience and Craniofacial Pain (INDCRAN); Madrid Spain
- Hospital La Paz Institute for Health Research; IdiPAZ; Madrid Spain
| | - Amanda Hidalgo-Pérez
- Department of Physiotherapy; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Physiotherapy; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Motion in Brains Research Group; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Institute of Neuroscience and Craniofacial Pain (INDCRAN); Madrid Spain
- Hospital La Paz Institute for Health Research; IdiPAZ; Madrid Spain
| | - Santiago Angulo-Diaz-Parreño
- Motion in Brains Research Group; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Faculty of Medicine; San Pablo CEU University; Madrid Spain
| | - Daniel Muñoz-García
- Department of Physiotherapy; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
- Motion in Brains Research Group; Centro Superior de Estudios Universitarios La Salle; Universidad Autónoma de Madrid; Madrid Spain
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Influence of TNF-α-308 G/A gene polymorphism on temporomandibular disorder. Am J Orthod Dentofacial Orthop 2017; 149:692-8. [PMID: 27131251 DOI: 10.1016/j.ajodo.2015.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Tumor necrosis factor alpha (TNF-α) levels are significantly upregulated in the synovial fluid of patients with temporomandibular joint disorder (TMD). The TNF-α influences pain generation and maintenance. Therefore, the aim of this study was to investigate the influence of single nucleotide polymorphism TNFA-308 (rs1800629) on TMD risk and on the pressure pain threshold. METHODS The genotypic and allelic frequencies of candidate single nucleotide polymorphisms were compared among 152 TMD patients and 91 sex- and age-matched healthy subjects in the control group using the real-time polymerase chain reaction technique. The pressure pain threshold in the temporomandibular joint, anterior fascicle of the temporal muscle, masseter muscle, and Achilles tendon were recorded with an algometer. After the pressure test, all participants received a complete physical examination, including masticatory muscle evaluation, temporomandibular joint palpation, and assessment of mandibular range of motion. RESULTS The TNFA-308 polymorphism is positively associated with TMD. Subjects with TMD had a 2.87 (95% confidence interval, 1.256-6.569) times greater chance of having the GA genotype than did the control group. Rare A-allele homozygotes demonstrated decreased pain sensitivity for the temporomandibular joint and anterior fascicle of the temporal muscle in the pressure pain threshold test compared with ancestral allele homozygotes. CONCLUSIONS This study presents an unprecedented association between the TNFA-308 (rs1800629) polymorphism and TMD. Future studies are needed to enlighten the association between TNFA-308 G/A single nucleotide polymorphism and mechanical pain sensitivity.
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Temporomandibular disorders and painful comorbidities: clinical association and underlying mechanisms. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:288-297. [DOI: 10.1016/j.oooo.2016.12.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/07/2016] [Accepted: 12/13/2016] [Indexed: 12/31/2022]
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Sanders C, Liegey-Dougall A, Haggard R, Buschang P, Karbowski S, Riggs R, Gatchel RJ. Temporomandibular Disorder Diagnostic Groups Affect Outcomes Independently of Treatment in Patients at Risk for Developing Chronicity: A 2-Year Follow-Up Study. J Oral Facial Pain Headache 2017; 30:187-202. [PMID: 27472521 DOI: 10.11607/ofph.1613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To evaluate whether a biobehavioral intervention would be more effective than a self-care intervention or no intervention in reducing psychosocial distress, reducing pain, and improving functioning in patients with an acute myofascial temporomandibular disorder (m-TMD). METHODS Participants (n = 435) were from community dental clinics in the Dallas-Fort Worth Metroplex who were seeking treatment for their acute TMD symptoms and were recruited between 2008 and 2013. The participants were diagnosed using the Research Diagnostic Criteria for TMD (RDC/TMD) and assigned to a biobehavioral intervention, self-care intervention, or no intervention. Three outcomes were assessed: psychosocial distress, pain, and functioning; and treatment effectiveness was assessed according to TMD diagnosis. Outcome evaluations were conducted immediately postintervention as well as at 1 and 2 years postintervention. Analyses were conducted using two-level hierarchical multilevel linear models (MLMs). RESULTS Contrary to expectations, patients did not respond differently to the intervention based on their TMD diagnosis. Acute m-TMD patients, especially those with other comorbid TMD diagnoses, reported the highest levels of pain and pain-related symptoms and disability. They also exhibited poorer jaw functioning, especially if they were at high risk for chronic TMD. CONCLUSION This study indicates that acute m-TMD tends to result in more severe symptom presentations, particularly if diagnosed in combination with other TMD comorbidities. Additionally, patients do not appear to respond better to biobehavioral or self-care intervention on the basis of their TMD diagnosis.
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Bonato LL, Quinelato V, De Felipe Cordeiro PC, De Sousa EB, Tesch R, Casado PL. Association between temporomandibular disorders and pain in other regions of the body. J Oral Rehabil 2016; 44:9-15. [DOI: 10.1111/joor.12457] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2016] [Indexed: 01/14/2023]
Affiliation(s)
- L. L. Bonato
- TMD and Orofacial Pain; School of Medicine of Petropolis; Rio de Janeiro RJ Brazil
- Department of Dentistry; Fluminense Federal University; Niteroi RJ Brazil
| | - V. Quinelato
- Department of Dentistry; Fluminense Federal University; Niteroi RJ Brazil
| | | | - E. B. De Sousa
- Program of Cell and Developmental Biology; Institute of Biomedical Sciences; Rio de Janeiro Federal University; Rio de Janeiro RJ Brazil
- Research Division; National Institute of Traumatology and Orthopedics Jamil Haddad; Rio de Janeiro RJ Brazil
| | - R. Tesch
- School of Medicine of Petropo-lis; Metropolis RJ Brazil
- Brazilian Dental Association - Petropolis and Duque de Caxias; Rio de Janeiro RJ Brazil
- Pontificia Universi-dad Catolica Madre y Maestra; Santo Domingo Dominican Republic
| | - P. L. Casado
- Periodontology Department; Fluminense Federal University; Niteroi RJ Brazil
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Psychosocial and Somatosensory Factors in Women with Chronic Migraine and Painful Temporomandibular Disorders. Pain Res Manag 2016; 2016:3945673. [PMID: 27818609 PMCID: PMC5081434 DOI: 10.1155/2016/3945673] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 09/12/2016] [Accepted: 09/20/2016] [Indexed: 01/01/2023]
Abstract
Introduction. Psychosocial and somatosensory factors are involved in the pathophysiology of chronic migraine (CM) and chronic temporomandibular disorders (TMD). Objective. To compare and assess the relationship between pain catastrophizing and kinesiophobia in patients with CM or chronic TMD. Method. Cross-sectional study of 20 women with CM, 19 with chronic TMD, and 20 healthy volunteers. Pain catastrophizing and kinesiophobia were assessed. The level of education, pain intensity, and magnitude of temporal summation of stimuli in the masseter (STM) and tibialis (STT) muscles were also evaluated. Results. There were significant differences between the CM and chronic TMD groups, compared with the group of asymptomatic subjects, for all variables (p < .05) except kinesiophobia when comparing patients with CM and healthy women. Moderate correlations between kinesiophobia and catastrophizing (r = 0.46; p < .01) were obtained, and the strongest association was between kinesiophobia and magnification (r = 0.52; p < .01). The strongest associations among physical variables were found between the STM on both sides (r = 0.93; p < .01) and between the left and right STT (r = 0.76; p < .01). Conclusion. No differences were observed in pain catastrophizing and kinesiophobia between women with CM and with chronic TMD. Women with CM or chronic TMD showed higher levels of pain catastrophizing than asymptomatic subjects.
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Campi LB, Jordani PC, Tenan HL, Camparis CM, Gonçalves DAG. Painful temporomandibular disorders and central sensitization: implications for management-a pilot study. Int J Oral Maxillofac Surg 2016; 46:104-110. [PMID: 27553896 DOI: 10.1016/j.ijom.2016.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 05/12/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Abstract
The objective was to investigate the presence of cutaneous allodynia and hyperalgesia in the trigeminal and extra-trigeminal areas, as a surrogate for central sensitization (CS), in women with a painful temporomandibular disorder (TMD) and without other painful conditions. Painful TMDs, depression, and non-specific physical symptoms (NSPS) were classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The amount of pain in the trigeminal and extra-trigeminal areas was determined using a visual analogue scale (0-100mm) after the application of a vibrotactile stimulus and assessment of the pressure pain threshold (PPT). Statistical tests (Fisher's, χ2, and Mann-Whitney) were performed, with a significance level of 5%. The sample comprised 45 women (mean age 37.5 years; 16 with a painful TMD) who were free of any headache, fibromyalgia, or other painful condition. Painful TMD was associated with higher pain sensitivity and lower PPT values in the trigeminal (P<0.01) and extra-trigeminal regions (P<0.01). The presence of depression contributed significantly to increased pain sensitivity. The presence of hyperalgesia and allodynia in both the trigeminal and extra-trigeminal regions among women with a painful TMD indicated the presence of CS. Changes involving the central nervous system should be considered during the evaluation and management of patients with a painful TMD.
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Affiliation(s)
- L B Campi
- Araraquara School of Dentistry, Universidade Estadual Paulista - UNESP, Araraquara, Sao Paulo, Brazil.
| | - P C Jordani
- Araraquara School of Dentistry, Universidade Estadual Paulista - UNESP, Araraquara, Sao Paulo, Brazil
| | - H L Tenan
- Araraquara School of Dentistry, Universidade Estadual Paulista - UNESP, Araraquara, Sao Paulo, Brazil
| | - C M Camparis
- Araraquara School of Dentistry, Universidade Estadual Paulista - UNESP, Araraquara, Sao Paulo, Brazil
| | - D A G Gonçalves
- Araraquara School of Dentistry, Universidade Estadual Paulista - UNESP, Araraquara, Sao Paulo, Brazil
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Shtein RM, Harper DE, Pallazola V, Harte SE, Hussain M, Sugar A, Williams DA, Clauw DJ. Discordant Dry Eye Disease (An American Ophthalmological Society Thesis). TRANSACTIONS OF THE AMERICAN OPHTHALMOLOGICAL SOCIETY 2016; 114:T4. [PMID: 28050051 PMCID: PMC5189926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To improve understanding of dry eye disease and highlight a subgroup of patients who have a component of central sensitization and neuropathic pain contributing to their condition. METHODS Prospective, cross-sectional, IRB-approved study comparing isolated dry eye disease (n=48) to fibromyalgia (positive control; n=23) and healthy (negative control; n=26) individuals with ocular surface examination, corneal confocal microscopy, quantitative sensory testing, and self-reported ocular symptoms and systemic associations. A subset of patients also underwent skin biopsy and/or brain neuroimaging. Dry eye patients were split into concordant (ie, those with dry eyes on examination) and discordant (ie, those with dry eye symptoms but normal examination) subgroups for further analysis. We hypothesized that on the systemic measures included, concordant patients would resemble healthy controls, whereas discordant patients would show evidence of centralized mechanisms similar to fibromyalgia. RESULTS Schirmer test and Ocular Surface Disease Index (OSDI) scores indicated significant decreases in tear production (Schirmer: healthy, 18.5±8.2 mm; dry, 11.2±5.4 mm; fibromyalgia, 14.4±7.5; P<.001) and increases in self-reported dry eye symptoms (OSDI: healthy, 1.9±3.0; dry, 20.3±17.7; fibromyalgia, 20.3±17.1; P<.001) in the dry eye and fibromyalgia patients, compared to controls. The discordant subgroup had decreased corneal nerve density and decreased visual quality-of-life scores, similar to patients with fibromyalgia. Concordant patients were more similar to healthy controls on these measures. CONCLUSIONS Individuals with discordant dry eye may have a central pathophysiologic mechanism leading to their eye pain symptoms, which could be an important factor to consider in treatment of chronic idiopathic dry eye.
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Affiliation(s)
- Roni M Shtein
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School (Dr Shtein, Mr Pallazola, Ms Hussain, Dr Sugar), and the Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School (Dr Harper, Dr Harte, Dr Williams, Dr Clauw)
| | - Daniel E Harper
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School (Dr Shtein, Mr Pallazola, Ms Hussain, Dr Sugar), and the Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School (Dr Harper, Dr Harte, Dr Williams, Dr Clauw)
| | - Vincent Pallazola
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School (Dr Shtein, Mr Pallazola, Ms Hussain, Dr Sugar), and the Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School (Dr Harper, Dr Harte, Dr Williams, Dr Clauw)
| | - Steven E Harte
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School (Dr Shtein, Mr Pallazola, Ms Hussain, Dr Sugar), and the Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School (Dr Harper, Dr Harte, Dr Williams, Dr Clauw)
| | - Munira Hussain
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School (Dr Shtein, Mr Pallazola, Ms Hussain, Dr Sugar), and the Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School (Dr Harper, Dr Harte, Dr Williams, Dr Clauw)
| | - Alan Sugar
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School (Dr Shtein, Mr Pallazola, Ms Hussain, Dr Sugar), and the Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School (Dr Harper, Dr Harte, Dr Williams, Dr Clauw)
| | - David A Williams
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School (Dr Shtein, Mr Pallazola, Ms Hussain, Dr Sugar), and the Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School (Dr Harper, Dr Harte, Dr Williams, Dr Clauw)
| | - Daniel J Clauw
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School (Dr Shtein, Mr Pallazola, Ms Hussain, Dr Sugar), and the Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School (Dr Harper, Dr Harte, Dr Williams, Dr Clauw)
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Niddam D, Lee SH, Su YT, Chan RC. Brain structural changes in patients with chronic myofascial pain. Eur J Pain 2016; 21:148-158. [DOI: 10.1002/ejp.911] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2016] [Indexed: 11/08/2022]
Affiliation(s)
- D.M. Niddam
- Brain Research Center; National Yang-Ming University; Taipei Taiwan
- Institute of Brain Science; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - S.-H. Lee
- Department of Physical Medicine and Rehabilitation; National Yang-Ming University; Taipei Taiwan
- Department of Physical Medicine and Rehabilitation; Taipei Veterans General Hospital; Taipei Taiwan
| | - Y.-T. Su
- Department of Physical Medicine and Rehabilitation; Far Eastern Memorial Hospital; New Taipei City Taiwan
| | - R.-C. Chan
- Department of Physical Medicine and Rehabilitation; National Yang-Ming University; Taipei Taiwan
- Department of Physical Medicine and Rehabilitation; Taipei Veterans General Hospital; Taipei Taiwan
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Furquim BD, Flamengui LMSP, Conti PCR. TMD and chronic pain: a current view. Dental Press J Orthod 2016; 20:127-33. [PMID: 25741834 PMCID: PMC4373025 DOI: 10.1590/2176-9451.20.1.127-133.sar] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/02/2014] [Indexed: 11/22/2022] Open
Abstract
This review aims at presenting a current view on the physiopathologic mechanisms
associated with temporomandibular disorders (TMDs). While joint pain is characterized
by a well-defined inflammatory process mediated by tumor necrosis factor-α and
interleukin, chronic muscle pain presents with enigmatic physiopathologic mechanisms,
being considered a functional pain syndrome similar to fibromyalgia, irritable bowel
syndrome, interstitial cystitis and chronic fatigue syndrome. Central sensitization
is the common factor unifying these conditions, and may be influenced by the
autonomic nervous system and genetic polymorphisms. Thus, TMDs symptoms should be
understood as a complex response which might get worse or improve depending on an
individual's adaptation.
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Robinson LJ, Durham J, Newton JL. A systematic review of the comorbidity between Temporomandibular Disorders and Chronic Fatigue Syndrome. J Oral Rehabil 2015; 43:306-16. [PMID: 26549386 DOI: 10.1111/joor.12367] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED The most common cause of chronic oro-facial pain is a group of disorders collectively termed temporomandibular disorders (TMDs). Chronic painful TMD is thought to be a 'central sensitivity syndrome' related to hypersensitivity of the nervous system, but the cause is unknown. A similar understanding is proposed for other unexplained conditions, including chronic fatigue syndrome (CFS). Exploring the comorbidity of the two conditions is a valuable first step in identifying potential common aetiological mechanisms or treatment targets. METHOD Systematic literature review. Studies were included if they recruited community or control samples and identified how many reported having both TMD and CFS, or if they recruited a sample of patients with either TMD or CFS and measured the presence of the other condition. RESULTS Six papers met inclusion criteria. In studies of patients with CFS (n = 3), 21-32% reported having TMD. In a sample of people with CFS and fibromyalgia, 50% reported having TMD. Studies in people with TMD (n = 3) reported 0-43% having CFS. Studies in samples recruited from oro-facial pain clinics (n = 2) reported a lower comorbidity with CFS (0-10%) than a study that recruited individuals from a TMD self-help organisation (43%). CONCLUSION The review highlights the limited standard of evidence addressing the comorbidity between oro-facial pain and CFS. There is a valuable signal that the potential overlap in these two conditions could be high; however, studies employing more rigorous methodology including standardised clinical assessments rather than self-report of prior diagnosis are needed.
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Affiliation(s)
- L J Robinson
- Academic Psychiatry, Newcastle University, Newcastle upon Tyne, UK.,Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Durham
- Centre for Oral Health Research and Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - J L Newton
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Durham J, Raphael KG, Benoliel R, Ceusters W, Michelotti A, Ohrbach R. Perspectives on next steps in classification of oro-facial pain - part 2: role of psychosocial factors. J Oral Rehabil 2015; 42:942-55. [PMID: 26257252 DOI: 10.1111/joor.12329] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 11/30/2022]
Abstract
This study was initiated by a symposium, in which the present authors contributed, organised by the International RDC/TMD Consortium Network in March 2013. The purpose of the study was to review the status of biobehavioural research - both quantitative and qualitative - related to oro-facial pain (OFP) with respect to the aetiology, pathophysiology, diagnosis and management of OFP conditions, and how this information can optimally be used for developing a structured OFP classification system for research. In particular, we address representation of psychosocial entities in classification systems, use of qualitative research to identify and understand the full scope of psychosocial entities and their interaction, and the usage of classification system for guiding treatment. We then provide recommendations for addressing these problems, including how ontological principles can inform this process.
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Affiliation(s)
- J Durham
- Centre for Oral Health Research & Institute of Health & Society, Newcastle University, Newcastle, UK
| | - K G Raphael
- New York University College of Dentistry, New York, NY, USA
| | - R Benoliel
- Rutgers School of Dental Medicine, Newark, NJ, USA
| | | | | | - R Ohrbach
- University at Buffalo, Buffalo, NY, USA
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Dahan H, Shir Y, Velly A, Allison P. Specific and number of comorbidities are associated with increased levels of temporomandibular pain intensity and duration. J Headache Pain 2015; 16:528. [PMID: 26002637 PMCID: PMC4441879 DOI: 10.1186/s10194-015-0528-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/02/2015] [Indexed: 12/22/2022] Open
Abstract
Background Temporomandibular pain disorder (TMD) is a common pain condition in the face. People with TMD report multiple pain comorbidities. The presence of fibromyalgia and migraine in people with TMD is associated with an increase in TMD pain intensity and duration. However, data on the relationship between increasing number of pain comorbidities and TMD pain are rare. The aims of this study were: firstly to evaluate the extent to which increasing number of comorbidities is associated with increasing TMD pain intensity and duration; and secondly to evaluate the extent to which the presence of specific comorbidities is associated with increasing TMD pain intensity and duration. Methods The sample included 180 people seeking TMD treatment at Boston and Montreal clinics. TMD was diagnosed using the Research Diagnostic Criteria for TMD. A Numerical Pain Rating Scale assessed TMD pain intensity and participants provided their TMD pain duration in a study questionnaire. The comorbidities of migraine, chronic fatigue syndrome, irritable bowel syndrome, interstitial cystitis and restless leg syndrome were diagnosed by 5 validated diagnostic questionnaires. The associations were analyzed by linear regression, controlling for confounders. Results There was a positive association between the number of comorbidities present and TMD pain intensity (p < 0.01) and between the number of comorbidities present and TMD pain duration (p < 0.01). Also, the presence of migraine was positively associated with TMD pain intensity (p < 0.01) and the presence of chronic fatigue syndrome was positively associated with TMD pain intensity (p < 0.05) and with TMD pain duration (p < 0.01). When TMD patients were separated into groups, these associations did not change for the myofascial pain group, whereas in the non-myofascial pain group, the relationship between number of comorbidities and TMD pain duration was the only one still present. Conclusion This study shows that the number of comorbidities is positively associated with TMD pain duration and intensity. The presence of specific conditions, such as migraine and chronic fatigue syndrome, is associated with an increase in TMD intensity and duration.
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Affiliation(s)
- Haissam Dahan
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, H3A 1G1, Canada,
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Durham J, Nixdorf DR. Healthcare pathway and biopsychosocial impact of persistent dentoalveolar pain disorder: a qualitative study. Int Endod J 2014; 47:1151-9. [DOI: 10.1111/iej.12263] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 02/05/2014] [Indexed: 01/08/2023]
Affiliation(s)
- J. Durham
- Institute for Health and Society and Centre for Oral Health Research; Newcastle University; Newcastle UK
| | - D. R. Nixdorf
- Division of TMD & Orofacial Pain; School of Dentistry and Department of Neurology; Medical School; University of Minnesota; Minneapolis MN USA
- HealthPartners Institute for Education and Research; Bloomington MN USA
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Developing Effective and Efficient care pathways in chronic Pain: DEEP study protocol. BMC Oral Health 2014; 14:6. [PMID: 24447722 PMCID: PMC3909482 DOI: 10.1186/1472-6831-14-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/13/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pain affecting the face or mouth and lasting longer than three months ("chronic orofacial pain", COFP) is relatively common in the UK. This study aims to describe and model current care pathways for COFP patients, identify areas where current pathways could be modified, and model whether these changes would improve outcomes for patients and use resources more efficiently. METHODS/DESIGN The study takes a prospective operations research approach. A cohort of primary and secondary care COFP patients (n = 240) will be recruited at differing stages of their care in order to follow and analyse their journey through care. The cohort will be followed for two years with data collected at baseline 6, 12, 18, and 24 months on: 1) experiences of the care pathway and its impacts; 2) quality of life; 3) pain; 4) use of health services and costs incurred; 5) illness perceptions. Qualitative in-depth interviews will be used to collect data on patient experiences from a purposive sub-sample of the total cohort (n = 30) at baseline, 12 and 24 months. Four separate appraisal groups (public, patient, clincian, service manager/commissioning) will then be given data from the pathway analysis and asked to determine their priority areas for change. The proposals from appraisal groups will inform an economic modelling exercise. Findings from the economic modelling will be presented as incremental costs, Quality Adjusted Life Years (QALYs), and the incremental cost per QALY gained. At the end of the modelling a series of recommendations for service change will be available for implementation or further trial if necessary. DISCUSSION The recent white paper on health and the report from the NHS Forum identified chronic conditions as priority areas and whilst technology can improve outcomes, so can simple, appropriate and well-defined clinical care pathways. Understanding the opportunity cost related to care pathways benefits the wider NHS. This research develops a method to help design efficient systems built around one condition (COFP), but the principles should be applicable to a wide range of other chronic and long-term conditions.
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Türp JC, Schindler HJ, Antes G. [Temporomandibular disorders: Evaluation of the usefulness of a self-test questionnaire]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2013; 107:285-90. [PMID: 23916266 DOI: 10.1016/j.zefq.2013.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 05/08/2013] [Accepted: 05/13/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND A self-test questionnaire has been provided in the internet and in some dental offices for some time now. By using this questionnaire, interested individuals may assess whether they have a temporomandibular disorder (TMD) which might require therapy. It is the aim of this article to examine whether the 11 questions are apt to reliably identify patients with suspected TMDs within a given population. METHODS Each question has been examined for its relevance by resorting to the current literature. Accordingly, the inclusion of each question into the self-test questionnaire has been rated as suitable or unsuitable. RESULTS Only 2½ of the 11 questions are useful to detect individuals with as-yet undiagnosed TMDs. CONCLUSIONS Due to its missing content validity, the questionnaire cannot be recommended.
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Affiliation(s)
- Jens C Türp
- Klinik für Rekonstruktive Zahnmedizin und Myoarthropathien, Universitätskliniken für Zahnmedizin, Basel, Schweiz.
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