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Ao X, Parisien M, Fillingim RB, Ohrbach R, Slade GD, Diatchenko L, Smith SB. Whole-genome methylation profiling reveals regions associated with painful temporomandibular disorders and active recovery processes. Pain 2024; 165:1060-1073. [PMID: 38015635 PMCID: PMC11018476 DOI: 10.1097/j.pain.0000000000003104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/24/2023] [Indexed: 11/30/2023]
Abstract
ABSTRACT Temporomandibular disorders (TMDs), collectively representing one of the most common chronic pain conditions, have a substantial genetic component, but genetic variation alone has not fully explained the heritability of TMD risk. Reasoning that the unexplained heritability may be because of DNA methylation, an epigenetic phenomenon, we measured genome-wide DNA methylation using the Illumina MethylationEPIC platform with blood samples from participants in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study. Associations with chronic TMD used methylation data from 496 chronic painful TMD cases and 452 TMD-free controls. Changes in methylation between enrollment and a 6-month follow-up visit were determined for a separate sample of 62 people with recent-onset painful TMD. More than 750,000 individual CpG sites were examined for association with chronic painful TMD. Six differentially methylated regions were significantly ( P < 5 × 10 -8 ) associated with chronic painful TMD, including loci near genes involved in the regulation of inflammatory and neuronal response. A majority of loci were similarly differentially methylated in acute TMD consistent with observed transience or persistence of symptoms at follow-up. Functional characterization of the identified regions found relationships between methylation at these loci and nearby genetic variation contributing to chronic painful TMD and with gene expression of proximal genes. These findings reveal epigenetic contributions to chronic painful TMD through methylation of the genes FMOD , PM20D1 , ZNF718 , ZFP57 , and RNF39 , following the development of acute painful TMD. Epigenetic regulation of these genes likely contributes to the trajectory of transcriptional events in affected tissues leading to resolution or chronicity of pain.
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Affiliation(s)
- Xiang Ao
- Faculty of Dental Medicine and Oral Health Sciences; Department of Anesthesia, Faculty of Medicine and Health Sciences; Alan Edwards Centre for Research on Pain; McGill University, Montreal, Canada
| | - Marc Parisien
- Faculty of Dental Medicine and Oral Health Sciences; Department of Anesthesia, Faculty of Medicine and Health Sciences; Alan Edwards Centre for Research on Pain; McGill University, Montreal, Canada
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York
| | - Gary D. Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Luda Diatchenko
- Faculty of Dental Medicine and Oral Health Sciences; Department of Anesthesia, Faculty of Medicine and Health Sciences; Alan Edwards Centre for Research on Pain; McGill University, Montreal, Canada
| | - Shad B. Smith
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
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Wang Y, Kim SH, Klein ME, Chen J, Gu E, Smith S, Bortsov A, Slade GD, Zhang X, Nackley AG. A mouse model of chronic primary pain that integrates clinically relevant genetic vulnerability, stress, and minor injury. Sci Transl Med 2024; 16:eadj0395. [PMID: 38598615 DOI: 10.1126/scitranslmed.adj0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/15/2024] [Indexed: 04/12/2024]
Abstract
Chronic primary pain conditions (CPPCs) affect over 100 million Americans, predominantly women. They remain ineffectively treated, in large part because of a lack of valid animal models with translational relevance. Here, we characterized a CPPC mouse model that integrated clinically relevant genetic (catechol-O-methyltransferase; COMT knockdown) and environmental (stress and injury) factors. Compared with wild-type mice, Comt+/- mice undergoing repeated swim stress and molar extraction surgery intervention exhibited pronounced multisite body pain and depressive-like behavior lasting >3 months. Comt+/- mice undergoing the intervention also exhibited enhanced activity of primary afferent nociceptors innervating hindpaw and low back sites and increased plasma concentrations of norepinephrine and pro-inflammatory cytokines interleukin-6 (IL-6) and IL-17A. The pain and depressive-like behavior were of greater magnitude and longer duration (≥12 months) in females versus males. Furthermore, increases in anxiety-like behavior and IL-6 were female-specific. The effect of COMT genotype × stress interactions on pain, IL-6, and IL-17A was validated in a cohort of 549 patients with CPPCs, demonstrating clinical relevance. Last, we assessed the predictive validity of the model for analgesic screening and found that it successfully predicted the lack of efficacy of minocycline and the CB2 agonist GW842166X, which were effective in spared nerve injury and complete Freund's adjuvant models, respectively, but failed in clinical trials. Yet, pain in the CPPC model was alleviated by the beta-3 adrenergic antagonist SR59230A. Thus, the CPPC mouse model reliably recapitulates clinically and biologically relevant features of CPPCs and may be implemented to test underlying mechanisms and find new therapeutics.
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Affiliation(s)
- Yaomin Wang
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Shin Hyung Kim
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Marguerita E Klein
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Jiegen Chen
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Elizabeth Gu
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Shad Smith
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Andrey Bortsov
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Gary D Slade
- Center for Pain Research and Innovation, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Xin Zhang
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Andrea G Nackley
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC 27710, USA
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Shrestha P, Graff M, Gu Y, Wang Y, Avery CL, Ginnis J, Simancas-Pallares MA, Ferreira Zandoná AG, Ahn HS, Nguyen KN, Lin DY, Preisser JS, Slade GD, Marazita ML, North KE, Divaris K. Multi-ancestry Genome-Wide Association Study of Early Childhood Caries. medRxiv 2024:2024.03.12.24303742. [PMID: 38562815 PMCID: PMC10984042 DOI: 10.1101/2024.03.12.24303742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Early childhood caries (ECC) is the most common non-communicable childhood disease. It is an important health problem with known environmental and social/behavioral influences that lacks evidence for specific associated genetic risk loci. To address this knowledge gap, we conducted a genome-wide association study of ECC in a multi-ancestry population of U.S. preschool-age children (n=6,103) participating in a community-based epidemiologic study of early childhood oral health. Calibrated examiners used ICDAS criteria to measure ECC with the primary trait using the dmfs index with decay classified as macroscopic enamel loss (ICDAS ≥3). We estimated heritability, concordance rates, and conducted genome-wide association analyses to estimate overall genetic effects; the effects stratified by sex, household water fluoride, and dietary sugar; and leveraged the combined gene/gene-environment effects using the 2-degree-of-freedom (2df) joint test. The common genetic variants explained 24% of the phenotypic variance (heritability) of the primary ECC trait and the concordance rate was higher with a higher degree of relatedness. We identified 21 novel non-overlapping genome-wide significant loci for ECC. Two loci, namely RP11-856F16 . 2 (rs74606067) and SLC41A3 (rs71327750) showed evidence of association with dental caries in external cohorts, namely the GLIDE consortium adult cohort (n=∼487,000) and the GLIDE pediatric cohort (n=19,000), respectively. The gene-based tests identified TAAR6 as a genome-wide significant gene. Implicated genes have relevant biological functions including roles in tooth development and taste. These novel associations expand the genomics knowledge base for this common childhood disease and underscore the importance of accounting for sex and pertinent environmental exposures in genetic investigations of oral health.
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Sanders AE, Divaris K, Godebo TR, Slade GD. Effect of bottled fluoridated water to prevent dental caries in primary teeth: study protocol for a phase 2 parallel-group 3.5-year randomized controlled clinical trial (waterBEST). Trials 2024; 25:167. [PMID: 38443989 PMCID: PMC10913546 DOI: 10.1186/s13063-024-08000-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Fluoridation of public water systems is known as a safe and effective strategy for preventing dental caries based on evidence from non-randomized studies. Yet 110 million Americans do not have access to a fluoridated public water system and many others do not drink tap water. This article describes the study protocol for the first randomized controlled trial (RCT) of fluoridated water that assesses its potential dental caries preventive efficacy when delivered in bottles. METHODS waterBEST is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo-controlled, parallel-group trial designed to estimate the potential efficacy of fluoridated versus non-fluoridated bottled water to prevent dental caries incidence in the first 4 years of life. Two hundred children living in eastern North Carolina, USA, and aged 2-6 months at screening are being allocated at random in a 1:1 ratio to receive fluoridated (0.7 mg/L F) or non-fluoridated bottled water sourced from two local public water systems. Throughout the 3.5-year intervention, study water is delivered monthly in 5-gallon bottles to each child's home with instructions to use it whenever the child consumes water as a beverage or in food preparation. Parents are interviewed quarterly to monitor children's water consumption and health. At annual visits, the presence of dental caries is evaluated with a dental screening examination. Clippings from fingernails and toenails are collected to quantify fluoride content as a biomarker of total fluoride intake. The primary endpoint is the number of primary tooth surfaces decayed, missing, or filled due to dental caries measured by the study dentist near the time of the child's fourth birthday. Tooth decay is assessed at the threshold of macroscopic enamel loss. For the primary aim, a least-squares, generalized linear model will estimate efficacy and its one-tailed, upper 80% confidence limit. DISCUSSION waterBEST is the first evaluation of a randomized intervention of fluoridated drinking water in bottles to prevent dental caries in the primary dentition. This innovative method of delivering fluoridated water has the potential to prevent early childhood caries in a large segment of the US population that currently does not benefit from fluoridated public water. TRIAL REGISTRATION ClinicalTrials.gov NCT04893681. Registered on March 2022. Last update posted on 10 October 2023. https://clinicaltrials.gov/study/NCT04893681?cond=Dental%20Caries%20in%20Children&term=fluoride&locStr=North%20Carolina,%20USA&country=United%20States&state=North%20Carolina&distance=50&rank=1.
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Affiliation(s)
- Anne E Sanders
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kimon Divaris
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tewodros R Godebo
- Department of Environmental Health Sciences, Tulane University, New Orleans, LA, USA
| | - Gary D Slade
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sanders AE, Godebo TR, Divaris K, Slade GD. Effect of bottled fluoridated water to prevent dental caries in primary teeth: study protocol for a phase 2 parallel group 3.5-year randomized controlled clinical trial (waterBEST). Res Sq 2024:rs.3.rs-3632524. [PMID: 38410455 PMCID: PMC10896389 DOI: 10.21203/rs.3.rs-3632524/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Background Fluoridation of public water systems is known as a safe and effective strategy for preventing dental caries based on evidence from non-randomized studies. Yet 110 million Americans do not have access to a fluoridated public water system and many others do not drink tap water. This article describes the study protocol for the first randomized controlled trial (RCT) of fluoridated water that assesses its potential dental caries preventive efficacy when delivered in bottles. Methods waterBEST is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo controlled, parallel group, trial designed to estimate the potential efficacy of fluoridated versus non-fluoridated bottled water to prevent dental caries incidence in the first four years of life. Two hundred children living in eastern North Carolina, USA, and aged 2-6 months at screening are being allocated at random in a 1:1 ratio to receive fluoridated (0.7 mg/L F) or non-fluoridated bottled water sourced from two local public water systems. Throughout the 3.5-year intervention, study water is delivered monthly in 5-gallon bottles to each child's home with instructions to use it whenever the child consumes water as a beverage or in food preparation. Parents are interviewed quarterly to monitor children's water consumption and health. At annual visits, the presence of dental caries is evaluated with a dental screening examination. Clippings from fingernails and toenails are collected to quantify fluoride content as a biomarker of total fluoride intake. The primary endpoint is the number of primary tooth surfaces decayed, missing, or filled due to dental caries measured by the study dentist near the time of the child's fourth birthday. Tooth decay is assessed at the threshold of macroscopic enamel loss. For the primary aim, a least-squares, generalized linear model will estimate efficacy and its one-tailed, upper 80% confidence limit. Discussion waterBEST is the first evaluation of a randomized intervention of fluoridated drinking water in bottles to prevent dental caries in the primary dentition. This innovative method of delivering fluoridated water has potential to prevent early childhood caries in a large segment of the U.S. population that currently does not benefit from fluoridated public water.
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Affiliation(s)
- Anne E Sanders
- UNC-Chapel Hill: The University of North Carolina at Chapel Hill
| | | | - Kimon Divaris
- UNC-Chapel Hill: The University of North Carolina at Chapel Hill
| | - Gary D Slade
- UNC-Chapel Hill: The University of North Carolina at Chapel Hill
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Daline IH, Slade GD, Fouad AF, Nixdorf DR, Tchivileva IE. Diagnostic Accuracy of a Temporomandibular Disorder Pain Screener in Patients Seeking Endodontic Treatment for Tooth Pain. J Endod 2024; 50:55-63. [PMID: 38379174 DOI: 10.1016/j.joen.2023.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 02/22/2024]
Abstract
INTRODUCTION This study assessed the accuracy of a TMD Pain Screener questionnaire in identifying patients with temporomandibular disorder (TMD) pain among those seeking endodontic treatment for tooth pain. It also investigated whether the screener accuracy could be improved by adding questions regarding putative predictors of TMD status. METHODS One hundred patients seeking endodontic treatment for tooth pain were enrolled. Participants completed the 6-question TMD Pain Screener before treatment. A board-certified orofacial pain specialist/endodontic resident conducted endodontic and TMD examinations using validated Diagnostic Criteria for TMD (DC/TMD). The sensitivity (Se), specificity (Sp), and positive/negative predictive values (PPVs/NPVs) were calculated for the 6-question and 3-question versions of the TMD Pain Screener. Logistic regression and receiver operating characteristic curve (AUROC) analyses were performed to determine the screening accuracy. RESULTS At the screening threshold of ≥3, TMD Pain Screener's sensitivity was 0.85, specificity 0.52, PPV 0.68, and NPV 0.75 for the 6-question version and 0.64, 0.65, 0.69, and 0.61, respectively, for the 3-question version. The AUROC was 0.71 (95% CL: 0.61, 0.82) and 0.60 (95% CL: 0.48, 0.71) for full and short versions, respectively. Adding a rating of current pain intensity of the chief complaint to the screener improved the AUROC to 0.81 (95% CL: 0.72, 0.89) and 0.77 (95% CL: 0.67, 0.86) for full and short versions, respectively, signifying useful overall accuracy. CONCLUSIONS The 6-question TMD Pain Screener, combined with the patient's rating of current pain intensity of the chief complaint, could be recommended for use in endodontic patients with tooth pain for detecting painful TMD.
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Affiliation(s)
- Iryna H Daline
- Division of Comprehensive Oral Health-Endodontics, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gary D Slade
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Ashraf F Fouad
- Department Endodontics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Department of Radiology, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Inna E Tchivileva
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Saraiya V, Bradshaw PT, Meyer K, Lund J, Slade GD, Olshan AF. The association between the Mediterranean Diet Score and death from cancer of the head and neck. Cancer Causes Control 2024; 35:77-92. [PMID: 37561271 DOI: 10.1007/s10552-023-01761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE The association between diet quality, captured by the Mediterranean Diet Score (MDS), and mortality was studied among 1184 individuals diagnosed with head and neck cancer (HNC) who reflected on the year preceding diagnosis about their usual diet using National Cancer Institute's Diet History Questionnaire (DHQ). METHODS Intakes of nine dietary components were scored and summed to construct the MDS (sample: median = 4; range (0-9); lower MDS reflected poorer diet quality; 5-year survival probability = 0.62). Cox regression estimated 5-year hazard ratios (HR) and 95% confidence intervals (95CI) for all-cause mortality and for HNC-specific death for contrasts of MDS quintiles. Effect measure modification (EMM) by tumor features [human papillomavirus (HPV) positivity; anatomic site] and sociodemographic behavioral factors [race, body mass index (BMI), smoking, alcohol consumption] was explored. RESULTS The 5-year [HR (95CI); P-trend] for all-cause mortality and HNC-specific mortality for highest versus lowest MDS quintile contrasts were [0.51 (0.33, 0.80); 0.014] and [0.43 (0.22, 0.85); 0.004], respectively. A unit increase in MDS adherence resulted in a 15% reduction of the 5-year HR for HNC-specific death for tumors located at the oral cavity [HR (95CI): 0.85 (0.75, 0.96)]. Poor diet quality (MDS ≤ 4) interacted with lower BMI (kg/m2 < 25) and separately with ever-using alcohol to produce 5-year HRs for all-cause and HNC-specific mortality that were statistically significantly larger than the sum of the individual HRs representing each combination (Poor diet quality + lower BMI; Poor diet quality + ever-using alcohol). CONCLUSION Greater adherence to a Mediterranean diet pattern prior to HNC diagnosis may reduce post-diagnosis mortality.
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Affiliation(s)
- Veeral Saraiya
- University of North Carolina-Chapel Hill Center for Health Promotion and Disease Prevention, Chapel Hill, NC, USA.
| | - Patrick T Bradshaw
- Department of Epidemiology, University of California-Berkeley, School of Public Health, Berkeley, CA, USA
| | - Katie Meyer
- Department of Nutrition, University of North Carolina-Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Jennifer Lund
- Department of Epidemiology, University of North Carolina-Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Gary D Slade
- Department of Oral and Craniofacial Health Sciences, University of North Carolina-Chapel Hill Adams School of Dentistry, Chapel Hill, NC, USA
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina-Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
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Sanders AE, Wallace ED, Ehrmann BM, Soma PS, Shaikh SR, Preisser JS, Ohrbach R, Fillingim RB, Slade GD. Non-esterified erythrocyte linoleic acid, arachidonic acid, and subjective sleep outcomes. Prostaglandins Leukot Essent Fatty Acids 2023; 195:102580. [PMID: 37451068 PMCID: PMC10529142 DOI: 10.1016/j.plefa.2023.102580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE This study investigated whether non-esterified erythrocyte omega-6 PUFAs were associated with subjective assessment of sleep quality and duration, and risk for obstructive sleep apnea. METHODS In this secondary analysis of the cross-sectional OPPERA-II study, 538 adults completed the Pittsburgh Sleep Quality Index (PSQI), reported their usual hours of sleep, and answered STOP screening questions for obstructive sleep apnea. Circulating non-esterified erythrocyte concentrations of omega-6 PUFA linoleic acid and arachidonic acid were quantified by liquid chromatography tandem mass spectroscopy. Sleep outcomes were dichotomized as poor (PSQI ≤5) vs good (PSQI ≥6) sleep quality, insufficient or excessive (≤6 or >9 h) vs good (7-9 h) sleep duration, and high (≥2 affirmative responses) vs low (<2 affirmative responses) risk for obstructive sleep apnea. Non-esterified omega-6 PUFAs and the continuous covariates of body mass index, Short Form (SF) 12 Health Survey Physical and Mental Component scores and resting measures of systolic and diastolic blood pressure were standardized for multivariable analysis. Categorical covariates were study site, age, sex, and race/ethnicity. Multivariable-adjusted logistic regression first estimated odds ratios (OR) and 95% confidence limits (CL) for sleep outcomes using linoleic acid as the main exposure. Analysis was then repeated using arachidonic acid as the main exposure. RESULTS In the multivariable-adjusted model, each standard deviation increase in non-esterified erythrocyte linoleic acid was associated with higher odds of poor sleep quality (OR=1.2, 95% CL: 1.1, 1.5), insufficient or excessive sleep (OR= 1.3, 95% CL: 1.1, 1.6) and high-risk for obstructive sleep apnea (OR=1.3, 95% CL: 1.1, 1.6). Likewise, for each standard deviation increase in non-esterified erythrocyte arachidonic acid, odds increased of poor sleep quality (OR=1.2, 95% CL: 1.1, 1.5), and insufficient or excessive sleep (OR=1.2, 95% CL: 1.1, 1.5). Odds of being high risk for obstructive sleep apnea increased with greater circulating arachidonic acid, but the association did not reach statistical significance (OR=1.1, 95% CL: 0.9, 1.4). CONCLUSION Non-esterified erythrocyte linoleic acid and arachidonic acid were associated with poor sleep quality and insufficient or excessive sleep duration. Linoleic acid, but not arachidonic acid, was also associated with high risk for obstructive sleep apnea.
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Affiliation(s)
- Anne E Sanders
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - E Diane Wallace
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Brandie M Ehrmann
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Paul S Soma
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Saame R Shaikh
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - John S Preisser
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, NY 14260, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL 32611, USA; Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL 32611, USA
| | - Gary D Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Tchivileva IE, Johnson KW, Chai X, VanDam LR, Lim PF, Slade GD. Evaluation of Plasma Calcitonin Gene-Related Peptide as a Biomarker for Painful Temporomandibular Disorder and Migraine. J Pain Res 2023; 16:2331-2346. [PMID: 37456357 PMCID: PMC10349596 DOI: 10.2147/jpr.s408044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To assess associations of plasma calcitonin gene-related peptide (CGRP) with chronic temporomandibular disorder (TMD) myalgia/arthralgia or frequent/chronic migraine, alone and in combination, and to evaluate relations between the CGRP concentration and clinical, psychological, and somatosensory characteristics of participants. Methods The cross-sectional study selected four groups of adult volunteers: healthy controls (HCs), TMD without migraine, migraine without TMD, and TMD with migraine. Each group comprised 20 participants, providing 94% power to detect statistically significant associations with CGRP concentration for either TMD or migraine. TMD and headache were classified according to the Diagnostic Criteria for TMD and the International Classification for Headache Disorders, 3rd edition, respectively. Plasma CGRP was quantified with a validated high-sensitivity electrochemiluminescent Meso Scale Discovery assay. Questionnaires and clinical examinations were used to evaluate characteristics of TMD, headache, psychological distress, and pressure pain sensitivity. Univariate regression models quantified associations of the CGRP concentration with TMD, migraine, and their interaction. Univariate associations of the CGRP concentration with clinical, psychological, and pressure pain characteristics were also assessed. Results Among 80 participants enrolled, neither TMD nor migraine was associated with plasma CGRP concentration (P = 0.761 and P = 0.972, respectively). The CGRP concentration (mean ± SD) was similar in all 4 groups: HCs 2.0 ± 0.7 pg/mL, TMD 2.1 ± 0.8 pg/mL, migraine 2.1 ± 0.9 pg/mL, and TMD with migraine 2.2 ± 0.7 pg/mL. CGRP concentration was positively associated with age (P = 0.034) and marginally with body mass index (P = 0.080) but was unrelated to other participant characteristics. Conclusion In this well-powered study, interictal plasma concentration of CGRP was a poor biomarker for TMD and migraine.
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Affiliation(s)
- Inna E Tchivileva
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kirk W Johnson
- Pain Research, Eli Lilly and Company, Indianapolis, IN, USA
| | - Xiyun Chai
- Precision Medicine Neuroscience, AbbVie, Chicago, IL, USA
| | | | - Pei Feng Lim
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Diagnostic Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gary D Slade
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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10
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Daline IH, Slade GD, Fouad AF, Nixdorf DR, Tchivileva IE. Prevalence of painful temporomandibular disorders in endodontic patients with tooth pain. J Oral Rehabil 2023. [PMID: 37021602 DOI: 10.1111/joor.13457] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Pain from temporomandibular disorders (TMDs) may mimic endodontic pain, but its prevalence in endodontic patients is unknown. OBJECTIVES This cross-sectional study investigated prevalence of painful TMDs in patients presenting for endodontic treatment of a painful tooth. Contribution of TMD pain to the chief complaint and characteristics associated with TMD prevalence were also assessed. METHODS Patients reporting tooth pain in the 30 days before attending university clinics for non-surgical root canal treatment or retreatment were enrolled. Before endodontic treatment, they completed questionnaires and a board-certified orofacial pain specialist/endodontic resident diagnosed TMD using published Diagnostic Criteria for TMD. Log-binomial regression models estimated prevalence ratios to quantify associations with patient characteristics. RESULTS Among 100 patients enrolled, prevalence of painful TMDs was 54%. In 26% of patients, TMD pain was unrelated to endodontic pain; in 20%, TMD contributed to their chief pain complaint; and in 8%, TMD was a sole etiology for pain. TMD prevalence was associated with greater intensity, frequency, and duration of the chief pain complaint; pain in more than one tooth; tenderness to tooth percussion and palpation; a diagnosis of symptomatic apical periodontitis; pain medication use; and psychological distress. CONCLUSION A majority of patients with tooth pain seeking endodontic treatment had painful TMDs; one quarter had TMD as a component or sole cause of their pain. TMD prevalence was associated with more severe symptoms and signs of tooth pain and with psychological factors. The high frequency of TMD comorbidity warrants consideration in management of endodontic patients with history of toothache.
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Affiliation(s)
- Iryna Hryvenko Daline
- Division of Comprehensive Oral Health - Endodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Gary D Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Ashraf F Fouad
- Department Endodontics, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donald R Nixdorf
- Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Inna E Tchivileva
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
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11
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Sharma S, Slade GD, Fillingim RB, Ohrbach R. A rose by another name? Characteristics that distinguish headache secondary to temporomandibular disorder from headache that is comorbid with temporomandibular disorder. Pain 2023; 164:820-830. [PMID: 36048529 PMCID: PMC9971346 DOI: 10.1097/j.pain.0000000000002770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/19/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Co-occurring pain conditions that affect overlapping body regions are complicated by the distinction between primary vs secondary pain conditions. We investigate the occurrence of headache and painful temporomandibular disorder (TMD) in a community-based, cross-sectional study of US adults in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA-II) study. A specific goal was to determine whether headache attributed to TMD is separable from primary headache. Using DC/TMD and International Classification of Headache Disorders-third edition criteria, 3 groups of individuals were created: (a) headache without TMD; (b) headache comorbid with TMD; and (c) headache attributed to TMD. Regression models compared study groups according to demographic and comorbid characteristics, and post hoc contrasts tested for differences. Descriptive statistics and Cohen d effect size were computed, by group, for each predictor variable. Differences in continuous predictors were analyzed using one-way analysis of variance. Nearly all demographic and comorbid variables distinguished the combined headache and TMD groups from the group with headache alone. Relative to the reference group with primary headache alone, markers related to headache, TMD, somatic pain processing, psychosocial, and health conditions were substantially greater in both headache comorbid with TMD and headache attributed to TMD, attesting to their qualitative similarities. However, effect sizes relative to the reference group were large for headache comorbid with TMD and larger again for headache attributed to TMD, attesting to their separability in quantitative terms. In summary, the presence of overlapping painful TMD and headache adds substantially to the biopsychosocial burden of headache and points to the importance of comprehensive assessment and differential management.
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Affiliation(s)
- Sonia Sharma
- Department of Neurosurgery, Neuro Pain Management Center, University of Rochester Medical Center, Rochester, NY, United States
- Department of Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, NY, United States
| | - Gary D Slade
- Division of Pediatric and Population Health, UNC Adams School of Dentistry, Chapel Hill, NC, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, NY, United States
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12
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Sanders AE, Weatherspoon ED, Ehrmann BM, Soma PS, Shaikh SR, Preisser JS, Ohrbach R, Fillingim RB, Slade GD. Circulating Polyunsaturated Fatty Acids and Pain Intensity in Five Chronic Pain Conditions. J Pain 2023; 24:478-489. [PMID: 36273777 PMCID: PMC9991951 DOI: 10.1016/j.jpain.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
Pain intensity is well-known to be influenced by a wide range of biobehavioral variables. Nutritional factors, however, have not been generally considered for their potential importance. This cross-sectional study examined associations between erythrocyte omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acids (PUFAs) and pain intensity in 605 adults. Pain intensity was computed on a 0 to 100 numeric rating scale from questions about 5 chronic pain conditions: orofacial pain, headache, low back pain, irritable bowel syndrome, and bodily pain. For each pain condition, multiple linear regression tested the hypothesis that a higher ratio of n-6 arachidonic acid to the sum of n-3 eicosapentaenoic acid and docosahexaenoic acid (AA/(EPA+DHA) was associated with greater pain intensity. In covariate-adjusted analysis, orofacial pain intensity increased 5.7 points (95% CI: 1.4, 9.9) per unit increase in n-6/n-3 PUFA ratio. Likewise, a 1 unit increase in n-6/n-3 PUFA ratio was associated with significant increases in pain intensity (range 5-8 points) of headache pain, low back pain, and bodily pain, but not abdominal pain. Separate multiple linear regression models investigated the independent strength of association of individual PUFAs to the intensity of each pain condition. Overall, n-3 docosahexaenoic acid was most strongly, and inversely, associated with pain intensity. PERSPECTIVE: A higher ratio of n-6/n-3 long-chain polyunsaturated fatty acids was associated greater pain intensity for orofacial pain, headache, low back pain, and bodily pain, but not abdominal pain. The n-6/n-3 PUFA ratio was more consistently associated with pain intensity than any individual constituent of the long-chain PUFA ratio.
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Affiliation(s)
- Anne E Sanders
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - E Diane Weatherspoon
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brandie M Ehrmann
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paul S Soma
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Saame R Shaikh
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John S Preisser
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida
| | - Gary D Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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13
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Soma PS, Ehrmann BM, Slade GD, Sanders AE, Weatherspoon ED. Dataset linking free polyunsaturated fatty acid concentrations in erythrocytes with chronic pain conditions in adults. Data Brief 2022; 46:108802. [PMID: 36561927 PMCID: PMC9764200 DOI: 10.1016/j.dib.2022.108802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Circulating polyunsaturated fatty acids (PUFAs) and lipid mediators were extracted from human red blood cells and quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The method encompassed 13 different PUFAs and lipid mediators, however, due to instrument capability only five were confidently quantified (EPA, ALA, AA, DHA, and LA). The extraction focused on free polyunsaturated fatty acids since they have a strong correlation with health in humans. The study design was a secondary analysis of the OPPERA-2 study of chronic overlapping pain conditions in adults. The data included are: a) raw LC-MS/MS data (.raw); b) processed data (.xlsx) including chromatographic peak area for each compound and a concentration (ng/mL) based on external calibration with internal standardization using pure analytical grade standards and heavy-isotope labeled internal standards; c) study participant demographics and phenotypes (.xlsx). This dataset consisting of circulating PUFA quantities measured in 605 humans has been made publicly available for analysis and interpretation.
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Affiliation(s)
- Paul S. Soma
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Brandie M. Ehrmann
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Gary D. Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Anne E. Sanders
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - E. Diane Weatherspoon
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States,Corresponding author. @DianeW_Chem
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14
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Sanders AE, Weatherspoon ED, Ehrmann BM, Soma PS, Shaikh SR, Preisser JS, Ohrbach R, Fillingim RB, Slade GD. Ratio of Omega-6/Omega-3 Polyunsaturated Fatty Acids Associated With Somatic and Depressive Symptoms in People With Painful Temporomandibular Disorder and Irritable Bowel Syndrome. J Pain 2022; 23:1737-1748. [PMID: 35477107 PMCID: PMC9561958 DOI: 10.1016/j.jpain.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/24/2022] [Accepted: 04/07/2022] [Indexed: 04/27/2023]
Abstract
Somatic symptom disturbance is among the strongest predictors of painful temporomandibular disorder (TMD). Related psychological constructs, such as anxiety and depression, respond therapeutically to omega-3 polyunsaturated fatty acids (PUFAs) in clinical trials. This cross-sectional study investigated associations between the omega-6/omega-3 PUFA ratio and somatic symptom disturbance and depressive symptoms in a community-based sample of 501 adults and determined whether these associations differed between adults with and without TMD or irritable bowel syndrome (IBS). Liquid chromatography tandem mass spectrometry quantified PUFAs in circulating erythrocytes. Somatic symptoms and depression were quantified using Symptom Checklist-90-Revised subscales. Presence or absence of TMD and IBS, respectively, were determined by clinical examination and Rome III screening questions. The standardized beta coefficient for the omega-6/omega-3 long-chain PUFA ratio was 0.26 (95% confidence limits (CL): 0.08, 0.43) in a multivariable linear regression model in which somatic symptom disturbance was the dependent variable. When modelling depressive symptoms as the dependent variable, the standardized beta coefficient was 0.17 (95% CL:0.01, 0.34). Both associations were stronger among TMD cases and IBS cases than among non-cases. Future randomized control trials that lower the omega-6/omega-3 PUFA ratio could consider somatic or depressive symptoms as a therapeutic target for TMD or IBS pain. PERSPECTIVE: In people with TMD or IBS, a high n-6/n-3 PUFA ratio was positively associated with somatic symptom disturbance and depressive symptoms. Both measures of psychological distress were elevated in people with painful TMD and IBS. Future randomized clinical trials will determine whether lowering the n-6/n-3 ratio is therapeutic for pain.
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Affiliation(s)
- Anne E Sanders
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina.
| | - E Diane Weatherspoon
- Department of Chemistry, University of North Carolina, Chapel Hill, North Carolina
| | - Brandie M Ehrmann
- Department of Chemistry, University of North Carolina, Chapel Hill, North Carolina
| | - Paul S Soma
- Department of Chemistry, University of North Carolina, Chapel Hill, North Carolina
| | - Saame R Shaikh
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - John S Preisser
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida
| | - Gary D Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina
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15
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Sanders AE, Weatherspoon ED, Ehrmann BM, Soma PS, Shaikh SR, Preisser JS, Ohrbach R, Fillingim RB, Slade GD. Circulating Omega-6 and Omega-3 Polyunsaturated Fatty Acids in Painful Temporomandibular Disorder and Low Back Pain. J Pain 2022; 23:1724-1736. [PMID: 35697285 PMCID: PMC9561056 DOI: 10.1016/j.jpain.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/03/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023]
Abstract
Preclinical studies demonstrate opposing effects of long-chain polyunsaturated fatty acid (PUFA) metabolites on inflammation and nociception. Omega-6 (n-6) PUFAs amplify both processes while omega-3 (n-3) PUFAs inhibit them. This cross-sectional study examined relationships between PUFAs in circulating erythrocytes and 2 chronic idiopathic pain conditions: temporomandibular disorder (TMD) and low back pain in a community-based sample of 503 U.S. adults. Presence or absence of TMD and low back pain, respectively, were determined by clinical examination and by responses to established screening questions. Liquid chromatography-tandem mass spectrometry quantified PUFAs. In multivariable logistic regression models, a higher ratio of n-6/n-3 long-chain PUFAs was associated with greater odds of TMD (odds ratio ((OR) = 1.75, 95% confidence limits (CL): 1.16, 2.64) and low back pain (OR = 1.63, 95% CL: 1.07, 2.49). Higher levels of the pronociceptive n-6 long-chain arachidonic acid (AA) were associated with a greater probability of both pain conditions for women, but not men. Higher levels of the antinociceptive long-chain n-3 PUFAs eicosapentaenoic and docosahexaenoic acids were associated with a lower probability of both pain conditions for men, but not women. As systemic inflammation is not a hallmark of these conditions, PUFAs may influence idiopathic pain through other mechanisms. PERSPECTIVE: This cross-sectional clinical study found that a higher ratio of circulating n-6/n-3 long-chain PUFAs was associated with greater odds of 2 common chronic overlapping pain conditions. This suggests that the pro and antinociceptive properties of n-6 and n-3 PUFAs, respectively, influence pain independently of their well-established inflammatory pathways.
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Affiliation(s)
- Anne E Sanders
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - E Diane Weatherspoon
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brandie M Ehrmann
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paul S Soma
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Saame R Shaikh
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John S Preisser
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida
| | - Gary D Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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16
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Sanders AE, Weatherspoon ED, Ehrmann BM, Soma PS, Shaikh SR, Preisser JS, Ohrbach R, Fillingim RB, Slade GD. Circulating polyunsaturated fatty acids, pressure pain thresholds, and nociplastic pain conditions. Prostaglandins Leukot Essent Fatty Acids 2022; 184:102476. [PMID: 35908377 PMCID: PMC10363286 DOI: 10.1016/j.plefa.2022.102476] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Polyunsaturated fatty acids (PUFAs) play a role in pain regulation. This study sought to determine whether free PUFAs found in red blood cells also play a role in nociceptive processing. We examined associations between circulating PUFAs and nociceptive thresholds to noxious mechanical stimuli. We also determined whether nociceptive thresholds were associated with nociplastic pain conditions. METHODS This cross-sectional study used stored red bloods cells and data from 605 adult participants in the OPPERA-2 study of chronic overlapping pain conditions. In OPPERA-2 adults completed quantitative sensory testing in which pressure algometry measured deep muscular tissue sensitivity at six anatomical sites. Standardized protocols classified adults for presence or absence of five nociplastic pain conditions: temporomandibular disorder, headache, low back pain, irritable bowel syndrome and fibromyalgia. Liquid chromatography tandem mass spectroscopy quantified erythrocyte PUFAs. We conducted three sets of analyses. First, a multivariable linear regression model assessed the association between n-6/n-3 PUFA ratio and the number of overlapping nociplastic pain conditions. Second, a series of 36 multivariable linear regression models assessed covariate-adjusted associations between PUFAs and nociceptive thresholds at each of six anatomical sites. Third, a series of 30 multivariable linear regression models assessed covariate-adjusted associations between nociceptive thresholds at six anatomical sites and each of five pain conditions. RESULTS In multiple linear regression, each unit increase in n-6/n-3 PUFA ratio was associated with more pain conditions (β = 0.30, 95% confidence limits: 0.07, 0.53, p = 0.012). Omega-6 linoleic acid and arachidonic acid were negatively associated with lower nociceptive thresholds at three and at five, respectively, anatomical sites. In contrast, omega-3 alpha-linolenic acid, eicosapentaenoic acid, docosahexaenoic acid and the n-6/n-3 PUFA ratio were not associated with nociceptive thresholds at any site. Pain cases had significantly lower nociceptive thresholds than non-case controls at all anatomical sites. CONCLUSION A higher n-6/n-3 PUFA ratio was associated with more pain conditions. Omega-6 PUFAs may promote a generalized upregulation of nociceptive processing.
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Affiliation(s)
- Anne E Sanders
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America.
| | - E Diane Weatherspoon
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Brandie M Ehrmann
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Paul S Soma
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Saame R Shaikh
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - John S Preisser
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, NY 14260, United States of America
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL 32611, United States of America; Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL 32611, United States of America
| | - Gary D Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
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Parisien M, Lima LV, Dagostino C, El-Hachem N, Drury GL, Grant AV, Huising J, Verma V, Meloto CB, Silva JR, Dutra GGS, Markova T, Dang H, Tessier PA, Slade GD, Nackley AG, Ghasemlou N, Mogil JS, Allegri M, Diatchenko L. Acute inflammatory response via neutrophil activation protects against the development of chronic pain. Sci Transl Med 2022; 14:eabj9954. [PMID: 35544595 DOI: 10.1126/scitranslmed.abj9954] [Citation(s) in RCA: 98] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The transition from acute to chronic pain is critically important but not well understood. Here, we investigated the pathophysiological mechanisms underlying the transition from acute to chronic low back pain (LBP) and performed transcriptome-wide analysis in peripheral immune cells of 98 participants with acute LBP, followed for 3 months. Transcriptomic changes were compared between patients whose LBP was resolved at 3 months with those whose LBP persisted. We found thousands of dynamic transcriptional changes over 3 months in LBP participants with resolved pain but none in those with persistent pain. Transient neutrophil-driven up-regulation of inflammatory responses was protective against the transition to chronic pain. In mouse pain assays, early treatment with a steroid or nonsteroidal anti-inflammatory drug (NSAID) also led to prolonged pain despite being analgesic in the short term; such a prolongation was not observed with other analgesics. Depletion of neutrophils delayed resolution of pain in mice, whereas peripheral injection of neutrophils themselves, or S100A8/A9 proteins normally released by neutrophils, prevented the development of long-lasting pain induced by an anti-inflammatory drug. Analysis of pain trajectories of human subjects reporting acute back pain in the UK Biobank identified elevated risk of pain persistence for subjects taking NSAIDs. Thus, despite analgesic efficacy at early time points, the management of acute inflammation may be counterproductive for long-term outcomes of LBP sufferers.
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Affiliation(s)
- Marc Parisien
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Lucas V Lima
- Department of Psychology, Faculty of Science, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Concetta Dagostino
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Nehme El-Hachem
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Gillian L Drury
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Audrey V Grant
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Jonathan Huising
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen 6525, Netherlands
| | - Vivek Verma
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Carolina B Meloto
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Jaqueline R Silva
- Departments of Anesthesiology and Perioperative Medicine and Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Gabrielle G S Dutra
- Department of Psychology, Faculty of Science, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Teodora Markova
- Department of Psychology, Faculty of Science, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Hong Dang
- Cystic Fibrosis Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Philippe A Tessier
- Department of Microbiology and Immunology, Faculty of Medicine, Laval University, Quebec City, Quebec G1V 0A6, Canada
| | - Gary D Slade
- Center for Pain Research and Innovation, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Andrea G Nackley
- Center for Translational Pain Medicine and Departments of Anesthesiology and Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - Nader Ghasemlou
- Departments of Anesthesiology and Perioperative Medicine and Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Jeffrey S Mogil
- Department of Psychology, Faculty of Science, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Massimo Allegri
- Pain Therapy Service, Policlinico of Monza Hospital, Monza 20900, Italy.,Pain Management and Neuromodulation Centre, Ensemble Hospitalier de la Côte, Morges 1110, Switzerland
| | - Luda Diatchenko
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
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18
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Akinkugbe AA, Brickhouse TH, Bandyopadhyay D, Nascimento MM, Slade GD. Prepregnancy BMI, gestational weight gain and offspring caries experience: Avon longitudinal study of parents and children. PLoS One 2022; 17:e0266247. [PMID: 35358251 PMCID: PMC8970488 DOI: 10.1371/journal.pone.0266247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/17/2022] [Indexed: 11/19/2022] Open
Abstract
Pre-existing maternal overweight/obesity and pregnancy weight gain are associated with adverse birth outcomes such as low birth weight and prematurity, which may increase the risk of developmental tooth defects and early childhood caries. We sought to investigate the association between prepregnancy BMI, gestational weight gain (GWG) and the risk of early childhood caries. Data from 1,429 mother-offspring participants of the 1991/1992 Avon Longitudinal Study of Parents and Children were analyzed. The exposures were prepregnancy BMI (under/normal weight vs. overweight/obese), and gestational weight gain (GWG) based on the Institute of Medicine’s recommended levels. The main outcome measured was offspring caries experience determined by clinical oral examinations at three time points. Log binomial regression estimated risk ratios and 95% confidence intervals. Seventy six percent (76%) of the mothers were under/normal weight prepregnancy, 39% and 26% respectively gained less and more than the recommended weight for their prepregnancy BMI during pregnancy. Being overweight/obese prepregnancy was associated with unadjusted RR (95% CI) of offspring caries of 1.16 (0.90, 1.51) at 31-months, 1.20 (0.96, 1.49) at 43-months and 1.09 (0.91, 1.30) at 61-months. GWG less than recommended was associated with higher unadjusted offspring caries experience of 1.13 (0.86, 1.48), 1.17 (0.92, 1.48) and 1.04 (0.87, 1.25) at 31-months, 43-months and 61-months respectively. There was insufficient evidence to indicate an association between prepregnancy BMI and gestational weight gain on offspring caries experience risk.
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Affiliation(s)
- Aderonke A. Akinkugbe
- Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, Virginia, United States of America
- * E-mail:
| | - Tegwyn H. Brickhouse
- Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Dipankar Bandyopadhyay
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Marcelle M. Nascimento
- Department of Restorative Dental Sciences, University of Florida College of Dentistry, Gainesville, Florida, United States of America
| | - Gary D. Slade
- Pediatric Public Health Department, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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19
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Gaynor SM, Fillingim RB, Zolnoun DA, Greenspan JD, Maixner W, Slade GD, Ohrbach R, Bair E. Association of Hormonal Contraceptive Use with Headache and Temporomandibular Pain: The OPPERA Study. J Oral Facial Pain Headache 2021; 35:105-112. [PMID: 34129655 DOI: 10.11607/ofph.2727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To determine the relationship between hormonal contraceptive (HC) use and painful symptoms, particularly those associated with headache and painful temporomandibular disorders (TMD). METHODS Data from the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) prospective cohort study were used. During the 2.5-year median follow-up period, quarterly health update (QHU) questionnaires were completed by 1,475 women aged 18 to 44 years who did not have TMD, menopause, hysterectomy, or hormone replacement therapy use at baseline. QHU questionnaires evaluated HC use, symptoms of headache and TMD, and pain of ≥ 1 day duration in 12 body regions. Participants who developed TMD symptoms were examined to classify clinical TMD. Headache symptoms were classified based on the International Classification of Headache Disorders 3 (ICHD-3). Associations between HC use and pain symptoms were analyzed using generalized estimating equations and Cox models. RESULTS HC use, endorsed in 33.7% of QHU questionnaires, was significantly associated with concurrent symptoms of TMD (odds ratio [OR]: 1.20, 95% CI: 1.06 to 1.35) and headache (OR: 1.26, 95% CI: 1.11 to 1.43). HC use was also significantly associated with concurrent pain of ≥ 1 day duration in the head (OR: 1.38, 95% CI: 1.16 to 1.63), face (OR: 1.44, 95% CI: 1.13 to 1.83), and legs (OR: 1.22, 95% CI: 1.01 to 1.47), but not elsewhere. Initiation of HC use was associated with increased odds of subsequent TMD symptoms (OR: 1.37, 95% CI: 1.13 to 1.66) and pain of ≥ 1 day in the head (OR: 1.37, 95% CI: 1.01 to 1.85). Discontinuing HC use was associated with lower odds of subsequent headache (OR: 0.82, 95% CI: 0.67 to 0.99). HC use was not significantly associated with subsequent onset of examiner-classified TMD. CONCLUSION These findings imply that HC influences craniofacial pain, and that this pain diminishes after cessation of HC use.
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20
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Tchivileva IE, Ohrbach R, Fillingim RB, Lin FC, Lim PF, Arbes SJ, Slade GD. Clinical, psychological, and sensory characteristics associated with headache attributed to temporomandibular disorder in people with chronic myogenous temporomandibular disorder and primary headaches. J Headache Pain 2021; 22:42. [PMID: 34022805 PMCID: PMC8141151 DOI: 10.1186/s10194-021-01255-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Headache attributed to Temporomandibular Disorder (HATMD) is a secondary headache that may have features resulting in diagnostic overlap with primary headaches, namely, tension-type (TTH) or migraine. This cross-sectional study of people with both chronic myogenous TMD and primary headaches evaluated characteristics associated with HATMD. Methods From a clinical trial of adults, baseline data were used from a subset with diagnoses of both TMD myalgia according to the Diagnostic Criteria for TMD (DC/TMD) and TTH or migraine according to the International Classification of Headache Disorders, 3rd edition. HATMD was classified based on the DC/TMD. Questionnaires and examinations evaluated 42 characteristics of facial pain, headache, general health, psychological distress, and experimental pain sensitivity. Univariate regression models quantified the associations of each characteristic with HATMD (present versus absent), headache type (TTH versus migraine), and their interaction in a factorial design. Multivariable lasso regression identified the most important predictors of HATMD. Results Of 185 participants, 114 (61.6%) had HATMD, while the numbers with TTH (n = 98, 53.0%) and migraine (n = 87, 47.0%) were similar. HATMD was more likely among migraineurs (61/87 = 70.1%) than participants with TTH (53/98 = 54.1%; odds ratio = 2.0; 95%CL = 1.1, 3.7). In univariate analyses, characteristics associated with HATMD included pain-free jaw opening and examination-evoked pain in masticatory muscles and temporomandibular joints (TMJ) as well as frequency and impact of headache, but not frequency or impact of facial pain. Lowered blood pressure but not psychological or sensory characteristics was associated with HATMD. Multiple characteristics of facial pain, headache, general health, and psychological distress differed between TTH or migraine groups. Few interactions were observed, demonstrating that most characteristics’ associations with HATMD were consistent in TTH and migraine groups. The lasso model identified headache frequency and examination-evoked muscle pain as the most important predictors of HATMD. Conclusions HATMD is highly prevalent among patients with chronic myogenous TMD and headaches and often presents as migraine. In contrast to primary headaches, HATMD is associated with higher headache frequency and examination-evoked masticatory muscle pain, but with surprisingly few measures of facial pain, general health, and psychological distress. A better understanding of HATMD is necessary for developing targeted strategies for its management. Trial identification and registration SOPPRANO; NCT02437383. Registered May 7, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01255-1.
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Affiliation(s)
- Inna E Tchivileva
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Division of Oral and Craniofacial Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Roger B Fillingim
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Feng-Chang Lin
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Pei Feng Lim
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Diagnostic Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Gary D Slade
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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21
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Khoury S, Wang QP, Parisien M, Gris P, Bortsov AV, Linnstaedt SD, McLean SA, Tungate AS, Sofer T, Lee J, Louie T, Redline S, Kaunisto MA, Kalso EA, Munter HM, Nackley AG, Slade GD, Smith SB, Zaykin DV, Fillingim RB, Ohrbach R, Greenspan JD, Maixner W, Neely GG, Diatchenko L. Multi-ethnic GWAS and meta-analysis of sleep quality identify MPP6 as a novel gene that functions in sleep center neurons. Sleep 2021; 44:zsaa211. [PMID: 33034629 PMCID: PMC7953222 DOI: 10.1093/sleep/zsaa211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/28/2020] [Indexed: 11/14/2022] Open
Abstract
Poor sleep quality can have harmful health consequences. Although many aspects of sleep are heritable, the understandings of genetic factors involved in its physiology remain limited. Here, we performed a genome-wide association study (GWAS) using the Pittsburgh Sleep Quality Index (PSQI) in a multi-ethnic discovery cohort (n = 2868) and found two novel genome-wide loci on chromosomes 2 and 7 associated with global sleep quality. A meta-analysis in 12 independent cohorts (100 000 individuals) replicated the association on chromosome 7 between NPY and MPP6. While NPY is an important sleep gene, we tested for an independent functional role of MPP6. Expression data showed an association of this locus with both NPY and MPP6 mRNA levels in brain tissues. Moreover, knockdown of an orthologue of MPP6 in Drosophila melanogaster sleep center neurons resulted in decreased sleep duration. With convergent evidence, we describe a new locus impacting human variability in sleep quality through known NPY and novel MPP6 sleep genes.
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Affiliation(s)
- Samar Khoury
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
| | - Qiao-Ping Wang
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-Sen University, Guangzhou, China
| | - Marc Parisien
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
| | - Pavel Gris
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
| | - Andrey V Bortsov
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, NC
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery and Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Samuel A McLean
- Institute for Trauma Recovery and Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew S Tungate
- Institute for Trauma Recovery and Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tamar Sofer
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Jiwon Lee
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Tin Louie
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Susan Redline
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Mari Anneli Kaunisto
- Department of Diagnostics and Therapeutics, University of Helsinki, Helsinki, Finland
| | - Eija A Kalso
- Department of Diagnostics and Therapeutics, University of Helsinki, Helsinki, Finland
| | | | - Andrea G Nackley
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, NC
| | - Gary D Slade
- School of dentistry, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Shad B Smith
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, NC
| | - Dmitri V Zaykin
- Biostatistics and Computational Biology, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | | | - Richard Ohrbach
- Department of Oral Diagnostic Services, University at Buffalo, Buffalo, NY
| | - Joel D Greenspan
- Department of Neural and Pain Sciences, Brotman Facial Pain Clinic, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD
| | - William Maixner
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, NC
| | - G Gregory Neely
- The Dr. John and Anne Chong Laboratory for Functional Genomics, Charles Perkins Centre and School of Life & Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Luda Diatchenko
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
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22
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Tchivileva IE, Ohrbach R, Fillingim RB, Lim PF, Giosia MD, Ribeiro-Dasilva M, Campbell JH, Hadgraft H, Willis J, Arbes SJ, Slade GD. Effect of comorbid migraine on propranolol efficacy for painful TMD in a randomized controlled trial. Cephalalgia 2021; 41:839-850. [PMID: 33560875 PMCID: PMC8166404 DOI: 10.1177/0333102421989268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction The migraine-preventive drug propranolol is efficacious in reducing pain from temporomandibular disorder, suggesting potential modifying or mediating effects of comorbid migraine. Methods In this randomized controlled trial, myofascial temporomandibular disorder patients were treated with propranolol or placebo for 9 weeks. The primary endpoint was change in a facial pain index derived from daily symptom diaries. Linear and logistic regression models tested for a migraine × treatment-group interaction in reducing facial pain index. Counterfactual models explored changes in headache impact and heart rate as mediators of propranolol's efficacy. Results Propranolol's efficacy in reducing facial pain index was greater among the 104 migraineurs than the 95 non-migraineurs: For example, for the binary ≥ 30% reduction in facial pain index, odds ratios were 3.3 (95% confidence limits: 1.4, 8.1) versus 1.3 (0.5, 3.2), respectively, although the interaction was statistically non-significant (p = 0.139). Cumulative response curves confirmed greater efficacy for migraineurs than non-migraineurs (differences in area under the curve 26% and 6%, respectively; p = 0.081). While 9% of the treatment effect was mediated by reduced headache impact, 46% was mediated by reduced heart rate. Conclusions Propranolol was more efficacious in reducing temporomandibular disorder pain among migraineurs than non-migraineurs, with more of the effect mediated by reduced heart rate than by reduced headache impact. Study identification and registration SOPPRANO; NCT02437383; https://clinicaltrials.gov/ct2/show/NCT02437383
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Affiliation(s)
- Inna E Tchivileva
- Center for Pain Research and Innovation, Adams School of Dentistry, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, College of Dentistry, 3463University of Florida, Gainesville, FL, USA
| | - Pei Feng Lim
- Center for Pain Research and Innovation, Adams School of Dentistry, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Diagnostic Sciences, Adams School of Dentistry, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Massimiliano Di Giosia
- Center for Pain Research and Innovation, Adams School of Dentistry, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Diagnostic Sciences, Adams School of Dentistry, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Margarete Ribeiro-Dasilva
- Department of Restorative Dental Science, Prosthodontics Division, College of Dentistry, 3463University of Florida, Gainesville, FL, USA
| | - John H Campbell
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA
| | | | | | | | - Gary D Slade
- Center for Pain Research and Innovation, Adams School of Dentistry, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Pediatric and Public Health, Adams School of Dentistry, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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23
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Divaris K, Slade GD, Ferreira Zandona AG, Preisser JS, Ginnis J, Simancas-Pallares MA, Agler CS, Shrestha P, Karhade DS, Ribeiro ADA, Cho H, Gu Y, Meyer BD, Joshi AR, Azcarate-Peril MA, Basta PV, Wu D, North KE. Cohort Profile: ZOE 2.0-A Community-Based Genetic Epidemiologic Study of Early Childhood Oral Health. Int J Environ Res Public Health 2020; 17:E8056. [PMID: 33139633 PMCID: PMC7663650 DOI: 10.3390/ijerph17218056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
Early childhood caries (ECC) is an aggressive form of dental caries occurring in the first five years of life. Despite its prevalence and consequences, little progress has been made in its prevention and even less is known about individuals' susceptibility or genomic risk factors. The genome-wide association study (GWAS) of ECC ("ZOE 2.0") is a community-based, multi-ethnic, cross-sectional, genetic epidemiologic study seeking to address this knowledge gap. This paper describes the study's design, the cohort's demographic profile, data domains, and key oral health outcomes. Between 2016 and 2019, the study enrolled 8059 3-5-year-old children attending public preschools in North Carolina, United States. Participants resided in 86 of the state's 100 counties and racial/ethnic minorities predominated-for example, 48% (n = 3872) were African American, 22% white, and 20% (n = 1611) were Hispanic/Latino. Seventy-nine percent (n = 6404) of participants underwent clinical dental examinations yielding ECC outcome measures-ECC (defined at the established caries lesion threshold) prevalence was 54% and the mean number of decayed, missing, filled surfaces due to caries was eight. Nearly all (98%) examined children provided sufficient DNA from saliva for genotyping. The cohort's community-based nature and rich data offer excellent opportunities for addressing important clinical, epidemiologic, and biological questions in early childhood.
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Affiliation(s)
- Kimon Divaris
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (P.V.B.); (K.E.N.)
| | - Gary D. Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
| | - Andrea G. Ferreira Zandona
- Department of Comprehensive Dentistry, School of Dental Medicine, Tufts University, Boston, MA 02111, USA;
| | - John S. Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (J.S.P.); (H.C.); (Y.G.); (D.W.)
| | - Jeannie Ginnis
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
| | - Miguel A. Simancas-Pallares
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
| | - Cary S. Agler
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
| | - Poojan Shrestha
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (P.V.B.); (K.E.N.)
| | - Deepti S. Karhade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
| | - Apoena de Aguiar Ribeiro
- Division of Diagnostic Sciences, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA;
| | - Hunyong Cho
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (J.S.P.); (H.C.); (Y.G.); (D.W.)
| | - Yu Gu
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (J.S.P.); (H.C.); (Y.G.); (D.W.)
| | - Beau D. Meyer
- Division of Pediatric Dentistry, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA;
| | - Ashwini R. Joshi
- Division of Surgery, School of Medicine, University of North Carolina-Chapel Hill, NC 27599-7050, USA;
| | - M. Andrea Azcarate-Peril
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, and UNC Microbiome Core, Department of Medicine, School of Medicine, University of North Carolina-Chapel Hill, NC 27599-7555, USA;
| | - Patricia V. Basta
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (P.V.B.); (K.E.N.)
| | - Di Wu
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (J.S.P.); (H.C.); (Y.G.); (D.W.)
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA
| | - Kari E. North
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (P.V.B.); (K.E.N.)
- Carolina Center for Genome Sciences, University of North Carolina-Chapel Hill, NC 27514, USA
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Slade GD, Fillingim RB, Ohrbach R, Hadgraft H, Willis J, Arbes SJ, Tchivileva IE. COMT Genotype and Efficacy of Propranolol for TMD Pain: A Randomized Trial. J Dent Res 2020; 100:163-170. [PMID: 33030089 PMCID: PMC8163522 DOI: 10.1177/0022034520962733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Propranolol is a nonselective β-adrenergic receptor antagonist that is
efficacious in reducing facial pain. There is evidence that its analgesic
efficacy might be modified by variants of the catechol-O-methyltransferase
(COMT) gene. We tested the hypothesis in a subset of 143
non-Hispanic Whites from a randomized controlled trial of patients with painful
temporomandibular disorder (TMD). Patients were genotyped for rs4680, a single
nucleotide polymorphism of COMT, and randomly allocated to
either propranolol 60 mg twice daily or placebo. During the 9-wk follow-up
period, patients recorded daily ratings of facial pain intensity and duration;
the product was computed as an index of facial pain. Postbaseline change in the
index at week 9 (the primary endpoint) was analyzed as a continuous variable and
dichotomized at thresholds of ≥30% and ≥50% reduction. Mixed models for repeated
measures tested for the genotype × treatment group interaction and estimated
means, odds ratios (ORs), and 95% confidence limits (95% CLs) of efficacy within
COMT genotypes assuming an additive genetic model. In
secondary analysis, the cumulative response curves were plotted for dichotomized
reductions ranging from ≥20% to ≥70%, and genotype differences in area under the
curve percentages (%AUC) were calculated to signify efficacy. Mean index
reduction did not differ significantly (P = 0.277) according to
genotype, whereas the dichotomized ≥30% reduction revealed greater efficacy
among G:G homozygotes (OR = 10.9, 95%CL = 2.4, 50.7) than among A:A homozygotes
(OR = 0.8, 95%CL = 0.2, 3.2) with statistically significant interaction
(P = 0.035). Cumulative response curves confirmed greater
(P = 0.003) efficacy for G:G homozygotes (%AUC difference =
43.7, 95%CL = 15.4, 72.1) than for A:A homozygotes (%AUC difference = 6.5, 95%CL
= -30.2, 43.2). The observed antagonistic effect of the A allele on
propranolol’s efficacy was opposite the synergistic effect hypothesized a
priori. This unexpected result highlights the need for better knowledge of
COMT’s role in pain pathogenesis if the gene is to be used
for precision-medicine treatment of TMD (ClinicalTrials.gov NCT02437383).
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Affiliation(s)
- G D Slade
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - R Ohrbach
- Department of Oral and Maxillofacial Surgery, University at Buffalo, State University of New York, Buffalo, NY, USA
| | | | | | | | - I E Tchivileva
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Greenspan JD, Slade GD, Rathnayaka N, Fillingim RB, Ohrbach R, Maixner W. Experimental Pain Sensitivity in Subjects with Temporomandibular Disorders and Multiple Other Chronic Pain Conditions: The OPPERA Prospective Cohort Study. J Oral Facial Pain Headache 2020; 34:s43-s56. [PMID: 32975540 PMCID: PMC10073961 DOI: 10.11607/ofph.2583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To investigate associations between experimental pain sensitivity and five chronic pain conditions among 655 participants in the OPPERA study. METHODS Quantitative sensory tests were used to measure sensitivity to three modalities of nociception: blunt pressure pain, mechanical pinprick pain, and thermal heat pain. Participants were also classified according to the presence or absence of five chronic pain conditions: temporomandibular disorders, headache, low back pain, irritable bowel syndrome, and fibromyalgia. RESULTS Univariate analyses found each modality to be significantly associated with at least one pain condition, most consistently for pressure pain sensitivity (8 of 15 instances) and least consistently for heat pain sensitivity (5 of 35 instances). Yet, multivariable analyses that evaluated the independent contributions of all five pain conditions found few significant associations (12 of 75 instances). Instead, pain sensitivity consistently varied according to the total number of pain conditions a person experienced, implying that the combination of pain conditions influences each nociceptive modality. CONCLUSION When evaluating nociceptive sensitivity in a chronic pain patient, comorbid pain conditions should be considered, as the more salient feature underlying sensitivity is likely the number rather than the type(s) of pain conditions.
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Slade GD, Greenspan JD, Fillingim RB, Maixner W, Sharma S, Ohrbach R. Overlap of Five Chronic Pain Conditions: Temporomandibular Disorders, Headache, Back Pain, Irritable Bowel Syndrome, and Fibromyalgia. J Oral Facial Pain Headache 2020; 34:s15-s28. [PMID: 32975538 PMCID: PMC10073941 DOI: 10.11607/ofph.2581] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To assess cohort retention in the OPPERA project and to compare the degree of overlap between pairs of chronic overlapping pain conditions (COPCs) using a cross-sectional analysis of data from 655 adults who completed follow-up in the OPPERA study. METHODS Subjects were classified for the absence or presence of each of the five COPCs. The extent of overlap beyond chance was quantified using odds ratios, which were calculated using binary logistic regression models. RESULTS While overlap was the norm, its magnitude varied according to COPC: 51% of people with headache had one or more overlapping COPCs, and this proportion increased to 90% for people with fibromyalgia. The degree of overlap between pairs of COPCs also varied considerably, with odds ratios being greatest for associations between musculoskeletal conditions (fibromyalgia, temporomandibular disorders, and low back pain) and less pronounced for overlap involving headache or IBS. Furthermore, univariate associations between some pairs of COPCs were nullified after adjusting for other COPCs. CONCLUSION There was greater overlap between fibromyalgia and either temporomandibular disorders or low back pain than between other pairs of COPCs. While musculoskeletal conditions exhibited some features that could be explained by a single functional syndrome, headache and irritable bowel syndrome did not.
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Sharma S, Slade GD, Fillingim RB, Greenspan JD, Rathnayaka N, Ohrbach R. Attributes Germane to Temporomandibular Disorders and Their Associations with Five Chronic Overlapping Pain Conditions. J Oral Facial Pain Headache 2020; 34:s57-s72. [PMID: 32975541 PMCID: PMC10073965 DOI: 10.11607/ofph.2582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To investigate whether TMD-related characteristics are indeed specific to TMD or whether they are also associated with other chronic overlapping pain conditions (COPCs). METHODS In this cross-sectional study, 22 characteristics related broadly to TMD (eg, jaw kinesiophobia, overuse behaviors, and functional limitation) were measured in 178 painful TMD cases who were also classified according to four COPCs: headache, low back pain, irritable bowel syndrome, and fibromyalgia. Differences in mean subscale scores were compared according to individual chronic pain conditions and according to number of COPCs. RESULTS Headache, low back pain, irritable bowel syndrome, and fibromyalgia were each associated (P < .05) with higher values of at least one TMD-relevant characteristic. In the multivariable analysis, TMD was independently associated with 20 of the 22 characteristics (P < .01), and other COPCs were associated variably. A critical threshold existed between the number of COPCs and TMD characteristics: all characteristics were elevated for subjects with ≥ 3 COPCs (P ≤ .01). CONCLUSION The overlap between COPCs and characteristics typically regarded as specific to painful TMD has implications for treatment targeted at both the local TMD condition and the broader pain disorder underlying the COPC(s). In TMD patients, the overall burden of pain from COPCs may create a shift in the pain-processing systems that underlie these TMD-relevant characteristics.
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Ohrbach R, Fillingim RB, Greenspan JD, Maixner W, Sanders AE, Sharma S, Slade GD. Authors' Response: When You Come to the Fork in the Road, Take It! Future Research into Chronic Pain as a General Condition. J Oral Facial Pain Headache 2020; 34:s12-s14. [PMID: 32975537 DOI: 10.11607/ofph.2020.suppl.ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Akinkugbe AA, Brickhouse TH, Nascimento MM, Slade GD. Prenatal smoking and the risk of early childhood caries: A prospective cohort study. Prev Med Rep 2020; 20:101201. [PMID: 33083206 PMCID: PMC7554205 DOI: 10.1016/j.pmedr.2020.101201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/14/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Dental caries is a chronic complex disease of multifactorial etiology that affects a quarter of U.S. children. This study evaluated the association between prenatal smoking and offspring caries experience and used a negative control exposure analysis to assess if the association is causal. Methods Data from 1429 mother-offspring participants of the 1991/92 Avon Longitudinal Study of Parents and Children conducted in Bristol, England were analyzed. Prenatal smoking (yes v. no) and quantity smoked (none, <half pack, ≥half pack) were self-reported while offspring caries experience was determined by clinical oral examinations at 3 time points. Discrete time hazards regression estimated hazard odds of first occurrence of offspring caries, and substituted partner smoking for prenatal smoking in a negative control exposure analysis. Results Overall, 22% smoked during pregnancy while 36% of partners smoked. The adjusted hazard odds of first occurrence of caries experience in the offsprings of prenatal smokers compared to the offsprings of non-smokers was 1.42 (95% CI: 1.08, 1.86). Relative to non-smoking, smoking <half pack/day and ≥half pack/day during pregnancy were associated with higher adjusted hazard odds of offspring caries experience: 1.10 (95% CI: 0.79, 1.54) and 1.38 (0.98, 1.95) respectively. Partner smoking was associated with 33% (95% CI: 1.07, 1.65) higher adjusted hazard odds of first offspring caries experience occurrence. Conclusions Prenatal and partner smoking appear associated with greater offspring caries experience. The positive association with partner smoking suggests either a shared genetic predisposition or unmeasured common environmental factors with the mother as opposed to a direct biological effect of the intrauterine environment.
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Affiliation(s)
- Aderonke A Akinkugbe
- Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA, United States.,Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA, United States
| | - Tegwyn H Brickhouse
- Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA, United States.,Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA, United States
| | - Marcelle M Nascimento
- Department of Restorative Dental Sciences, University of Florida College of Dentistry, Gainesville, FL, United States
| | - Gary D Slade
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Sabbah W, Slade GD, Sanders AE, Bernabé E. Denture wearing and mortality risk in edentulous American adults: A propensity score analysis. J Dent 2020; 100:103360. [PMID: 32404256 DOI: 10.1016/j.jdent.2020.103360] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the association between complete denture use and subsequent mortality among edentulous adults. METHODS Data from 1649 edentulous adults who participated in the Third National Health and Nutritional Examination Survey were linked to public-use mortality files for the period up to December 2015. Denture wearing, defined as use of complete dentures in both arches (clinically inspected) all the time or only when awake, was compared to non-wearing, defined as use of dentures occasionally or not at all. The primary outcome was all-cause mortality. Data on 27 covariates, classified as sociodemographic characteristics, behavioral factors, health insurance, laboratory tests and general health status, were used to create propensity scores for weighted and matched analyses. RESULTS In weighted data, the difference in mortality rate between denture and non-denture wearers was 11.1 (95 %CI: 3.6-18.6) deaths per 1000 person-years and the number needed to treat (NNT) at 10 years was 12. Denture wearers had 15 % lower risk of death (HR: 0.85; 95 % CI: 0.73-0.98) than non-denture wearers. In the matched sample, the mortality rate difference between denture and non-denture wearers was 8.8 (95 %CI: 0.2-17.4) deaths per 1000 person-years and the NNT at 10 years was 11. Risk of death was 21 % lower among denture wearers (HR: 0.79; 95 % CI: 0.68, 0.92) than non-denture wearers. CONCLUSION This longitudinal analysis showed that the use of complete dentures was associated with longer survival and lower all-cause mortality risk among American edentulous adults. NNT is interpreted as one death prevented after 10 years for every twelve rehabilitated dentitions with removable complete dentures. CLINICAL SIGNIFICANCE Edentulous adults wearing complete dentures had longer survival and lower overall mortality risk than non-denture wearers, suggesting that prosthodontic rehabilitation with removable complete dentures might have benefits beyond restoring oral functioning.
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Affiliation(s)
- Wael Sabbah
- Dental Public Health Group, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
| | - Gary D Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Anne E Sanders
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Eduardo Bernabé
- Dental Public Health Group, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom.
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Sanders AE, Slade GD, Fillingim RB, Ohrbach R, Arbes SJ, Tchivileva IE. Effect of Treatment Expectation on Placebo Response and Analgesic Efficacy: A Secondary Aim in a Randomized Clinical Trial. JAMA Netw Open 2020; 3:e202907. [PMID: 32297945 PMCID: PMC7163405 DOI: 10.1001/jamanetworkopen.2020.2907] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This randomized clinical trial assessed the effect of patients’ treatment expectations on the efficacy of propranolol vs placebo among patients with temporomandibular disorder–associated myalgia.
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Affiliation(s)
- Anne E. Sanders
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Gary D. Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville
| | - Richard Ohrbach
- Department of Oral and Maxillofacial Surgery, University at Buffalo, State University of New York, Buffalo
| | | | - Inna E. Tchivileva
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill
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Fillingim RB, Ohrbach R, Greenspan JD, Sanders AE, Rathnayaka N, Maixner W, Slade GD. Associations of Psychologic Factors with Multiple Chronic Overlapping Pain Conditions. J Oral Facial Pain Headache 2020; 34:s85-s100. [PMID: 32975543 PMCID: PMC10165716 DOI: 10.11607/ofph.2584] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To characterize psychologic functioning across five chronic overlapping pain conditions (COPCs)-temporomandibular disorders, fibromyalgia, low back pain, headache, and irritable bowel syndrome-and their overlaps. METHODS Participants were 655 adults in the OPPERA study. Psychologic variables were standardized in separate logistic regression models to compare their relative strength of association with each COPC. Random forest regression was used to explore the association of all psychologic measures with COPCs simultaneously. Linear regression analyses examined whether the count of COPCs was associated with psychologic measures. RESULTS In univariate and multivariable analyses, measures of somatic symptom burden showed the strongest associations with individual COPCs and with the number of COPCs. Additional psychologic variables that showed significant associations with individual COPCs and their overlap included negative mood, perceived stress, and pain catastrophizing. CONCLUSION These findings highlight the importance of psychologic functioning in the assessment and management of these overlapping pain conditions.
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Ohrbach R, Sharma S, Fillingim RB, Greenspan JD, Rosen JD, Slade GD. Clinical Characteristics of Pain Among Five Chronic Overlapping Pain Conditions. J Oral Facial Pain Headache 2020; 34:s29-s42. [PMID: 32975539 PMCID: PMC10073942 DOI: 10.11607/ofph.2573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To describe the pain characteristics of five index chronic overlapping pain conditions (COPCs) and to assess each COPC separately in order to determine whether the presence of comorbid COPCs is associated with bodily pain distribution, pain intensity, pain interference, and high-impact pain of the index COPC. METHODS Data were from a convenience sample of 655 US adults, of whom 388 had one or more of the five COPCs: painful temporomandibular disorders, headache, low back pain, irritable bowel syndrome, and/or fibromyalgia. Data were collected using pain location checklists and self-report questions regarding pain attributes. The contributions of the COPCs to reported pain intensity and interference were assessed using multivariable regression models. RESULTS/CONCLUSION Heat maps from a pain body manikin illustrated that very little of the body was pain free within these COPCs. All pain attributes were the most severe for fibromyalgia and the least severe for irritable bowel syndrome. Within each index COPC, pain intensity, pain interference, and the proportion of participants with high-impact pain increased with each additional comorbid COPC up to four or more COPCs (including the index COPC) (P < .01). High-impact pain associated with an index COPC was influenced by type and number of comorbid COPCs, largely in a gradient-specific manner.
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Sanders AE, Greenspan JD, Fillingim RB, Rathnayaka N, Ohrbach R, Slade GD. Associations of Sleep Disturbance, Atopy, and Other Health Measures with Chronic Overlapping Pain Conditions. J Oral Facial Pain Headache 2020; 34:s73-s84. [PMID: 32975542 PMCID: PMC9879298 DOI: 10.11607/ofph.2577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS To quantify the contributions of atopic disorders, sleep disturbance, and other health conditions to five common pain conditions. METHODS This cross-sectional analysis used data from 655 participants in the OPPERA study. The authors investigated the individual and collective associations of five chronic overlapping pain conditions (COPCs) with medically diagnosed atopic disorders and self-reported sleep disturbance, fatigue, and symptoms of obstructive sleep apnea. Atopic disorders were allergies, allergic rhinitis, atopic dermatitis, allergic asthma, urticaria, allergic conjunctivitis, and food allergy. Logistic regression models estimated odds ratios as measures of association with temporomandibular disorders, headache, irritable bowel syndrome, low back pain, and fibromyalgia. Measures of sleep and atopy disorders were standardized to z scores to determine the relative strength of their associations with each COPC. Sociodemographic characteristics and body mass index were covariates. Random forest regression analyzed all variables simultaneously, computing importance metrics to determine which variables best differentiated pain cases from controls. RESULTS Fatigue and sleep disturbance were strongly associated with each COPC and with the total number of COPCs. An increase of one standard deviation in fatigue or sleep disturbance score was associated with approximately two-fold greater odds of having a COPC. In random forest models, atopic disorders contributed more than other health measures to differentiating between cases and controls of headache, whereas other COPCs were best differentiated by measures of fatigue or sleep. CONCLUSION Atopic disorders, previously recognized as predictors of poor sleep, are associated with COPCs after accounting for sleep problems.
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Affiliation(s)
- Anne E. Sanders
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joel D. Greenspan
- Department of Neural and Pain Sciences, Brotman Facial Pain Clinic, School of Dentistry, University of Maryland, Baltimore, Maryland, USA
| | - Roger B. Fillingim
- Department of Community Dentistry & Behavioral Science, Pain Research and Intervention Center of Excellence, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Nuvan Rathnayaka
- Department of Biostatistics, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, New York, USA; Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Gary D. Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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Abstract
INTRODUCTION Expansion of community water fluoridation has stalled in the United States, leaving 115 million Americans without fluoridated drinking water. OBJECTIVE This study used spatial regression methods to assess contributions of supply-side factors (neighboring counties' fluoridation coverage) and demand-side factors (health literacy, education, and population density of the local county) in predicting the extent of fluoridation in US counties. METHODS For this cross-sectional ecological analysis, data from the 2014 Water Fluoridation Reporting System for all 3,135 US counties were merged with sociodemographic data from the 2014 American Community Survey and county-level estimates of health literacy based on the National Association of Adult Literacy Survey. We employed multilevel geographically weighted autoregressive models to predict fluoridation coverage of each county as a function of fluoridation coverage of neighboring counties and local-county covariates: either health literacy or sociodemographic characteristics. Akaike's Information Criterion was used to distinguish the better model in terms of explanatory power and parsimony. RESULTS In the best-fit model, an increase from the first to third quartile of neighboring counties' fluoridation coverage was associated with an increase of 27.76 percentage points (95% confidence limits [CI] = 27.71, 27.81) in a local county's fluoridation coverage, while an increase from the first to third quartile of local county's health literacy was associated with an increase of 2.8 percentage points (95% CL = 2.68, 2.89). The results are consistent with a process of emulation, in which counties implement fluoridation based upon their population's health literacy and the extent of fluoridation practiced in neighboring counties. CONCLUSION These results suggest that demand for community water fluoridation will increase as health literacy increases within a county. Furthermore, when considering expansion of fluoridation, non-fluoridated communities can benefit from precedents from nearby communities that are fluoridated. KNOWLEDGE TRANSFER STATEMENT Expanded coverage of community water fluoridation has stalled in the United States. The economic theory of diffusion describes how, over time and space, policy enacted in one community can influence public opinion in a neighboring community. This study applies geospatial analysis of county-level data and the theory of policy diffusion to demonstrate that fluoridated counties can promote the implementation of community water fluoridation in their neighboring, non-fluoridated communities.
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Affiliation(s)
- J A Curiel
- Political Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A E Sanders
- Division of Pediatric and Public Health, UNC Adams School of Dentistry, Chapel Hill, NC, USA
| | - G D Slade
- Division of Pediatric and Public Health, UNC Adams School of Dentistry, Chapel Hill, NC, USA
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Akinkugbe AA, Barritt AS, Cai J, Offenbacher S, Thyagarajan B, Khambaty T, Singer R, Kallwitz E, Heiss G, Slade GD. Periodontitis and prevalence of elevated aminotransferases in the Hispanic Community Health Study/Study of Latinos. J Periodontol 2019; 89:949-958. [PMID: 29717494 DOI: 10.1002/jper.17-0579] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 02/07/2018] [Accepted: 02/26/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) prevalence is greater among Hispanics/Latinos than other racial/ethnic groups and prevalence is further reported to vary among Hispanic/Latino background groups. Experimental animal and human studies demonstrate associations between periodontitis and NAFLD, not yet reported among Hispanics/Latinos. This study examined periodontitis as a novel risk factor that may contribute to the burden of NAFLD among Hispanics/Latinos. METHODS Data came from 11,914 participants of the Hispanic Community Health Study/Study of Latinos. Periodontitis was defined as the extent (none, < 30%, ≥30%) of periodontal sites with clinical attachment level (CAL) of ≥3 mm or probing pocket depth (PD) of ≥4 mm. Elevated serum transaminases indicative of suspected NAFLD were defined as having alanine aminotransferase levels (ALT) > 40 IU/L or aspartate aminotransferase (AST) > 37 IU/L for men and ALT > 31 IU/L or AST > 31 IU/L for women. Survey-logistic regression models estimated prevalence odds ratios (POR) and 95% confidence intervals (CI) for the association between periodontitis and suspected NAFLD. RESULTS The overall age-standardized percentage of study participants with < 30% of sites with CAL ≥3 mm or PD ≥4 mm was 53.5% and 58.6%, respectively, while participants with ≥30% sites with CAL ≥3 mm or PD ≥4 mm comprised 16% and 5.72%, respectively. The overall age-standardized prevalence (95% CI) of suspected NAFLD was 18.1% (17.1-19.0). For the entire cohort, we observed a dose-response (i.e. graded) association between PD ≥4 mm and the prevalence odds of suspected NAFLD, whereby participants with < 30% affected had a crude POR = 1.19 (95% CI: 1.03, 1.38) while participants with ≥30% affected had a crude POR = 1.39 (95% CI: 1.02, 1.90). These crude estimates were attenuated toward the null and rendered non-significant upon covariate adjustment. No differences were found by Hispanic/Latino background group. CONCLUSION Previously reported associations between periodontitis and NAFLD were marginal to null in this study of a diverse group of Hispanics/Latinos.
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Affiliation(s)
- Aderonke A Akinkugbe
- Oral Health Services Research Core, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - A Sidney Barritt
- Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Steven Offenbacher
- Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Tasneem Khambaty
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD
| | - Richard Singer
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL.,College of Dental Medicine, Nova Southeastern University, Ft. Lauderdale, FL
| | - Eric Kallwitz
- Department of Medicine, Loyola University Medical Center, Maywood, IL
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gary D Slade
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Ohrbach R, Slade GD, Bair E, Rathnayaka N, Diatchenko L, Greenspan JD, Maixner W, Fillingim RB. Premorbid and concurrent predictors of TMD onset and persistence. Eur J Pain 2019; 24:145-158. [PMID: 31421009 DOI: 10.1002/ejp.1472] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/28/2019] [Accepted: 08/11/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Multiple risk factors predict temporomandibular disorders (TMD) onset, but temporal changes in risk factors and their contribution to risk of TMD have not been evaluated. The study aims were to (a) describe changes occurring in premorbid TMD risk factors when re-measured at TMD onset and 6 months later, and (b) determine if measures of change improve accuracy in predicting TMD incidence compared to premorbid measures alone. METHODS In this observational prospective cohort study at four university research clinics, 3,258 community-based, 18- to 44-year-olds without TMD were enrolled. During the 3-year median follow-up, 260 incident cases of first-onset TMD were identified, and 196 TMD-free subjects were selected as matched controls. Six-months later, 147 of 260 incident cases (56.6%) were re-examined revealing 72 (49%) with 'persistent TMD' and 75 (51%) whose condition had resolved ('transient TMD'). Virtually all (126) of the 127 re-examined controls remained without TMD. Questionnaires and clinical measurements evaluated risk factors from clinical, health, psychological and behavioural and neurosensory domains. RESULTS Most risk factors across all four domains increased with TMD onset, remained elevated in the persistent group and declined in the transient group (i.e., significant ANOVA interactions, p < .05). Accuracy in predicting first-onset TMD, quantified as area under the receiver operating characteristic curve was 0.71 (95% CL 0.68, 0.73) using only premorbid measures of risk factors, which increased to 0.91 (95% CL 0.89, 0.94) after addition of change measures. CONCLUSIONS TMD pain onset and persistence appear to be determined by enduring characteristics of the person as well as mutually interactive with temporally evolving variables. SIGNIFICANCE TMD is known to be a complex disorder, in which onset and persistence are associated with disease-related variables in multiple domains, including environmental exposure, clinical, psychological, health status, and pain processing variables. Using a more dynamic approach in order to capture change across time, many aspects of those domains were found to worsen prior to the reporting of pain, with bidirectional influences between domains and pain emergence likely. TMD onset appears to represent the cumulative effect of multiple system dysregulation.
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Affiliation(s)
- Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York
| | - Gary D Slade
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Center for Pain Research and Innovation, University of North Carolina, Chapel Hill, North Carolina
| | - Eric Bair
- Center for Pain Research and Innovation, University of North Carolina, Chapel Hill, North Carolina.,Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina.,Department of Endodontics, University of North Carolina, Chapel Hill, North Carolina
| | - Nuvan Rathnayaka
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Luda Diatchenko
- Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
| | - Joel D Greenspan
- Department of Neural and Pain Sciences, and Brotman Facial Pain Clinic, University of Maryland School of Dentistry, Baltimore, Maryland
| | - William Maixner
- Department of Anesthesiology, Center for Translational Pain Medicine, Duke University, Durham, North Carolina
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, Gainesville, Florida
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Khoury S, Piltonen MH, Ton AT, Cole T, Samoshkin A, Smith SB, Belfer I, Slade GD, Fillingim RB, Greenspan JD, Ohrbach R, Maixner W, Neely GG, Serohijos AWR, Diatchenko L. A functional substitution in the L-aromatic amino acid decarboxylase enzyme worsens somatic symptoms via a serotonergic pathway. Ann Neurol 2019; 86:168-180. [PMID: 31177555 DOI: 10.1002/ana.25521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/10/2019] [Accepted: 06/02/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Heightened somatic symptoms are reported by a wide range of patients with chronic pain and have been associated with emotional distress and physical dysfunction. Despite their clinical significance, molecular mechanisms leading to their manifestation are not understood. METHODS We used an association study design based on a curated list of 3,295 single nucleotide polymorphisms mapped to 358 genes to test somatic symptoms reporting using the Pennebaker Inventory of Limbic Languidness questionnaire from a case-control cohort of orofacial pain (n = 1,607). A replication meta-analysis of 3 independent cohorts (n = 3,189) was followed by functional validation, including in silico molecular dynamics, in vitro enzyme assays, and measures of serotonin (5-HT) plasma concentration. RESULTS An association with the T allele of rs11575542 coding for an arginine to glutamine substitution in the L-aromatic amino acid decarboxylase (AADC) enzyme was replicated in a meta-analysis of 3 independent cohorts. In a combined meta-analysis of all cohorts, this association reached p = 6.43 × 10-8 . In silico studies demonstrated that this substitution dramatically reduces the conformational dynamics of AADC, potentially lowering its binding capacity to a cofactor. in vitro enzymatic assays showed that this substitution reduces the maximum kinetic velocity of AADC, hence lowering 5-HT levels. Finally, plasma samples from 90 subjects showed correlation between low 5-HT levels and heightened somatic symptoms. INTERPRETATION Using functional genomics approaches, we identified a polymorphism in the AADC enzyme that contributes to somatic symptoms through reduced levels of 5-HT. Our findings suggest a molecular mechanism underlying the pathophysiology of somatic symptoms and opens up new treatment options targeting the serotonergic system. ANN NEUROL 2019;86:168-180.
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Affiliation(s)
- Samar Khoury
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - Marjo H Piltonen
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - Anh-Tien Ton
- Department of Biochemistry, Robert Cedergren Centre on Bioinformatics and Genomics, University of Montreal, Montreal, Quebec, Canada
| | - Tiffany Cole
- Dr John and Anne Chong Laboratory for Functional Genomics, Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Alexander Samoshkin
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada.,School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Shad B Smith
- Department of Anesthesia, Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC
| | - Inna Belfer
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD
| | - Gary D Slade
- Department of Dental Ecology, School of Dentistry, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Roger B Fillingim
- University of Florida Pain Research and Intervention Center of Excellence, College of Dentistry, University of Florida, Gainesville, FL
| | - Joel D Greenspan
- Department of Neural and Pain Sciences, Brotman Facial Pain Clinic, School of Dentistry, University of Maryland, Baltimore, MD
| | - Richard Ohrbach
- Department of Oral Diagnostic Services, University at Buffalo, Buffalo, NY
| | - William Maixner
- Department of Anesthesia, Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC
| | - G Gregory Neely
- Dr John and Anne Chong Laboratory for Functional Genomics, Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian W R Serohijos
- Department of Biochemistry, Robert Cedergren Centre on Bioinformatics and Genomics, University of Montreal, Montreal, Quebec, Canada
| | - Luda Diatchenko
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
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Slade GD, Rosen JD, Ohrbach R, Greenspan JD, Fillingim RB, Parisien M, Khoury S, Diatchenko L, Maixner W, Bair E. Anatomical selectivity in overlap of chronic facial and bodily pain. Pain Rep 2019; 4:e729. [PMID: 31583346 PMCID: PMC6749913 DOI: 10.1097/pr9.0000000000000729] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/04/2019] [Accepted: 01/30/2019] [Indexed: 02/07/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. Background: Chronic facial pain often overlaps with pain experienced elsewhere in the body, although previous studies have focused on a few, selected pain conditions when assessing the degree of overlap. Aim: To quantify the degree of overlap between facial pain and pain reported at multiple locations throughout the body. Methods: Data were from a case–control study of US adults participating in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) project. They were interviewed to determine the presence of chronic facial pain (n = 424 cases) or its absence (n = 912 controls). A mailed questionnaire with a body drawing asked about pain at other locations. Odds ratios (ORs) and 95% confidence limits (95% CLs) quantified the degree of overlap between facial pain and pain at other locations. For replication, cross-sectional data were analyzed from the UK Biobank study (n = 459,604 participants) and the US National Health Interview Survey (n = 27,731 participants). Results: In univariate analysis, facial pain had greatest overlap with headache (OR = 14.2, 95% CL = 9.7–20.8) followed by neck pain (OR = 8.5, 95% CL = 6.5–11.0), whereas overlap decreased substantially (ORs of 4.4 or less) for pain at successively remote locations below the neck. The same anatomically based ranking of ORs persisted in multivariable analysis that adjusted for demographics and risk factors for facial pain. Findings were replicated in the UK Biobank study and the US National Health Interview Survey. The observed anatomical selectivity in the degree of overlap could be a consequence of neurosensory and/or affective processes that differentially amplify pain according to its location.
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Affiliation(s)
- Gary D Slade
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Departments of Dental Ecology.,Epidemiology and
| | - Jonathan D Rosen
- Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, NY, USA
| | - Joel D Greenspan
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA.,Brotman Facial Pain Clinic, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Marc Parisien
- The Allan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Samar Khoury
- The Allan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Luda Diatchenko
- The Allan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - William Maixner
- Center for Translational Pain Medicine, Duke University, Durham, NC, USA
| | - Eric Bair
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
This cohort study examines the incidence of dental caries in children and adolescents of varying income levels living in areas with vs without water fluoridation.
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Affiliation(s)
- Anne E. Sanders
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill
| | | | | | - John A. Curiel
- Odum Institute for Research in Social Science, Department of Political Science, University of North Carolina at Chapel Hill
| | - Gary D. Slade
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill
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Curiel JA, Slade GD, Christian TML, Lafferty-Hess S, Carsey TM, Sanders AE. Referendum opposition to fluoridation and health literacy: a cross-sectional analysis conducted in three large US cities. BMJ Open 2019; 9:e022580. [PMID: 30709861 PMCID: PMC6367990 DOI: 10.1136/bmjopen-2018-022580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore health literacy as a marker of voter confusion in order to understand the basis for public opposition to community water fluoridation. DESIGN A cross-sectional study. SETTING Conducted in three large US cities of San Antonio, Texas (602 voting precincts); Wichita, Kansas (171 voting precincts); and Portland, Oregon (132 voting precincts). Precinct-level voting data were compiled from community water fluoridation referendums conducted in San Antonio in 2002, Wichita in 2012 and Portland in 2013. PARTICIPANTS Voter turnout expressed as a percentage of registered voters was 38% in San Antonio (n=2 92 811), 47% in Wichita (n=129 199) and 38% in Portland (n=164 301). MAIN OUTCOME MEASURES The dependent variable was the percentage of votes in favour of fluoridating drinking water. Precinct-level voting data were mapped to precinct scores of health literacy, and to US Census and American Community Survey characteristics of race/ethnicity, age, income and educational attainment. Multilevel regression with post-stratification predicted the precinct mean health literacy scores, with weights generated from the National Association of Adult Literacy health literacy survey, with item response theory computed scoring for health literacy. Predictive models on voter support of community water fluoridation were compared using robust linear regression to determine how precinct-level characteristics influenced voter support in order to determine whether health literacy explained more variance in voting preference than sociodemographic characteristics. RESULTS Precinct-level health literacy was positively associated with voter turnout, although sociodemographic characteristics were better predictors of turnout. Approximately 60% of voters opposed community water fluoridation in Wichita and Portland, whereas in San Antonio, a small majority (53%) voted in favour of it. Models suggest that a one SD increase in health literacy scores predicted a 12 percentage point increase support for community water fluoridation. CONCLUSION Educational attainment and health literacy are modifiable characteristics associated with voting precincts' support for community water fluoridation.
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Affiliation(s)
- John A Curiel
- Odum Institute for Research in Social Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Gary D Slade
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thu-Mai L Christian
- Odum Institute for Research in Social Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sophia Lafferty-Hess
- Odum Institute for Research in Social Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Thomas M Carsey
- Odum Institute for Research in Social Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anne E Sanders
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Ginnis J, Ferreira Zandoná AG, Slade GD, Cantrell J, Antonio ME, Pahel BT, Meyer BD, Shrestha P, Simancas-Pallares MA, Joshi AR, Divaris K. Measurement of Early Childhood Oral Health for Research Purposes: Dental Caries Experience and Developmental Defects of the Enamel in the Primary Dentition. Methods Mol Biol 2019; 1922:511-523. [PMID: 30838597 PMCID: PMC6642073 DOI: 10.1007/978-1-4939-9012-2_39] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Epidemiological investigations of early childhood oral health rely upon the collection of high-quality clinical measures of health and disease. However, ascertainment of valid and accurate clinical measures presents unique challenges among young, preschool-age children. The paper presents a clinical research protocol for the conduct of oral epidemiological examinations among children, implemented in ZOE 2.0, a large-scale population-based genetic epidemiologic study of early childhood caries (ECC). The protocol has been developed for the collection of information on tooth surface-level dental caries experience and tooth-level developmental defects of the enamel in the primary dentition. Dental caries experience is recorded using visual criteria modified from the International Caries Detection and Assessment System (ICDAS), and measurement of developmental defects is based upon the modified Clarkson and O'Mullane Developmental Defects of the Enamel Index. After a dental prophylaxis (toothbrushing among all children and flossing as needed), children's teeth are examined by trained and calibrated examiners in community locations, using portable dental equipment, compressed air, and uniform artificial light and magnification conditions. Data are entered directly onto a computer using a custom Microsoft Access-based data entry application. The ZOE 2.0 clinical protocol has been implemented successfully for the conduct of over 6000 research examinations to date, contributing phenotype data to downstream genomics and other "omics" studies of ECC and DDE, as well as traditional clinical and epidemiologic dental research.
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Affiliation(s)
- Jeannie Ginnis
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Andrea G Ferreira Zandoná
- Department of Comprehensive Dentistry, Tufts University School of Dental Medicine, Tufts University, Boston, MA, USA
| | - Gary D Slade
- Department of Dental Ecology, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - John Cantrell
- Oral and Craniofacial Health Sciences, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Mikafui E Antonio
- Oral and Craniofacial Health Sciences, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Bhavna T Pahel
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Beau D Meyer
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Poojan Shrestha
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Miguel A Simancas-Pallares
- Oral and Craniofacial Health Sciences, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Ashwini R Joshi
- Oral and Craniofacial Health Sciences, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Kimon Divaris
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
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Miller VE, Poole C, Golightly Y, Barrett D, Chen DG, Ohrbach R, Greenspan JD, Fillingim RB, Slade GD. Characteristics Associated With High-Impact Pain in People With Temporomandibular Disorder: A Cross-Sectional Study. J Pain 2018; 20:288-300. [PMID: 30292793 DOI: 10.1016/j.jpain.2018.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/16/2018] [Accepted: 09/25/2018] [Indexed: 12/21/2022]
Abstract
High-impact (disabling) pain diminishes the quality of life and increases health care costs. The purpose of this study was to identify the variables that distinguish between high- and low-impact pain among individuals with painful temporomandibular disorder (TMD). Community-dwelling adults (N = 846) with chronic TMD completed standardized questionnaires that assessed the following: 1) sociodemographic characteristics, 2) psychological distress, 3) clinical pain, and 4) experimental pain. We used high-impact pain, classified using the Graded Chronic Pain Scale, as the dependent variable in logistic regression modeling to evaluate the contribution of variables from each domain. Cross-validated area under the receiver operating characteristic curve (AUC) quantified model discrimination. One-third of the participants had high-impact pain. Sociodemographic variables discriminated weakly between low- and high-impact pain (AUC = .61, 95% confidence interval [CI] = 0.57, 0.65), with the exception of race. An 18-variable model encompassing all 4 domains had good discrimination (AUC = 0.79, 95% CI = 0.75, 0.82), as did a simplified model (sociodemographic variables plus catastrophizing, jaw limitation, and number of painful body sites) (AUC = 0.79, 95% CI = 0.76, 0.82). Duration of pain, sex, and experimental pain testing results were not associated. The characteristics that discriminated most effectively between people with low- and high-impact TMD pain included clinical pain features and the ability to cope with pain. PERSPECTIVE: This article presents the results of a multivariable model designed to discriminate between people with high- and low-impact pain in a community-based sample of people with painful chronic TMD. The findings emphasize the importance of catastrophizing, jaw limitation, and painful body sites associated with pain-related impact.
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Affiliation(s)
- Vanessa E Miller
- Program on Integrative Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Charles Poole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yvonne Golightly
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Deborah Barrett
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ding-Geng Chen
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York
| | - Joel D Greenspan
- Department of Neural and Pain Sciences, University of Maryland, Baltimore, Maryland
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Gary D Slade
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Vivaldi D, Di Giosia M, Tchivileva IE, Jay GW, Slade GD, Lim PF. Headache attributed to TMD Is Associated With the Presence of Comorbid Bodily Pain: A Case-Control Study. Headache 2018; 58:1593-1600. [DOI: 10.1111/head.13404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/24/2018] [Accepted: 06/25/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Daniela Vivaldi
- Department of Endodontics and Department of Dental Ecology, School of Dentistry; UNC-CH; Chapel Hill NC USA
| | | | - Inna E. Tchivileva
- Department of Endodontics, School of Dentistry; UNC-CH; Chapel Hill NC USA
| | - Gary W. Jay
- Department of Neurology, School of Medicine; UNC-CH; Chapel Hill NC USA
| | - Gary D. Slade
- Department of Dental Ecology, School of Dentistry; UNC-CH; Chapel Hill NC USA
| | - Pei F. Lim
- Department of Endodontics, School of Dentistry; UNC-CH; Chapel Hill NC USA
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Sanders AE, Shaikh SR, Slade GD. Long-chain omega-3 fatty acids and headache in the U.S. population. Prostaglandins Leukot Essent Fatty Acids 2018; 135:47-53. [PMID: 30103932 DOI: 10.1016/j.plefa.2018.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 12/19/2022]
Abstract
UNLABELLED The objective of this study was to assess whether dietary intake of long-chain omega-3 polyunsaturated fatty acids (PUFAs) is associated with lower prevalence of headache in the U.S. POPULATION This cross-sectional study used data for a nationally representative sample of 12,317 men and women aged ≥ 20 years participating in the National Health and Nutrition Examination Surveys of 1999-2004. Interviewers recorded self-report of severe headache or migraine in the past three months. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were quantified from 24-hour dietary recall using the U.S. Department of Agriculture National Nutrient Database. Serum concentration of C-reactive protein, a marker of inflammation and potential mediator of PUFA's analgesic properties, was quantified by latex-enhanced nephelometry. Multivariable generalized linear models estimated prevalence ratios (PR) with 95% confidence limits (CL) for severe headache or migraine adjusting for NHANES cycle, sociodemographic characteristics, body mass index and total energy intake. The unadjusted prevalence of severe headache or migraine was 22.0% (females 28.2%, males 15.5%). In multivariable analysis, greater intake of omega-3 PUFAs was associated with lower prevalence of severe headache or migraine: PR 0.94 (95% CL: 0.88, 0.99, p = 0.035) per log unit increase in EPA, and PR 0.94 (95% CL: 0.90, 0.99, p = 0.023) per log unit increase in DHA. The strength of association was greater for non-Mexican Hispanics than for other racial/ethnic groups but was not attenuated after adjustment for C-reactive protein. In conclusion, higher dietary intakes of EPA and DHA were associated with lower prevalence of headache supporting the hypothesis that omega-3 PUFAs may prevent or reduce headache.
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Affiliation(s)
- A E Sanders
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.; Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA..
| | - S R Shaikh
- Department of Nutrition, Gillings School of Global Public Health & School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - G D Slade
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.; Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
Fluoridation of America's drinking water was among the great public health achievements of the 20th century. Yet there is a paucity of studies from the past 3 decades investigating its dental health benefits in the U.S. POPULATION This cross-sectional study sought to evaluate associations between availability of community water fluoridation (CWF) and dental caries experience in the U.S. child and adolescent population. County-level estimates of the percentage of population served by CWF (% CWF) from the Centers for Disease Control and Prevention's Water Fluoridation Reporting System were merged with dental examination data from 10 y of National Health and Nutrition Examination Surveys (1999 to 2004 and 2011 to 2014). Dental caries experience in the primary dentition (decayed and filled tooth surfaces [dfs]) was calculated for 7,000 children aged 2 to 8 y and in the permanent dentition (decayed, missing, and filled tooth surfaces [DMFS]) for 12,604 children and adolescents aged 6 to 17 y. Linear regression models estimated associations between % CWF and dental caries experience with adjustment for sociodemographic characteristics: age, sex, race/ethnicity, rural-urban location, head-of-household education, and period since last dental visit. Sensitivity analysis excluded counties fluoridated after 1998. In unadjusted analysis, caries experience in the primary dentition was lower in counties with ≥75% CWF (mean dfs = 3.3; 95% confidence limit [CL] = 2.8, 3.7) than in counties with <75% CWF (mean dfs = 4.6; 95% CL = 3.9, 5.4), a prevented fraction of 30% (95% CL = 11, 48). The difference was also statistically significant, although less pronounced, in the permanent dentition: mean DMFS (95% CL) was 2.2 (2.0, 2.4) and 1.9 (1.8, 2.1), respectively, representing a prevented fraction of 12% (95% CL = 1, 23). Statistically significant associations likewise were seen when % CWF was modeled as a continuum, and differences tended to increase in covariate-adjusted analysis and in sensitivity analysis. These findings confirm a substantial caries-preventive benefit of CWF for U.S. children and that the benefit is most pronounced in primary teeth.
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Affiliation(s)
- G D Slade
- 1 Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - W R Maas
- 3 Dental Public Health Consultant, North Bethesda, MD, USA
| | - A E Sanders
- 1 Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Curiel JA, Sanders AE, Christian TML, Lafferty-Hess S, Carsey TM, Lampiris LN, Slade GD. Fluoridation advocacy in referenda where media coverage is balanced yet biased. J Am Dent Assoc 2018; 149:273-280.e3. [PMID: 29454461 DOI: 10.1016/j.adaj.2017.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/11/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Despite supporting scientific evidence, community water fluoridation (CWF) often fails in public referenda. To understand why, the authors quantitatively analyzed text from news media coverage of CWF referenda. METHODS The authors analyzed text from 234 articles covering 11 CWF referenda conducted in 3 US cities from 1956 through 2013. The authors used cluster analysis to identify each article's core rhetoric and classified it according to sentiment and tone. The authors used multilevel count regression models to measure the use of positive and negative words regarding CWF. RESULTS Media coverage more closely resembled core rhetoric used by fluoridation opponents than the rhetoric used by fluoridation proponents. Despite the scientific evidence, the media reports were balanced in tone and sentiment for and against CWF. However, in articles emphasizing children, greater negative sentiment was associated with CWF rejection. CONCLUSIONS Media coverage depicted an artificial balance of evidence and tone in favor of and against CWF. The focus on children was associated with more negative tone in cities where voters rejected CWF. PRACTICAL IMPLICATIONS When speaking to the media, advocates for CWF should emphasize benefits for children and use positive terms about dental health rather than negative terms about dental disease.
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Sanders AE, Slade GD. Blood Lead Levels and Dental Caries in U.S. Children Who Do Not Drink Tap Water. Am J Prev Med 2018; 54:157-163. [PMID: 29191396 PMCID: PMC5783762 DOI: 10.1016/j.amepre.2017.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/04/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION This study's purpose is to determine whether nonconsumption of tap water is associated with lower prevalence of elevated blood lead levels and higher prevalence of dental caries in children and adolescents. METHODS Cross-sectional data from the National Health and Nutrition Examination Survey 2005-2014 recorded drinking water source (n=15,604) and blood lead levels (n=12,373) for participants aged 2-19 years, and dental caries experience for the 2011-2014 subset (n=5,677). The threshold for elevated blood lead level was ≥3 μg/dL. A binary outcome indicated presence or absence of dental caries experience. Multivariable generalized linear models estimated adjusted prevalence ratios with 95% confidence limits. RESULTS In analysis conducted in 2017, 15% of children and adolescents did not drink tap water, 3% had elevated blood lead levels ≥3 μg/dL, and 50% had dental caries experience. Children and adolescents who did not drink water were less likely than tap water drinkers to have an elevated blood lead level (adjusted prevalence ratios=0.62, 95% confidence limits=0.42, 0.90). Nonconsumers of tap water were more likely to have dental caries (adjusted prevalence ratios=1.13, 95% confidence limits=1.03, 1.23). Results persisted after adjustment for other covariates and using a higher threshold for elevated blood lead level. CONCLUSIONS In this nationally representative U.S. survey, children and adolescents who did not drink tap water had lower prevalence of elevated blood lead levels and higher prevalence of dental caries than those who drank tap water.
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Affiliation(s)
- Anne E Sanders
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Gary D Slade
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Akinkugbe AA, Slade GD, Barritt AS, Cole SR, Offenbacher S, Petersmann A, Kocher T, Lerch MM, Mayerle J, Völzke H, Heiss G, Holtfreter B. Periodontitis and Non-alcoholic Fatty Liver Disease, a population-based cohort investigation in the Study of Health in Pomerania. J Clin Periodontol 2017; 44:1077-1087. [PMID: 28804947 DOI: 10.1111/jcpe.12800] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) affects 20%-30% of adults with risk factors like obesity and insulin resistance putatively acting through chronic low-grade inflammation. Because periodontitis elicits low-grade inflammation, we hypothesized that it could contribute to NAFLD occurrence. OBJECTIVE To investigate epidemiologic associations between periodontitis and the incidence of NAFLD among 2,623 participants of the Study of Health in Pomerania. METHODS Periodontitis at baseline was defined as the percentage of sites (0%, <30%, ≥30%) with (i) clinical attachment level (CAL) ≥3 mm; (ii) probing pocket depth (PD) ≥4 mm. Incident NAFLD was defined as a significant increase in liver echogenicity on ultrasound relative to the kidneys, with the diaphragm indistinct or the echogenic walls of the portal veins invisible. RESULTS After a median 7.7 years of follow-up, 605 incident NAFLD cases occurred at a rate of 32.5 cases per 1,000 person-years. Relative to participants without CAL ≥3 mm, NAFLD incidence was elevated slightly in participants with <30% of sites affected and moderately in participants with ≥30% of sites affected (multivariable-adjusted incidence rate ratio = 1.28, 95% CI, 0.84, 1.95 and 1.60, 95% CI, 1.05-2.43), respectively. A similar dose-response relationship was not observed for PD. CONCLUSION History of periodontitis may be a risk factor for NAFLD.
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Affiliation(s)
- Aderonke A Akinkugbe
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gary D Slade
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A Sidney Barritt
- Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephen R Cole
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steven Offenbacher
- Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine, Ludwig-Maximilians University, Munich, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Birte Holtfreter
- Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
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Maixner W, Fillingim RB, Williams DA, Smith SB, Slade GD. Overlapping Chronic Pain Conditions: Implications for Diagnosis and Classification. J Pain 2017; 17:T93-T107. [PMID: 27586833 DOI: 10.1016/j.jpain.2016.06.002] [Citation(s) in RCA: 278] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 12/26/2022]
Abstract
UNLABELLED There is increasing recognition that many if not most common chronic pain conditions are heterogeneous with a high degree of overlap or coprevalence of other common pain conditions along with influences from biopsychosocial factors. At present, very little attention is given to the high degree of overlap of many common pain conditions when recruiting for clinical trials. As such, many if not most patients enrolled into clinical studies are not representative of most chronic pain patients. The failure to account for the heterogeneous and overlapping nature of most common pain conditions may result in treatment responses of small effect size when these treatments are administered to patients with chronic overlapping pain conditions (COPCs) represented in the general population. In this brief review we describe the concept of COPCs and the putative mechanisms underlying COPCs. Finally, we present a series of recommendations that will advance our understanding of COPCs. PERSPECTIVE This brief review describes the concept of COPCs. A mechanism-based heuristic model is presented and current knowledge and evidence for COPCs are presented. Finally, a set of recommendations is provided to advance our understanding of COPCs.
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Affiliation(s)
- William Maixner
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina.
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - David A Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Shad B Smith
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Gary D Slade
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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