Abstract
Stress is a contributing factor to painful temporomandibular disorders (TMD). Nevertheless, the underpinnings of this relationship are not fully understood. Objective To investigate the effects of acute mental stress on conditioned pain modulation (CPM) in TMD patients compared with healthy individuals.Methodology Twenty women with chronic myofascial TMD diagnosed according to the RDC/TMD and 20 age-matched healthy women had the CPM assessed before and after a stressful task using the Paced Auditory Serial Addition Task (PASAT) in a single session. Subjective stress response was assessed with the aid of visual analog scale (VAS). Pressure pain threshold (PPT) on masseter muscle was the test stimulus (TS) and immersion of the participant’s hand on hot water was the conditioning stimulus (CS) - CPM-sequential paradigm.Results Healthy individuals reported PASAT are more stressful when compared with TMD patients and the stress task did not affect the CPM in neither group. Nonetheless, a negative correlation was observed between change in CPM and change in TS from baseline to post-stress session, which indicates that the greater the increase in PPT after the stress task, the greater was the decrease in CPM magnitude. The correlation was strong for healthy controls (r=- 0.72, p<0.001) and moderate for TMD patients (r=- 0.44, p=0.047).Conclusions The correlation between the change in CPM and the TS change following the stress task may possibly indicate an overlapping pathway between stress-induced analgesia/hyperalgesia and descending pain inhibition.
Highlights
Pain-related temporomandibular disorders (TMD) are the most common chronic orofacial pain disorders.[1,2] Pain-related TMD negatively affect the quality of life, since the pain can interfere with daily activities, such as talking, eating, laughing and working.[3]
Post-stress task values were higher for healthy individuals when compared with TMD patients (Tukey’s: p=0.0013)
Our study investigated the effects of acute mental stress in the conditioned pain modulation (CPM) magnitude of TMD patients and healthy controls
Summary
Pain-related temporomandibular disorders (TMD) are the most common chronic orofacial pain disorders.[1,2] Pain-related TMD negatively affect the quality of life, since the pain can interfere with daily activities, such as talking, eating, laughing and working.[3]. Several studies have investigated the relationship between TMDs and stress, i.e., a perception of uncontrollably and unpredictability of stimuli.[4]. TMD patients present greater psychosocial stress levels and report higher number of traumatic stressors when compared with pain-free subjects.[5,6]. Traumatic stressors are related to increased pain severity, distress, and disability among patients with TMD,[5] and the Orofacial Pain Prospective Evaluation and Risk Assessment (OPPERA) cohort study observed that psychosocial stress is a risk factor for the onset of pain-related TMD.[7]. There is evidence in favor of a relevant relationship between stress and TMD. The underpinnings of this relationship are not fully understood
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