Abstract
BackgroundThe purpose of this study was to characterize patients with chronic temporomandibular disorders (TMD) in terms of existing hyperalgesia against cold, heat and pressure.MethodsThe extent of hyperalgesia for pressure and thermal sensation in TMD patients was determined by the use of the painDETECT questionnaire ("Is cold or heat in this area occasionally painful?” “Does slight pressure in this area, e.g., with a finger, trigger pain?") and experimental somatosensory testing against thermal and pressure stimuli (Quantitative Sensory Testing; QST). In addition, we explored psychological comorbidity among the chronic TMD patients (hospital anxiety and depression scale, HADS-D and coping strategies questionnaire, CSQ).ResultsNineteen patients with chronic TMD and 38 healthy subjects participated in the study. N = 12 patients had a painDETECT score ≤ 12, n = 3 patients had a painDETECT score of 13–18 and n = 4 patients had a painDETECT score ≥ 19. TMD patients with painDETECT scores ≥19 had moderately, strong or very strong enhancement of thermal and pressure pain perception, whereas patients with painDETECT scores 13–18 and ≤ 12 responded these questions with “never”, “hardly noticed” or “slightly painful” (p < 0.05–0.01). With increasing painDETECT scores we found increased hyperalgesia for pressure (p < 0.01) and thermal stimuli (p < 0.05) in QST. The patients with a painDETECT score ≥ 19 showed increased signs of anxiety (p < 0.05), depression (p < 0.01), praying and hoping (p < 0.05).ConclusionThe present study has shown that the PainDETECT questionnaire can be a helpful additional diagnostic tool. Together with QST, the PainDETECT questionnaire detected hyperalgesia for pressure and thermal sensation. Therefore the PainDETECT questionnaire is helpful to decide which TMD patients should undergo QST.
Highlights
The purpose of this study was to characterize patients with chronic temporomandibular disorders (TMD) in terms of existing hyperalgesia against cold, heat and pressure
TMD subgroups as a function of painDETECT scores Examining the patients with chronic TMD according to their painDETECT scores, we found patients within the “painDETECT ≥ 19” subgroup showing notably increased sensitivity towards palpation of the temporalis, the sternocleidomastoid muscle and the masseter muscle
Clinical findings TMD patients (TMD all) Regarding the patients with chronic TMD in its entirety (TMD all) we found no changes in the function of mimic muscle
Summary
The purpose of this study was to characterize patients with chronic temporomandibular disorders (TMD) in terms of existing hyperalgesia against cold, heat and pressure. Repeated episodes of pain and continuous nociceptive input may shift the balance of central modulation, contributing to sustained chronic pain [18] For these patients, spontaneous pain most often is present in the area of the trigeminal nerve, but throughout the whole body. Stress and anxiety exert modulatory influences on pain depending on the nature, duration and intensity of the stressor and developmental influences on the maturation of the stress and pain system [21] In this context there is a bidirectional relationship between psychological comorbidity and spontaneous myogenic pain. To reveal such stress-induced hyperalgesia, a comprehensive analysis of the medical history and a careful clinical examination is required in the diagnostic process of chronic TMD patients
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