Abstract
Objectives The pressure pain threshold (PPT) may be an efficient approach to screen and evaluate orofacial pain. However, the results of previous PPT studies have varied greatly. The aim of this paper was to determine whether the PPT is an efficient approach for screening and evaluating orofacial pain. Methods The search yielded 123 articles. After removal of duplicates and screening of abstracts, 32 articles were selected for further evaluation. The Cochrane Collaboration tool for assessing the risk of bias was used for the evaluation of the studies. Results The studies covered a total of 4403 adult patients, aged 16-62, and 30 children. The studies investigated the reliability and validity of the PPT (measured by a pressure algometer) in TMD patients. The PPT was investigated in relation to headache, menstrual cycle, oral contraception, occlusal interference, and occlusal appliances. Generally, the risk of bias was low to unclear. Some structural limitations were inherent in the studies, such as small samples and short duration of the testing involved. Also, the analyzed studies lacked consistency in study design and patient management. Pressure increase values differed from 20 kPa/s to 50 kPa/s and from 0.5 kg/cm2/s to 2 kg/cm2/s. Descriptions of the PPT examination points also varied, from very precise and repeatable to a simple listing of anatomical points. The number of measurements varied from 1 to 5 at each visit. The intervals ranged from 5 seconds to 15 minutes. However, some studies confirmed that the pressure algometer is an effective tool for determining the source of orofacial pain. Conclusions Based on the analyzed articles, the authors argue that the PPT is not an efficient approach for screening and evaluating orofacial pain. What is more, it should not be used as the only diagnostics tool for patients with orofacial pain. Importantly, however, additional factors should be considered in the future for the evaluation of the PPT, including body symmetry and posture, hormone levels and the menstrual phase in women, and the use of medications and its influence on the PPT. Further clinical trials should also be performed on the PPT, examining head and neck pain patients, with more precise study design and larger samples.
Highlights
A subsequent study by Chaves et al, comparing algometry and muscle palpation, confirmed that algometry is more effective for the examination of pain perception in widespread orofacial pain and that muscle palpation is superior for differentiating healthy controls from groups that report pain [6]
Visscher et al revealed that the recognition of TMD pain complaints by pressure algometry was comparable to the recognition achieved by palpation [7]
Overall, based on the analyzed articles, the authors state that the pressure pain threshold (PPT) is not an efficient approach for screening and evaluating orofacial pain
Summary
According to the definition of pain proposed by the Subcommittee on Taxonomy of the International Association for the Study of Pain, pain is a subjective sensation which is individual and depends on numerous contributing factors. Pain in the orofacial region influences everyday life, largely by limiting the ability to chew or speak, which calls for the investigation of the problem to improve diagnosis and treatment of orofacial pain patients [1]. Myofascial TMD pain is the most common diagnosis (42%) among patients reporting to the dental office due to orofacial pain [2]. It occurs as a variety of conditions that can affect the temporomandibular joints (TMJ), face, head, and cervical
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