Myofascial Pain Dysfunction Patients Research Articles

The relationship of the temporomandibular disorders with headaches: A retrospective analysis

The objective of this study was to retrospectively analyze the incidence of the concurrent existence of temporomandibular disorders (TMD) and headaches. Forty patients (36 female, 4 male, mean age: 29.9±9.6 years) clinically diagnosed with TMD were screened. Patient records were analyzed regarding: range of mouth opening, temporomandibular joint (TMJ) noises, pain on palpation of the TMJ and masticatory muscles and neck and upper back muscles, and magnetic resonance imaging of the TMJ. According to patient records, a total of 40 (66.6%) patients were diagnosed with TMD among 60 patients with headache. Thirty-two (53%) patients had TMJ internal derangement (ID), 8 (13%) patients had only myofascial pain dysfunction (MPD) and 25 (41.6%) patients had concurrent TMJ ID/MPD. There were statistically significant relationships between the number of tender masseter muscles and MPD patients (p=0.04) and between the number of tender medial pterygoid muscles and patients with reducing disc displacement (RDD) (p=0.03). The TMJ and associated orofacial structures should be considered as possible triggering or perpetuating factors for headaches, especially tension-type. There might be a significant connection between TMD and headache. However, most medical and dental practitioners are unaware of this relationship. Therefore, a careful evaluation of the TMJ and associated orofacial structures is required for a correct interpretation of the craniofacial pain in headache patients, and these patients should be managed with a multidisciplinary approach.

Comparison of muscle activity between conventional and neuromuscular splints

The muscle relaxation appliance (MRA) has been used in the treatment of myofascial pain dysfunction (MPD) patients. The neuromuscular orthotic is a version of the MRA and is constructed from a three-dimensional mandibular position when muscles are in a state of minimal electromyographic (EMG) activity. The purpose of this study was to investigate the affect of two muscle relaxation appliances and a placebo (cotton rolls) on EMG activity of the functional masseter and anterior temporalis muscles. A centric relation mandibular MRA and a neuromuscular orthotic were constructed under controlled protocols for 12 women MPD patients with a mean age of 38 years. EMG measurements were taken during a 10-second clench of both appliance and placebo. No statistical difference was found between the centric relation mandibular MRA and neuromuscular orthotic. A statistically significant difference was found between the mean EMG values of the placebo and two treatment appliances.

Length-Tension Relations of the Masticatory Elevator Muscles in Normal Subjects and Pain Dysfunction Patients

Myofascial pain and dysfunction is the primary diagnosis in a large proportion of facial pain complaints. Myofascial disease can present in the form of trigger points, fibromyositis, myositis, muscle spasm, and muscle weakness. The purpose of this study is to research for quantifiable physiological differences between groups of normal subjects and myofascial pain dysfunction (MPD) patients. The first specific aim was to determine the opening of the jaw at which maximal isometric tension can be produced by the jaw closing muscles, with the hypothesis that this opening of maximal tension would be less for a group of MPD patients than for a group of normal subjects being tested. The second aim was to test the hypothesis that the maximal isometric bite forces for the two groups would differ. Patients with mandibular dysfunction are reported to have a lower maximal bite than normal subjects. Bite force was measured with the T-Scan system. An 80 micron horseshoe-shaped sensor connected to a dedicated IBM XT computer recorded the data. A self-contained printer produced the hard copy for later analysis. Vertical dimension or jaw opening was increased in 0.5-mm increments using double flat plane appliances standardized by the Relator. A MANOVA was used for statistical analysis of the data. MPD patients had significantly higher bite forces at 8.0, 8.5, 9, and 9.5 mm. Normal subjects had higher force values at 5.0 mm. There was no significant difference in mean maximal bite force between groups.

Comparison of Clinical Characteristics in Myogenic, TMJ Internal Derangement and Atypical Facial Pain Patients

Temporomandibular joint (TMJ) disorders have been collectively grouped as myofascial pain-dysfunction syndrome (MPDS) or temporomandibular joint dysfunction syndrome (TMJDS). In the past, these terms have been used synonomously to describe a set of clinical signs and symptoms that include pain in the TMJ and muscles of mastication, limited or deviant opening of the mandible, and/or joint sounds. The present study segregated two major subgroups subsumed within this diagnostic classification and assigned them to a myogenic facial pain (MFP) group and a TMJ internal derangement (TMJID) group. Previous studies may have included both of these disorders as MPDS/TMJDS. While some signs and symptoms are similar, the primary differentiation is based on meniscus displacement present with TMJID patients and pain distribution patterns between the two groups. While MFP/TMJID patients comprise the majority of the facial pain population, a third major group of patients is encountered, being classified under the diagnostic appellation of atypical facial pain (AFP). Patients with AFP usually complain of vague and wandering pain in the maxilla or mandible; however, no identifiable source of infection or organic disease can be uncovered. One hundred fifty patients seeking consultation and care for facial pain met the criteria for inclusion into one of three clinical groups. The groups were compared for age, sex, duration of symptoms, bruxism and/or clenching habits, and disturbed sleep patterns. Differences in surface electromyographic levels from the facial and cervical muscles were also examined. Minnesota Multiphasic Personality Inventory (MMPI) scores from 95 subjects were compared with self-report measures of depression and anxiety. It was concluded that subcategorization of myofascial pain dysfunction patients into a MFP and TMJID group is justified on the basis of psychometric differences, clenching habits, masseter EMG levels, and male:female ratio. Furthermore, psychopathological factors are more significant among MFP and AFP subjects than TMJID patients.

Electromyographic biofeedback and rest position training of masticatory muscles in myofascial pain-dysfunction patients

Twenty-four women outpatients with myofascial pain-dysfunction were divided into three groups of eight. All received bilateral masseter electromyographic biofeedback training. One group received biofeedback only; one group received additional instructions and modeling to place their jaw in the “rest” position; and one group was given a prosthetic guide that spaced the incisors 6.8 mm apart. Two 15-minute training sessions were conducted at a 1-week interval, with posttreatment assessment 2 weeks later. The instruction and prosthesis groups obtained significantly greater electromyographic reductions in masseter activity and increases in mandibular range of motion compared with the biofeedback-only group. Subjects with pain obtained a significant reduction in therapist and self-report pain ratings. The results suggest that short-term biofeedback treatment may be meaningfully augmented by procedures that place the mandible in the rest position.

Psychophysiological responses to stress in patients with myofascial pain-dysfunction syndrome.

The hypothesis was tested that patients diagnosed with myofascial pain-dysfunction (MPD) syndrome display a stereotypic response to stress via increased activity in the facial muscles. Twenty MPD patients and 20 matched control subjects were seated and exposed to affectively neutral, then stressful, then affectively neutral film clips. During film viewing, heart rates and skin-conductance levels were recorded along with bilateral EMG activity from the frontalis, temporalis, and masseter muscles and unilateral EMG activity from the forearm extensor. While both groups showed facial EMG responses to the stressor, MPD patients showed lower heart-rate and skin-conductance responses to experimental stress than did normals and a differentially higher frontalis EMG response. MPD patients also showed higher resting EMG levels than did normals at four of six facial muscle sites.

Pain assessment in temporomandibular disorders.

Pain characteristics, symptoms, medication use, demographic and psychological variables were assessed in 85 patients diagnosed with temporomandibular (TM) disorders. Results showed that 46 myofascial pain dysfunction (MPD) patients responded differently from 39 temporomandibular joint (TMJ) patients for numerous measures of pain-related variables. MPD patients perceived more generalized facial pain of longer duration and were able to identify more specific symptoms associated with their pain. The only symptom variable rated higher by TMJ patients was the presence of bothersome joint noise. When asked to rate their pain at its worse, the unpleasantness of pain was significantly higher in MPD patients than reported by TMJ patients. MPD patients might be considered more psychologically distressed than TMJ patients, as shown by their higher ratings for anxiety and inability to endure the pain. Although both types of pain patients took the same categories of medications, MPD patients consumed a larger total number. Such findings suggest that the prognosis of the dysfunction for MPD patients would be less favorable than for TMJ patients.

The effects of treatment on masticatory muscle activity and mandibular posture in myofascial pain-dysfunction patients.

The purpose of this study was to evaluate tonic masticatory muscle activity and the postural rest position of the mandible, pre- and post-treatment, in patients with TM disorders. Forty-one patients diagnosed as suffering from myofascial pain-dysfunction (MPD) were evaluated, with electromyography (EMG) used to measure the muscle activity of the masseteric and anterior temporal areas at rest. Postural rest position was assessed by measurement of interocclusal distance. Twenty-three asymptomatic subjects were also tested as controls. Treatment for the pain group emphasized cognitive awareness of dysfunctional orofacial behavior and biofeedback training of the masseteric area to teach masticatory muscle relaxation. The pre-treatment EMG values of both the masseteric and anterior temporal areas were significantly higher for the pain group than for the control group. Post-hoc division of the pain group into successful and unsuccessful subgroups was made on the basis of the degree of symptom improvement. EMG activity decreased significantly in the masseters of both subgroups, but only the unsuccessful subgroup showed a significant decrease in anterior temporal activity following therapy. Interocclusal distance was significantly increased in both subgroups. These results suggest that tonic masticatory muscle activity may be elevated in MPD patients. They also suggest that a decrease in EMG activity in the masseter and anterior temporalis muscles and an opening of the postural rest position of the mandible may accompany completion of psychophysiological therapy, but these changes do not correspond directly with the outcome of that therapy.

Combined Use of Experimental Pain and Visual Analogue Scales in Providing Standardized Measurement of Clinical Pain

Myofascial pain dysfunction (MPD) patients, pain-free control subjects, and low back patients from a previous study were compared for visual analogue scale (VAS) responses to experimental pain (43–51°C temperatures) and clinical pain. MPD, low back pain, and control groups' nociceptive temperature-VAS response functions were all power functions with exponents of 2.1 for VAS-sensory-intensity responses, and 2.4–2.7 for VAS-affective responses. MPD patients' VAS-sensory responses to clinical pain, direct temperature matches to clinical pain, and temperature-VAS response function were internally consistent. The similar nociceptive stimulus-VAS response functions and consistent use of VAS to rate experimental and clinical pain provide a standardized procedure, whereby intensities of different types of pain can be accurately compared.

Pain behavior and pain coping strategies in low back pain and myofascial pain dysfunction syndrome patients

Pain behavior and pain coping strategies were systematically measured in a group of 32 chronic low back pain (LBP) and 32 myofascial pain dysfunction (MPD) syndrome patients. Both groups reported high levels of psychological distress on the SCL-90R. The LBP patients were significantly less active, took more narcotic and sedative-hypnotic medications, and showed higher levels of motor pain behavior (guarding, rubbing, and bracing) than the MPD patients. The LBP patients used attention diversion, and praying or hoping as pain coping skills to a much greater extent than the MPD patients. The relationship of these findings to prior research is described, and future research needs in this area are identified.

Psychometric profiles and facial pain

The myofacial pain-dysfunction syndrome and atypical facial pain are the most prevalent chronic pain disorders of the facial region. Previously, the myofacial pain-dysfunction syndrome included all TMJ/masticatory muscle pain, jaw dysfunction, and joint clicking. We have segregated two major subgroups subsumed within this diagnostic classification and have assigned them to a myogenic facial pain (MFP) group and a TMJ internal derangement (TMJID) group. Significant age and personality differences were uncovered when these subpopulations were compared to subjects with atypical facial pain (AFP). Both MFP and TMJID groups are relatively homologous, involving younger persons than AFP subjects. Alternatively, when MFP, TMJID, and AFP subjects were compared for differences in MMPI psychometric scales, MFP and AFP subjects exhibited significantly higher scores, particularly for hypochondriasis, depression, and hysteria, than did TMJID subjects. It is concluded that subcategorization of myofascial pain-dysfunction patients into a myogenic pain group and a TMJ internal derangement group is justified on the basis of psychometric differences. Furthermore, psychopathologic factors are more significant among MFP and AFP subjects than among TMJID patients.

Differences in pain perception between myofascial pain dysfunction patients and normal subjects: a signal detection analysis

Differences in pain perception between myofascial pain dysfunction patients and normal subjects: a signal detection analysis

Stress-pain relationship in MPD syndrome patients and non-MPD syndrome patients

1 ff’lt o e ective y reat myofascial pain-dysfunction (MPD) syndrome, it is important to understand its etiology. Malocclusion’-” and psychologic traits’.’ have been identified as causal factors. The present study will focus on the MPD syndrome patient’s stress perception and relationship of this perception to pain assessment. Such information should be of use to dentists and other health professionals who treat MPD patients. Laskin,” for example, indicates the importance of psychophysiologic theory in the treatment of MPD syndrome. He reported that, “Initiating factors for the MPD syndrome are generally emotional, rather than physical, (and) treatment must be directed toward this aspect of the problem. . . ” syndrome patients were classified by a psychiatrist as neurotic. The remaining six patients were either psychotic or healthy. These authors note that the number of patients was too small to provide statistical evidence for clusters of these findings.

Differences in pain perception between Myofascial Pain Dysfunction patients and normal subjects: A signal detection analysis

Patients suffering from a chronic psychophysiological orofacial pain disorder, Myofascial Pain Dysfunction Syndrome, were compared with normal control subjects in their reaction to tonic pain stimulation. A signal detection analysis of the data was employed to assess sensitivity and response bias in the perception of pain. The patient group had lower pain thresholds, were less able to discriminate varying intensities of pressure stimulation and demonstrated a greater tendency to report pain as compared to normal control subjects. Possible physiological and psychological mechanisms that could account for the results are discussed.

Predictability of Treatment Outcome in Patients with Myofascial Pain-Dysfunction (MPD) Syndrome

Responses to the Minnesota Multiphasic Personality Inventory (MMPI) were used to develop a 29-item scale designed to predict the treatment outcome of 135 patients with Myofascial Pain-Dysfunction (MPD) Syndrome. The results suggested that a single scale to predict treatment outcome would be ineffective due to the absence of consistent personality differences in MPD patients.

The myofascial pain dysfunction: dental symptoms and psychological and muscular function. An overview. A preliminary study by team approach.

Patients with myofascial pain dysfunction (MPD) are traditionally seen by dentists. No organic lesions are found, and there is accumulating evidence that psychological factors influence both the onset and the development of the disorder, thus calling for a multiprofessional investigation approach. This report presents a preliminary study by a team consisting of a psychiatrist, a dentist and a physiotherapist. 25 patients with MPD diagnosis were examined. Almost all of the patients had tense muscles in neck and back, indicating that muscular tension is not a local phenomenon in the masticatory muscles. It was possible to distinguish two main categories of MPD patients, the 'typical MPD patients' and the 'multiproblem patients'. Problems that need further investigation are pointed out.