Temporomandibular Joint Disorder Pain Research Articles

Pain detection by clinical questionnaire in patients referred for temporomandibular disorders in a Chilean hospital.

Aim: To determine pain frequency by means of a clinical screening questionnaire in patients with temporomandibular disorders (TMD) referred to the general Hospital of Valdivia (HBV) between September and December 2014. Material and method: A descriptive study, which included patients referred to the TMD Unit of the dental service at HBV between September and December 2014, was carried out. A clinical screening questionnaire was applied by an examiner in order to detect painful Temporomandibular Joint Disorders. The variables age, sex, wait time, and presence of related TMD pain were measured. Results: 101 patients were surveyed; 88.17% (84 patients) were women. Average age was 33.5 (11-70) years; 66% of patients had mandibular pain or stiffness upon awakening; 80% informed pain related to painful TMD. Conclusion: Most surveyed patients were women. Pain was highly frequent in the surveyed population; its main location was in temporal areas.

Influência de abordagens biopsicossociais e autocuidados no controle das disfunções temporomandibulares crônicas

JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular (DTM), condição musculoesquelética do sistema mastigatório, pode se tornar crônica, causando maior comprometimento na qualidade de vida (QV) dos pacientes. Devido à inter-relação entre sintomas físicos e emocionais, há uma crescente busca pelo modelo integrativo, o qual inclui abordagens psicossociais para o tratamento de condições dolorosas. O objetivo deste estudo foi realizar uma revisão de literatura sobre o impacto da educação e modalidades simples de autocuidados podem ter na dor e na disfunção relacionadas à DTM dolorosa crônica. CONTEÚDO: Os fatores psicossociais estão frequentemente envolvidos na cronificação da dor, tornando as abordagens biocomportamentais cada vez mais indicadas para mudar a percepção da dor, reduzir o sofrimento e as alterações psicossociais que acompanham as dores persistentes. CONCLUSÃO: A literatura existente, apesar de não ser vasta, indica resultados positivos da aplicação de métodos de educação e autocuidados em DTM dolorosa crônica. Mais estudos são necessários para reforçar tais achados e disseminar a aplicação de tais abordagens no controle da dor crônica e da DTM.

Depressive and Anxiety Symptoms as Risk Factors for Temporomandibular Joint Pain: A Prospective Cohort Study in the General Population

Previous studies have associated depression and temporomandibular joint disorders (TMDs). The temporality, however, remains to be clarified. Most patient studies have selected subjects from treatment facilities, whereas in epidemiological studies a clinical examination has not been performed. In this study the 5-year follow-up data of the population-based Study of Health in Pomerania (SHIP) were analyzed. To estimate the effect of symptoms of depression and those of anxiety on the risk of TMD pain, the Composite International Diagnostic-Screener (CID-S) and a clinical functional examination with palpation of the temporomandibular joint and the masticatory muscles were used. After exclusion of subjects having joint pain at baseline, a sample of 3,006 Caucasian participants with a mean age of 49 years resulted. Of those, 122 participants had signs of TMD joint pain upon palpation. Subjects with symptoms of depression had an increased risk of TMD joint pain upon palpation (rate ratio: 2.1; 95% confidence interval: 1.5–3.0; P < .001). Anxiety symptoms were associated with joint and with muscle pain. The diagnosis, prevention, and therapy of TMD pain should also consider symptoms of depression and those of anxiety, and appropriate therapies if necessary. PerspectiveDepressive and anxiety symptoms should be considered as risk factors for TMD pain. Depressive symptoms are specific for joint pain whereas anxiety symptoms are specific for muscle pain, findings that deserve detailed examination. These findings may support decision-making in treating TMD.

Orofacial Pain Prospective Evaluation and Risk Assessment Study – The OPPERA Study

This Journal of Pain Compendium presents the initial outcomes from the first large population-based study designed to identify the biopsychosocial and genetic risk factors that contribute to the onset and persistence of painful temporomandibular joint disorders (TMD) – The OPPERA Study. This study is supported by NIDCR Cooperative Agreement U01 {type:entrez-nucleotide,attrs:{text:DE017018,term_id:62259868,term_text:DE017018}}DE017018 that was initiated September 22, 2005.

Surface electromyographic assessment of patients with long lasting temporomandibular joint disorder pain

The normalized electromyographic characteristics of masticatory muscles in patients with temporomandibular joint disorders (TMD) and healthy controls were compared. Thirty TMD patients (15 men, 15 women, mean age 23 years) with long lasting pain (more than 6 months), and 20 control subjects matched for sex and age were examined. All patients had arthrogenous TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD). Surface electromyography of masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position. Standardized EMG indices and the median power frequency were obtained, and compared between the two groups and sexes using ANOVAs. During clenching, the TMD patients had larger asymmetry in their temporalis muscles, larger temporalis activity relative to masseter, and reduced mean power frequencies than the control subjects ( p < 0.05, ANOVA). In both groups, the mean power frequencies of the temporalis muscles were larger than those of the masseter muscles ( p < 0.001). No sex related differences, and no sex × group interactions were found. In conclusion, young adult patients with long lasting TMD have an increased and more asymmetric standardized activity of their temporalis anterior muscle, and reduced mean power frequencies, relative to healthy controls.

Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain

The relationship of the frequency of temple headache to signs and symptoms of temporomandibular joint (TMJ) disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included 86 painful TMD, nonheadache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria for Temporomandibular Disorders diagnoses of myofascial pain, TMJ arthralgia, and TMJ osteoarthritis. Mild to moderate-intensity temple headaches were classified by frequency using criteria based on the International Classification of Headache Disorder, 2nd edition, classification of tension-type headache. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), pressure pain thresholds, and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients.Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches.

Journey Into Healing: The Transformative Experience of Shamanic Healing on Women With Temporomandibular Joint Disorders

To evaluate participants' perceptions of illness, healing process, and experience of effects from shamanic treatment as reported from in-depth interviews. Consistent with a whole systems research model, qualitative methods were used to evaluate the outcomes and experiences of clinical trial participants. Quantitative results are reported elsewhere. Twenty participants completed five visits with a randomly assigned shamanic practitioner and completed pretreatment and posttreatment in-depth interviews conducted by trained, qualitative researchers. Some physical and psychological symptoms associated with temporomandibular joint disorders (TMD) may be indicative of the shamanic definition of soul loss. Because this was the first clinical trial of shamanic healing for TMD pain, a mixed-methods approach enabled researchers to capture a wide range of participants' experiences. Eligible volunteers were women aged between 25 to 55 years, naive to shamanic healing, with a confirmed diagnosis of TMD and a pain level of three or higher on the Research Diagnostic Criteria Axis II questionnaire. For consistency, interviewers followed a guide that allowed individual experiences to emerge. Interviews lasted about one hour, were recorded, and professionally transcribed. ANALYSIS AND INTERPRETATION: Following standard qualitative analysis procedures, researchers developed and applied thematic codes to transcribed text of interviews. Coded text was reviewed to generate summaries of thematic content. Although participants described physical changes, three times as much text was devoted to changes in self-awareness, capacity for coping, improvement in relationships, and taking better care of themselves. Their experience describes a process of transformation.

Psychophysical stress increases the expression of phospho-CREB, Fos protein and neurokinin-1 receptors in superficial laminae of trigeminal subnucleus caudalis in female rats

Psychological stress and estrogen status are risk factors to develop painful temporomandibular joint disorders (TMJD); however, the neural basis for this relationship is not known. This study tested the hypothesis that repeated forced swim stress and estradiol treatment alter the phosphorylation of cAMP responsive element-binding protein (pCREB) in trigeminal subnucleus caudalis (Vc), the initial site of sensory input from the TMJ. Ovariectomized female rats were given low or high dose estradiol and subjected to repeated forced swim stress for 3 days and on day 4 an intra-TMJ injection of mustard oil or vehicle was given. Forced swim alone increased the number of pCREB-positive neurons, independent of estradiol treatment or TMJ stimulation, in superficial and deep laminae of Vc. Forced swim also increased the number of Fos-positive neurons in superficial laminae and neurokinin-1 receptor mRNA in whole dorsal Vc, independent of estradiol treatment. These results indicated that persistent psychophysical stress alone was sufficient to increase the expression of pCREB and downstream regulated genes associated with enhanced excitability in the caudal medullary dorsal horn, a brainstem region thought to be critical for TMJD pain.

Situational Versus Dispositional Measurement of Catastrophizing: Associations With Pain Responses in Multiple Samples

Catastrophizing is widely recognized as an important risk factor for adverse pain-related outcomes. However, questions remain surrounding the details of its assessment. In particular, recent laboratory studies suggest that evaluation of "situational" catastrophizing (ie, catastrophizing measured during or directly after the administration of noxious stimulation) may provide information distinct from that obtained by standard, or "dispositional" measures, which assess individuals' recall of catastrophizing in daily life. However, comparatively little research has systematically investigated the interrelationships and properties of these 2 different forms of pain-related catastrophizing. The current study evaluated both situational and dispositional catastrophizing measures within multiple samples: healthy individuals (N = 84), patients with painful temporomandibular joint disorders (TMD; N = 48), and patients with painful arthritis (N = 43). All participants first completed the Pain Catastrophizing Scale (PCS), and then underwent psychophysical pain testing, which included heat, cold, and pressure pain. Participants then completed a situational catastrophizing measure with reference to the laboratory pain he/she had just undergone. Situational catastrophizing scores were not significantly correlated with dispositional PCS scores in the healthy participants and arthritis patients, though they were associated in TMD patients. Situational catastrophizing was more strongly associated with experimental pain responses than dispositional PCS scores for the healthy subjects and arthritis patients. In general, higher levels of situational catastrophizing were associated with lower pain thresholds and higher pain ratings across all 3 samples. The findings highlight the importance of multidimensional assessment of pain-related catastrophizing, and suggests a role for measuring catastrophizing related to specific, definable events. This study adds to a growing literature examining catastrophizing. Our findings highlight the potential importance of the multidimensional assessment of pain-related catastrophizing, and suggest a role for measuring catastrophizing related to specific, definable events.

Long Lasting Pain Hypersensitivity following Ligation of the Tendon of the Masseter Muscle in Rats: A Model of Myogenic Orofacial Pain

BackgroundA major subgroup of patients with temporomandibular joint (TMJ) disorders have masticatory muscle hypersensitivity. To study myofacial temporomandibular pain, a number of preclinical models have been developed to induce myogenic pain of the masseter muscle, one of the four muscles involved in mastication. The currently used models, however, generate pain that decreases over time and only lasts from hours to weeks and hence are not suitable for studying chronicity of the myogenic pain in TMJ disorders. Here we report a model of constant myogenic orofacial pain that lasts for months.ResultsThe model involves unilateral ligation of the tendon of the anterior superficial part of the rat masseter muscle (TASM). The ligation of the TASM was achieved with two chromic gut (4.0) ligatures via an intraoral approach. Nocifensive behavior of the rat was assessed by probing the skin site above the TASM with a series of von Frey filaments. The response frequencies were determined and an EF50 value, defined as the von Frey filament force that produces a 50% response frequency, was derived and used as a measure of mechanical sensitivity. Following TASM ligation, the EF50 of the injured side was significantly reduced and maintained throughout the 8-week observation period, suggesting the presence of mechanical hyperalgesia/allodynia. In sham-operated rats, the EF50 of the injured side was transiently reduced for about a week, likely due to injury produced by the surgery. Somatotopically relevant Fos protein expression was indentified in the subnucleus caudalis of the spinal trigeminal sensory complex. In the same region, persistent upregulation of NMDA receptor NR1 phosphorylation and protein expression and increased expression of glial markers glial fibrillary acidic protein (astroglia) and CD11b (microglia) were found. Morphine (0.4-8 mg/kg, s.c.) and duloxetine (0.4-20 mg/kg, i.p.), a selective serotonin-norepinephrine reuptake inhibitor, produced dose-dependent attenuation of hyperalgesia.ConclusionsLigation injury of the TASM in rats led to long-lasting and constant mechanical hypersensitivity of myogenic origin. The model will be particularly useful in studying the chronicity of myogenic pain TMJ disorders. The model can also be adapted to other regions of the body for studying pathology of painful tendinopathy seen in sports injury, muscle overuse, and rheumatoid arthritis.

Impact of tobacco use on the symptoms of painful temporomandibular joint disorders

This study examines the relationship between the severity of painful temporomandibular joint disorders (TMD) symptoms and current tobacco use in patients evaluated at a specialized orofacial pain clinic. Medical records, including responses to the Chronic Pain Grading Scale (CPGS), from 606 consecutive patients evaluated at the Mayo Clinic orofacial pain clinic with TMD by RDC-TMD criteria were retrospectively reviewed. Univariate analyses were performed comparing tobacco users and non-users. Analysis of covariance and multiple logistic regression models were used to adjust for demographic variables. A p value⩽0.05 was accepted as the level of significance. Current tobacco use was reported by 91 subjects (15.1%). Tobacco users were younger (p<0.01), less frequently married or widowed (p<0.01), more frequently unemployed (p<0.01), and less educated (p<0.01). In univariate analysis, tobacco users were more likely to have moderate to severe pain interference defined as GPGS III–IV (OR=1.94, 95% CI 1.16–3.22 for tobacco users compared to non-users), but this difference was not significant after adjustment for demographic variables. In the subset of subjects who lacked a myofascial component of pain (N=333) this difference remained significant in the adjusted analysis (adjusted OR=4.56, 95% CI 1.46–14.24). Current tobacco use was associated with unfavorable demographic background variables and more pain interference in subjects with TMD presenting to a specialized orofacial pain clinic. These effects were more pronounced in cases where myofascial pain was not present.

(320) In-vivo vs. standard catastrophizing in multiple pain measures among healthy, TMD and arthritis patients

Catastrophizing is widely recognized as an important risk factor for adverse pain-related outcomes. There are, however, questions surrounding its assessment. In particular, recent laboratory studies suggest that evaluation of “in-vivo” catastrophizing (i.e., catastrophizing measured during the administration of noxious stimulation) may provide information distinct from that obtained by standard measures which assess catastrophizing in daily life. However, comparatively little research has systematically investigated these relationships using different stimulus modalities and subject samples. The current study sought to elucidate the associations of in-vivo and standard catastrophizing measures with a variety of experimental pain responses among healthy individuals (N=84), patients with painful temporomandibular joint disorders (TMD; N=48), and patients with arthritis pain (N=43). All participants first completed the Pain Catastrophizing Scale (PCS), and then underwent psychophysical pain testing, including evaluation of responses to noxious heat, cold, and pressure. Immediately following the pain induction procedures, participants completed an in-vivo catastrophizing measure with reference to the laboratory pain experience they had just undergone. In-vivo catastrophizing scores were uncorrelated with PCS scores in the controls (r= -.002) and arthritis patients (r=.24, p’s > .1), though there was a significant positive association in the TMD patients (r = .46, p = .001). Moreover, in-vivo catastrophizing was generally more strongly associated with experimental pain responses (e.g. pain threshold, suprathreshold pain ratings) than PCS scores, though these results varied by pain testing modality. Finally, the associations between catastrophizing and psychophysical pain responses were strongest in TMD patients relative to the other two groups. Overall, these findings highlight the importance of assessing in-vivo catastrophizing, and suggest a role for measurement of catastrophizing related to recent, specified painful events.

Assessment of pain in temporomandibular disorders: the bio-psychosocial complexity

Temporomandibular joint disorders (TMD) affect the joint, the masticatory muscles, or are expressed as a clinical combination of these two factors. The aims of this study were to: (i) identify the clinical and psychosocial factors that aid in the diagnosis and classification of acute and chronic TMD, (ii) determine specific initiating and perpetuating factors which may act as a guide to differentiate between acute and chronic TMD, (iii) identify factors which might predispose to conversion from acute to chronic TMD. Twenty-two patients were examined in the pain clinics at the Eastman Dental Institute. The assessment technique incorporated questionnaires, clinical history and examination including dental panoramic tomography. The results of this pilot study show a significant correlation between mood and enjoyment of life in both groups, mood and relationships in the chronic group, average pain and sleep in the chronic group, average pain and eating–chewing in the chronic group, and phobia for physical disease with trust in clinicians in the chronic group. The bio-psychosocial model of pain is an important appraisal tool. The newly designed TMD Pain Assessment is described with good results.

COX-2 selective inhibitors: a literature review of analgesic efficacy and safety in oral-maxillofacial surgery.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed analgesic agents in surgical outpatients. Major limitations of NSAIDs are their gastrointestinal (GI) adverse events (perforation, ulceration, and bleeding), impairment of hemostatic function, and renal failure (with long-term therapy). A new class of NSAIDs, the COX-2 selective inhibitors (CSIs or Coxibs), have been developed with the aim of reducing the GI adverse events of traditional NSAIDs while maintaining their effective anti-inflammatory and analgesic properties. This is a narrative review of the literature aimed to discuss analgesic efficacy, clinical safety and cost-benefit ratio of CSIs in the treatment of post-oral surgery pain. Relevant drug and clinical studies of analgesic efficacy and safety of CSIs in the management of postoperative dental pain were identified through searches of MEDLINE/PubMed, in peer-reviewed journals of medicine and dentistry. The Food and Drug Administration Web site was searched for data of tolerability. Hand-searching included several dental journals and bibliographies of relevant studies. The last electronic search was conducted in April 2003. Data from well-designed, randomized, controlled trials of CSIs on the management of post-oral surgery pain indicate that these drugs are as well-effective analgesic agents as traditional NSAIDs and offer clinical advantages in terms of GI safety and unimpaired platelet function. CSIs do not offer advantages of renal safety over traditional NSAIDs. Although CSIs display analgesic efficacy similar to that of traditional NSAIDs in the treatment of acute, post-oral surgery pain, there is reasonable evidence that these new drugs are preferable in patients who are at an increased risk of developing serious upper-GI complications, in patients who take aspirin for cardiovascular comorbid conditions, and in those allergic to aspirin. Furthermore, CSIs may be given more safely than NSAIDs in perioperative settings, because of their lack of impairment of the blood-clotting. However, the high costs of CSIs available at present limit their routine use in the short period of postoperative dental pain-in most cases 2 to 4 days after surgery-because there is not an increased risk of developing serious GI complications with the use of cost-saving NSAIDs. The GI safety advantages of CSIs may improve the tolerability of long-duration analgesic therapies, such as cases of painful temporomandibular joint disorders and chronic orofacial pain. Further studies are needed to determine the cost-benefit ratio of using CSIs for the management of acute pain.

Bite-force endurance in patients with temporomandibular joint osteoarthrosis and internal derangement.

The aim of this study was to investigate the potential clinical relevance of testing bite force endurance in patients with articular temporomandibular disorders. The endurance of a 50 N bite force was measured in 51 patients with painful temporomandibular joint disorders. The results were compared to those of a control group of 20 subjects. The force exerted was sustained until this task could not be continued because of intolerable pain or fatigue. The endurance test was repeated following therapy. Testing bite force endurance could be reliably carried out (paired t-test not significant, product-moment correlation coefficient 0.87). The mean endurance time in the patient group was significantly different from that of the control group (t = 7.43, df = 69, P < 0.01). The 95% confidence intervals for patients and controls did not show any overlap. No difference in endurance time between diagnostic subgroups could be detected (F = 1.30, df = 4,46, P < 0.28). Following treatment, all patients showed a significant increase of endurance time (t = 8.09, df = 50, P < 0.01) and reported a decrease in post-test pain. The mean difference between pre- and post-treatment endurance was 60s. Subjects of the control group stopped the biting effort predominantly because of muscle fatigue. By contrast, the main reason of the patients to cease the effort was TMJ pain. The results of this study indicate that the discriminatory power of the test is sufficient to justify its utility as a complementary tool in assessing the functional capacity of the masticatory system.