Bilateral Widespread Mechanical Pain Sensitivity in Women With Myofascial Temporomandibular Disorder: Evidence of Impairment in Central Nociceptive Processing

Fernández-de-las-Peñas, César; Galán-del-Río, Fernando; Fernández-Carnero, Josué; Pesquera, Jorge; Arendt-Nielsen, Lars; Svensson, Peter

doi:10.1016/j.jpain.2009.04.017

« Previous Next »The Journal of Pain
Volume 10, Issue 11 , Pages 1170-1178, November 2009

Bilateral Widespread Mechanical Pain Sensitivity in Women With Myofascial Temporomandibular Disorder: Evidence of Impairment in Central Nociceptive Processing

César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
- Esthesiology Laboratory of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
- Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Address reprint requests to César Fernández de las Peñas, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain.
Fernando Galán-del-Río
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
- Esthesiology Laboratory of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
- Esthesiology Laboratory of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
Jorge Pesquera
- Dental and Orofacial Pain Department, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
Lars Arendt-Nielsen
- Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
Peter Svensson
- Department of Clinical Oral Physiology, School of Dentistry, University of Aarhus, Aarhus, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
- Orofacial Pain Laboratory, Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark

Received 9 February 2009; received in revised form 18 March 2009; accepted 20 April 2009. published online 10 July 2009.

Abstract

Our aim was to investigate bilateral, widespread pressure-pain hypersensitivity in nerve, muscle, and joint tissues in women with myofascial temporomandibular disorders (TMD) without concomitant comorbid conditions. Twenty women with myofascial TMD (aged 20 to 28 years old), and 20 healthy matched women (aged 20 to 29 years), were recruited. Pressure-pain thresholds (PPT) were bilaterally assessed over supra-orbital (V1), infra-orbital (V2), mental (V3) nerves, median (C5), radial (C6) and ulnar (C7) nerve trunks, the C5-C6 zygapophyseal joint, the lateral pole of the temporo mandibular joint (TMJ), and the tibialis anterior muscle in a blinded design. The results showed that PPTs were significantly decreased bilaterally over the supra-orbital, infra-orbital, and mental nerves, median, ulnar, and radial nerve trunks, the lateral pole of the TMJ, the C5-C6 zygapophyseal joint, and the tibialis anterior muscle in patients with myofascial TMD as compared to healthy controls (all sites: P < .001). There were no significant differences in the magnitude of PPT decreases between the trigeminal and extratrigeminal test sites. PPT over the mental nerve, the TMJ, C5-C6 zygapophyseal joint and tibialis anterior muscle were negatively correlated to both duration of pain symptoms and TMD pain intensity (P < .05). Our findings revealed bilateral, widespread pressure hypersensitivity in women presenting with myofascial TMD, suggesting that widespread central sensitization is involved in myofascial TMD women.

Perspective

This article reveals the presence of bilateral and widespread pressure-pain hypersensitivity in women with myofascial TMD, suggesting that widespread central sensitization is involved in myofascial TMD. This finding has implications for development of management strategies.

Key words: Temporomandibular disorder, pressure-pain threshold, central sensitization