Abstract
Individuals with temporomandibular disorder (TMD) suffer from persistent facial pain
and exhibit abnormal sensitivity to tactile stimulation. To better understand the
pathophysiological mechanisms underlying TMD, we investigated cortical correlates
of this abnormal sensitivity to touch. Using functional magnetic resonance imaging
(fMRI), we recorded cortical responses evoked by low-frequency vibration of the index
finger in subjects with TMD and in healthy controls (HC). Distinct subregions of contralateral
primary somatosensory cortex (SI), secondary somatosensory cortex (SII), and insular
cortex responded maximally for each group. Although the stimulus was inaudible, primary
auditory cortex was activated in TMDs. TMDs also showed greater activation bilaterally
in anterior cingulate cortex and contralaterally in the amygdala. Differences between
TMDs and HCs in responses evoked by innocuous vibrotactile stimulation within SI,
SII, and the insula paralleled previously reported differences in responses evoked
by noxious and innocuous stimulation, respectively, in healthy individuals. This unexpected
result may reflect a disruption of the normal balance between central resources dedicated
to processing innocuous and noxious input, manifesting itself as increased readiness
of the pain matrix for activation by even innocuous input. Activation of the amygdala
in our TMD group could reflect the establishment of aversive associations with tactile
stimulation due to the persistence of pain.
Perspective
This article presents evidence that central processing of innocuous tactile stimulation
is abnormal in TMD. Understanding the complexity of sensory disruption in chronic
pain could lead to improved methods for assessing cerebral cortical function in these
patients.
Key words
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Article info
Publication history
Published online: May 12, 2010
Accepted:
February 8,
2010
Received in revised form:
January 20,
2010
Received:
July 9,
2009
Footnotes
Supported by NIH grant P01 NS045685.
Identification
Copyright
© 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.
