Advertisement

Evidence for Sustained Mechanical Pain Sensitization in Women With Chronic Temporomandibular Disorder Versus Healthy Female Participants

Published:August 14, 2015DOI:https://doi.org/10.1016/j.jpain.2015.08.002

      Highlights

      • Sustained mechanical pain sensitization discriminated patients with temporomandibular disorder (TMD) and control individuals.
      • Sustained pain sensitization showed predictive validity for clinical TMD pain.
      • Sustained pain sensitization might represent 1 marker of chronic TMD pain.

      Abstract

      Generalized dysfunction of the nociceptive system has been hypothesized to be an important pathophysiologic process underlying temporomandibular disorder (TMD) pain. Studies have not identified sensitization to painful stimuli administered prospectively across consecutive days among participants with TMD with chronic pain. We attempted to isolate an empirically derived laboratory-based marker of sustained mechanical pain sensitization. We examined whether this index accounted for variance in prospective assessments of clinical TMD pain. Participants were women with a clinical diagnosis of chronic TMD (n = 30) and healthy female controls (n = 30). Pain thresholds were assessed using digital algometry 4 times at 12-hour intervals over 48 consecutive hours and clinical TMD pain via follow-up telephone assessments. Sustained mechanical pain sensitization, defined by statistically significant linear decrements in pressure pain thresholds across the consecutive testing sessions, discriminated chronic TMD and control participants. An index of sustained sensitization at the masseter accounted for unique variance in clinical TMD pain over the subsequent 3-month assessment period, even controlling for mean pain threshold and baseline pain severity. These preliminary findings highlight discriminant and predictive validity characteristics of a novel marker of protracted pain sensitization among women with chronic TMD pain.

      Perspective

      A laboratory-based and empirically defined marker of sustained mechanical pain sensitization over the course of days with acceptable discriminant and predictive validity was identified. This marker may represent a clinically useful marker of chronic TMD pain in women.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Aaron L.A.
        • Burke M.M.
        • Buchwald D.
        Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder.
        Arch Intern Med. 2000; 160: 221-227
        • Buysse D.J.
        • Reynolds 3rd, C.F.
        • Monk T.H.
        • Berman S.R.
        • Kupfer D.J.
        The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.
        Psychiatry Res. 1989; 28: 193-213
        • Carlson C.R.
        • Reid K.I.
        • Curran S.L.
        • Studts J.
        • Okeson J.P.
        • Falace D.
        • Nitz A.
        • Bertrand P.M.
        Psychological and physiological parameters of masticatory muscle pain.
        Pain. 1998; 76: 297-307
        • Cohen J.
        • Cohen P.
        • West S.G.
        • Aiken L.S.
        Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences.
        Erlbaum, Hillsdale, NJ2003
        • Cohen J.
        • Cohen P.
        • West S.G.
        • Aiken L.S.
        Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences.
        Routledge, Mahwah, NJ2013
        • Derogatis L.R.
        • Melisaratos N.
        The brief symptom inventory: an introductory report.
        Psychol Med. 1983; 13: 595-605
        • Diatchenko L.
        • Nackley A.G.
        • Slade G.D.
        • Fillingim R.B.
        • Maixner W.
        Idiopathic pain disorders–pathways of vulnerability.
        Pain. 2006; 123: 226-230
        • Dworkin S.F.
        • LeResche L.
        Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique.
        J Craniomandib Disord. 1992; 6: 301-355
        • Edwards R.R.
        • Fillingim R.B.
        Effects of age on temporal summation and habituation of thermal pain: clinical relevance in healthy older and younger adults.
        J Pain. 2001; 2: 307-317
        • Edwards R.R.
        • Grace E.
        • Peterson S.
        • Klick B.
        • Haythornthwaite J.A.
        • Smith M.T.
        Sleep continuity and architecture: associations with pain-inhibitory processes in patients with temporomandibular joint disorder.
        Eur J Pain. 2009; 13: 1043-1047
        • Edwards R.R.
        • Kronfli T.
        • Haythornthwaite J.A.
        • Smith M.T.
        • McGuire L.
        • Page G.G.
        Association of catastrophizing with interleukin-6 responses to acute pain.
        Pain. 2008; 140: 135-144
        • Edwards R.R.
        • Ness T.J.
        • Weigent D.A.
        • Fillingim R.B.
        Individual differences in diffuse noxious inhibitory controls (DNIC): association with clinical variables.
        Pain. 2003; 106: 427-437
        • Edwards R.R.
        • Sarlani E.
        • Wesselmann U.
        • Fillingim R.B.
        Quantitative assessment of experimental pain perception: multiple domains of clinical relevance.
        Pain. 2005; 114: 315-319
        • Edwards R.R.
        • Wasan A.D.
        • Bingham 3rd, C.O.
        • Bathon J.
        • Haythornthwaite J.A.
        • Smith M.T.
        • Page G.G.
        Enhanced reactivity to pain in patients with rheumatoid arthritis.
        Arthritis Res Ther. 2009; 11: R61
        • Farella M.
        • Michelotti A.
        • Steenks M.
        • Romeo R.
        • Cimino R.
        • Bosman F.
        The diagnostic value of pressure algometry in myofascial pain of the jaw muscles.
        J Oral Rehabil. 2000; 27: 9-14
        • Fernandez-de-las-Penas C.
        • Caminero A.B.
        • Madeleine P.
        • Guillem-Mesado A.
        • Ge H.-Y.
        • Arendt-Nielsen L.
        • Pareja J.A.
        Multiple active myofascial trigger points and pressure pain sensitivity maps in the temporalis muscle are related in women with chronic tension type headache.
        Clin J Pain. 2009; 25: 506-512
        • Fernández-de-Las-Peñas C.
        • Galán-del-Río F.
        • Fernández-Carnero J.
        • Pesquera J.
        • Arendt-Nielsen L.
        • Svensson P.
        Bilateral widespread mechanical pain sensitivity in women with myofascial temporomandibular disorder: evidence of impairment in central nociceptive processing.
        J Pain. 2009; 10: 1170-1178
        • Fernández-de-Las-Peñas C.
        • Galán-del-Río F.
        • Ortega-Santiago R.
        • Jiménez-García R.
        • Arendt-Nielsen L.
        • Svensson P.
        Bilateral thermal hyperalgesia in trigeminal and extra-trigeminal regions in patients with myofascial temporomandibular disorders.
        Exp Brain Res. 2010; 202: 171-179
        • Fillingim R.B.
        • King C.D.
        • Ribeiro-Dasilva M.C.
        • Rahim-Williams B.
        • Riley III, J.L.
        Sex, gender, and pain: a review of recent clinical and experimental findings.
        J Pain. 2009; 10: 447-485
        • Goodin B.R.
        • Bulls H.W.
        • Herbert M.S.
        • Schmidt J.
        • King C.D.
        • Glover T.L.
        • Sotolongo A.
        • Sibille K.T.
        • Cruz-Almeida Y.
        • Staud R.
        • Fessler B.J.
        • Redden D.T.
        • Bradley L.A.
        • Fillingim R.B.
        Temporal summation of pain as a prospective predictor of clinical pain severity in adults aged 45 years and above with knee osteoarthritis: ethnic differences.
        Psychosom Med. 2014; 76: 302-310
        • Greenspan J.D.
        • Slade G.D.
        • Bair E.
        • Dubner R.
        • Fillingim R.B.
        • Ohrbach R.
        • Knott C.
        • Diatchenko L.
        • Liu Q.
        • Maixner W.
        Pain sensitivity and autonomic factors associated with development of TMD: the OPPERA prospective cohort study.
        J Pain. 2013; 14: T63-T74.e61–e66
        • Greenspan J.D.
        • Slade G.D.
        • Bair E.
        • Dubner R.
        • Fillingim R.B.
        • Ohrbach R.
        • Knott C.
        • Mulkey F.
        • Rothwell R.
        • Maixner W.
        Pain sensitivity risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case control study.
        J Pain. 2011; 12 (2011): T61-T74
        • Kashima K.
        • Rahman O.
        • Sakoda S.
        • Shiba R.
        Increased pain sensitivity of the upper extremities of TMD patients with myalgia to experimentally-evoked noxious stimulation: possibility of worsened endogenous opioid systems.
        Cranio. 1999; 17: 241-246
        • Kupers R.C.
        • Svensson P.
        • Jensen T.S.
        Central representation of muscle pain and mechanical hyperesthesia in the orofacial region: a positron emission tomography study.
        Pain. 2004; 108: 284-293
        • Maixner W.
        • Fillingim R.
        • Booker D.
        • Sigurdsson A.
        Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain.
        Pain. 1995; 63: 341-351
        • Maixner W.
        • Fillingim R.
        • Sigurdsson A.
        • Kincaid S.
        • Silva S.
        Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain: evidence for altered temporal summation of pain.
        Pain. 1998; 76: 71-81
        • Martinez V.
        • Fletcher D.
        • Bouhassira D.
        • Sessler D.I.
        • Chauvin M.
        The evolution of primary hyperalgesia in orthopedic surgery: quantitative sensory testing and clinical evaluation before and after total knee arthroplasty.
        Anesth Analg. 2007; 105: 815
        • O'Connor M.-F.
        • Motivala S.J.
        • Valladares E.M.
        • Olmstead R.
        • Irwin M.R.
        Sex differences in monocyte expression of IL-6: role of autonomic mechanisms.
        Am J Physiol Regul Integr Comp Physiol. 2007; 293: R145-R151
        • Pfau D.B.
        • Rolke R.
        • Nickel R.
        • Treede R.-D.
        • Daublaender M.
        Somatosensory profiles in subgroups of patients with myogenic temporomandibular disorders and fibromyalgia syndrome.
        Pain. 2009; 147: 72-83
        • Quartana P.J.
        • Buenaver L.F.
        • Edwards R.R.
        • Klick B.
        • Haythornthwaite J.A.
        • Smith M.T.
        Pain catastrophizing and salivary cortisol responses to laboratory pain testing in temporomandibular disorder and healthy participants.
        J Pain. 2010; 11: 186-194
        • Quartana P.J.
        • Campbell C.M.
        • Edwards R.R.
        Pain catastrophizing: a critical review.
        Expert Rev Neurother. 2009; 9: 745-758
        • Quartana P.J.
        • Wickwire E.M.
        • Klick B.
        • Grace E.
        • Smith M.T.
        Naturalistic changes in insomnia symptoms and pain in temporomandibular joint disorder: a cross-lagged panel analysis.
        Pain. 2010; 149: 325-331
        • Reid K.I.
        • Gracely R.H.
        • Dubner R.A.
        The influence of time, facial side, and location on pain-pressure thresholds in chronic myogenous temporomandibular disorder.
        J Orofac Pain. 1994; 8: 258-265
        • Rosenthal R.
        • Rosnow R.L.
        Essentials of Behavioral Research: Methods and Data Analysis. vol. 2. McGraw-Hill, New York1991
        • Sarlani E.
        • Garrett P.H.
        • Grace E.G.
        • Greenspan J.D.
        Temporal summation of pain characterizes women but not men with temporomandibular disorders.
        J Orofac Pain. 2007; 21: 309
        • Sarlani E.
        • Grace E.G.
        • Reynolds M.A.
        • Greenspan J.D.
        Evidence for up-regulated central nociceptive processing in patients with masticatory myofascial pain.
        J Orofac Pain. 2004; 18: 41-55
        • Sarlani E.
        • Greenspan J.
        Why look in the brain for answers to temporomandibular disorder pain?.
        Cells Tissues Organs. 2005; 180: 69-75
        • Sarlani E.
        • Greenspan J.D.
        Evidence for generalized hyperalgesia in temporomandibular disorders patients.
        Pain. 2003; 102: 221-226
        • Slade G.D.
        • Sanders A.E.
        • Ohrbach R.
        • Fillingim R.B.
        • Dubner R.
        • Gracely R.H.
        • Bair E.
        • Maixner W.
        • Greenspan J.D.
        Pressure pain thresholds fluctuate with, but do not usefully predict, the clinical course of painful temporomandibular disorder.
        Pain. 2014;
        • Smith M.T.
        • Wickwire E.M.
        • Grace E.G.
        • Edwards R.R.
        • Buenaver L.F.
        • Peterson S.
        • Klick B.
        • Haythornthwaite J.A.
        Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder.
        Sleep. 2009; 32: 779-790
        • Svensson P.
        • Arendt-Nielsen L.
        • Nielsen H.
        • Larsen J.K.
        Effect of chronic and experimental jaw muscle pain on pain-pressure thresholds and stimulus-response curves.
        J Orofac Pain. 1995; 9: 347-356
        • Svensson P.
        • List T.
        • Hector G.
        Analysis of stimulus-evoked pain in patients with myofascial temporomandibular pain disorders.
        Pain. 2001; 92: 399-409
        • Tan G.
        • Jensen M.P.
        • Thornby J.I.
        • Shanti B.F.
        Validation of the Brief Pain Inventory for chronic nonmalignant pain.
        J Pain. 2004; 5: 133-137
        • van Wijk G.
        • Veldhuijzen D.S.
        Perspective on diffuse noxious inhibitory controls as a model of endogenous pain modulation in clinical pain syndromes.
        J Pain. 2010; 11: 408-419