Raphael Karen G, Janal Malvin N, Anathan Sowmya, Cook Dane B, Staud Roland
Department of Psychiatry, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101-1709, USA.
J Orofac Pain. 2009 Winter;23(1):54-64.
To compare patients with temporomandibular disorders (TMD) to control subjects on two measures of central processing, ie, temporal summation of heat pain and decay of subsequent aftersensations, following thermal stimulation in both a trigeminal and extratrigeminal area.
A "wind-up" protocol was used in which 19 female TMD patients and 17 female controls were exposed to 15 heat stimuli at a rate of 0.3 Hz. Numeric pain ratings were elicited after the 1st, 5th, 10th, and 15th stimulus presentation and every 15 seconds after final presentation (aftersensations) for up to 2 minutes. In separate trials, the thermode was placed on the thenar eminence of the hand and the skin overlying the masseter muscle.
Groups did not differ with respect to the slope of wind-up when stimulated at either anatomic site, although asymptotic levels occurred sooner for TMD patients than for controls. In analysis of aftersensations, a significant group x site x time interaction was detected, in which TMD patients experienced more prolonged painful aftersensations than controls when stimulated on the skin overlying the masseter muscles.
These results are consistent with the presence of enhanced central sensitivity in TMD and suggest that this sensitivity may be largely confined to the region of clinical pain. This contrasts with conditions such as fibromyalgia, where central sensitivity appears to be widespread.
在三叉神经和三叉神经外区域进行热刺激后，比较颞下颌关节紊乱症（TMD）患者与对照受试者在两种中枢处理测量指标上的差异，即热痛的时间总和以及后续后感觉的衰减。
采用一种“累积”方案，让19名女性TMD患者和17名女性对照受试者以0.3Hz的频率接受15次热刺激。在第1次、第5次、第10次和第15次刺激呈现后以及最后一次呈现后每15秒（后感觉）引出数字疼痛评分，持续2分钟。在单独的试验中，将热刺激器置于手部大鱼际肌和咬肌上方的皮肤处。
尽管TMD患者比对照受试者更快达到渐近水平，但在两个解剖部位进行刺激时，两组在累积斜率方面没有差异。在对后感觉的分析中，检测到显著的组×部位×时间交互作用，即当在咬肌上方的皮肤进行刺激时，TMD患者比对照受试者经历更长时间的疼痛后感觉。
这些结果与TMD中存在增强的中枢敏感性一致，并表明这种敏感性可能主要局限于临床疼痛区域。这与纤维肌痛等情况形成对比，在纤维肌痛中，中枢敏感性似乎是广泛存在的。
