Nixdorf Donald R, Hemmaty Azar, Look John O, Schiffman Eric L, John Mike T
Department of Diagnostic & Biological Sciences, School of Dentistry, Minneapolis, MN 55455, USA.
BMC Musculoskelet Disord. 2009 Jul 30;10:94. doi: 10.1186/1471-2474-10-94.
Current methods for identifying patients with pain hypersensitivity are sufficiently complex to limit their widespread application in clinical settings. We assessed the reliability and validity of a simple multi-modal vibrotactile stimulus, applied using an electric toothbrush, to evaluate its potential as a screening tool for central sensitization.
Fourteen female temporomandibular disorders (TMD) subjects with myofascial pain (RDC/TMD Ia or Ib) and arthralgia (RDC/TMD IIIa) were compared to 13 pain-free controls of matched age and gender. Vibrotactile stimulus was performed with an electric toothbrush, applied with 1 pound pressure for 30 seconds in four locations: over the lateral pole of the temporomandibular joint, masseter, temporalis, and mid-ventral surface of forearm. Pain intensity (0-10) was recorded following the stimulus at 0, 15, 30, and 60 seconds. Test-retest reliability was assessed with measurements from 8 participants, taken 2-12 hours apart. Case versus control differentiation involved comparison of area under the curve (AUC). A receiver operating characteristic (ROC) curve was used to determine cutoff AUC scores for maximum sensitivity and specificity for this multi-modal vibrotactile stimulus.
Test-retest reliability resulted in an ICC of 0.87 for all 4 pooled sites. ROC-determined AUC cutoff scores resulted in a sensitivity of 57% and specificity of 92% for all 4 pooled sites.
The electric toothbrush stimulus had excellent test-retest reliability. Validity of the scores was demonstrated with modest sensitivity and good specificity for differentiating TMD pain patients from controls, which are acceptable properties for a screening test.
目前用于识别疼痛超敏患者的方法足够复杂，限制了它们在临床环境中的广泛应用。我们评估了一种使用电动牙刷施加的简单多模式振动触觉刺激的可靠性和有效性，以评估其作为中枢敏化筛查工具的潜力。
将14名患有肌筋膜疼痛（RDC/TMD Ia或Ib）和关节痛（RDC/TMD IIIa）的女性颞下颌关节紊乱（TMD）受试者与13名年龄和性别匹配的无疼痛对照者进行比较。使用电动牙刷进行振动触觉刺激，在四个部位以1磅压力施加30秒：颞下颌关节外侧极、咬肌、颞肌和前臂腹侧中部表面。在刺激后0、15、30和60秒记录疼痛强度（0-10）。通过对8名参与者在2-12小时内进行的测量来评估重测可靠性。病例与对照的区分涉及曲线下面积（AUC）的比较。使用受试者工作特征（ROC）曲线来确定此多模式振动触觉刺激的最大敏感性和特异性的临界AUC分数。
所有4个合并部位的重测可靠性导致ICC为0.87。ROC确定的AUC临界分数导致所有4个合并部位的敏感性为57%，特异性为92%。
电动牙刷刺激具有出色的重测可靠性。该分数的有效性通过区分TMD疼痛患者与对照者的适度敏感性和良好特异性得到证明，这对于筛查测试来说是可接受的特性。
