Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922, Alcorcón, Madrid, Spain.
Exp Brain Res. 2010 Apr;202(1):171-9. doi: 10.1007/s00221-009-2121-x. Epub 2009 Dec 17.
Our aim was to assess thermal sensitivity in both trigeminal and extra-trigeminal regions in patients with myofascial temporomandibular disorder (TMD) but without comorbid conditions as compared to age-matched controls. Twenty women (age 24 +/- 3 years) diagnosed with myofascial TMD according to the research diagnostic criteria for TMD and 20 healthy women (age 24 +/- 4 years) were included. Warm and cold detection thresholds (WDT and CDT, respectively) and heat and cold pain thresholds (HPT and CPT, respectively) were bilaterally assessed over the masseter and frontalis muscles (trigeminal regions) and the wrist (extra-trigeminal region). The mean of three determinations at each site was calculated and used for analysis. The order of the test sites was randomized. A two-way ANOVA was used to test for differences between groups and sides (most painful/contra-lateral side; dominant/non-dominant). No significant differences between groups for WDT or CDT in trigeminal and extra-trigeminal regions (ANOVA, P > 0.389) were found. There were significant differences between groups, but not between sides, for HPT and CPT in both trigeminal and extra-trigeminal areas (ANOVA, P < 0.001). CPT (P < 0.001) over the trigeminal area was positively correlated with both pain intensity and duration of pain symptoms: the longer the history of pain or the greater the pain intensity, the higher the CPT (i.e., the greater cold hyperalgesia) over the trigeminal region. Our findings revealed bilateral thermal hyperalgesia (lower HPT and higher CPT) but normal WDT and CDT in trigeminal and extra-trigeminal regions in women with myofascial TMD as compared to healthy controls. Bilateral heat/cold hyperalgesia in trigeminal and extra-trigeminal areas may reflect a dysfunction of thermal channels in myofascial TMD patients as result of some combination of peripheral sensitization, facilitation of central nociceptive processing and/or decreased descending inhibition.
我们的目的是评估患有肌筋膜颞下颌关节紊乱症(TMD)但无合并症的患者的三叉神经和三叉神经外区域的热敏感性,并与年龄匹配的对照组进行比较。20 名女性(年龄 24 +/- 3 岁)根据 TMD 的研究诊断标准诊断为肌筋膜 TMD,20 名健康女性(年龄 24 +/- 4 岁)作为对照组。分别评估双侧咬肌和额肌(三叉神经区)和手腕(三叉神经外区)的温觉和冷觉检测阈值(WDT 和 CDT)以及热痛和冷痛阈值(HPT 和 CPT)。每个部位的三个测定值的平均值用于分析。测试部位的顺序是随机的。采用双因素方差分析检验组间和侧间(最痛/对侧;优势/非优势)差异。三叉神经和三叉神经外区域的 WDT 或 CDT 在组间无显著差异(方差分析,P > 0.389)。对于 HPT 和 CPT,两组在三叉神经和三叉神经外区域均有显著差异,但侧间无差异(方差分析,P < 0.001)。三叉神经区的 CPT(P < 0.001)与疼痛强度和疼痛持续时间呈正相关:疼痛史越长或疼痛强度越大,三叉神经区的 CPT 越高(即冷超敏越高)。我们的研究结果显示,与健康对照组相比,患有肌筋膜 TMD 的女性在三叉神经和三叉神经外区域均存在双侧热超敏(HPT 降低和 CPT 升高),但 WDT 和 CDT 正常。三叉神经和三叉神经外区域的双侧热/冷超敏可能反映了肌筋膜 TMD 患者热通道功能障碍,这是由于外周敏化、中枢伤害性加工易化和/或下行抑制减少的某种组合所致。