Department of Nursing, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
J Headache Pain. 2012 Nov;13(8):625-37. doi: 10.1007/s10194-012-0477-y. Epub 2012 Aug 31.
Our aim was to compare the differences in the prevalence and the anatomical localization of referred pain areas of active trigger points (TrPs) between women with myofascial temporomandibular disorder (TMD) or fibromyalgia (FMS). Twenty women (age 46 ± 8 years) with TMD and 20 (age 48 ± 6 years) with FMS were recruited from specialized clinic. Bilateral temporalis, masseter, sternocleidomastoid, upper trapezius, and suboccipital muscles were examined for TrPs. TrPs were identified by palpation and considered active when the pain reproduced familiar pain symptom experienced by the patient. The referred pain areas were drawn on anatomical maps, digitalized and also measured. A new analysis technique based on a center of gravity (COG) method was used to quantitative estimate of the localization of the TrP referred pain areas. Women with FMS exhibited larger areas of usual pain symptoms than women with myofascial TMD (P < 0.001). The COG coordinates of the usual pain on the frontal and posterior pain maps were located more superior in TMD than in FMS. The number of active TrPs was significantly higher in TMD (mean ± SD 6 ± 1) than in FMS (4 ± 1) (P = 0.002). Women with TMD exhibited more active TrPs in the temporalis and masseter muscles than FMS (P < 0.01). Women with FMS had larger referred pain areas than those with TMD for sternocleidomastoid and suboccipital muscles (P < 0.001). Significant differences within COG coordinates of TrP referred pain areas were found in TMD, the referred pain was more pronounced in the orofacial region, whereas the referred pain in FMS was more pronounced in the cervical spine. This study showed that the referred pain elicited from active TrPs shared similar patterns as usual pain symptoms in women with TMD or FMS, but that distinct differences in TrP prevalence and location of the referred pain areas could be observed. Differences in location of referred pain areas may help clinicians to determine the most relevant TrPs for each pain syndrome in spite of overlaps in pain areas.
我们的目的是比较患有肌筋膜性颞下颌关节紊乱（TMD）或纤维肌痛（FMS）的女性主动触发点（TrP）牵涉痛区的患病率和解剖定位的差异。从专门的诊所招募了 20 名患有 TMD 的女性（年龄 46±8 岁）和 20 名患有 FMS 的女性（年龄 48±6 岁）。双侧颞肌、咬肌、胸锁乳突肌、上斜方肌和枕下肌检查 TrP。通过触诊确定 TrP，并在疼痛重现患者所经历的熟悉疼痛症状时将其视为活动状态。将牵涉痛区域绘制在解剖图谱上，进行数字化并进行测量。使用基于重心（COG）方法的新分析技术对 TrP 牵涉痛区域的定位进行定量估计。患有 FMS 的女性比患有肌筋膜 TMD 的女性表现出更大的常见疼痛症状区域（P<0.001）。在前额和后痛图上，TMD 的常见疼痛 COG 坐标位于更上方。TMD（平均±SD 6±1）的活动 TrP 数量明显高于 FMS（4±1）（P=0.002）。与 FMS 相比，TMD 中的颞肌和咬肌中存在更多的活动 TrP（P<0.01）。患有 FMS 的女性比患有 TMD 的女性在胸锁乳突肌和枕下肌的牵涉痛区域更大（P<0.001）。在 TMD 中，在 TrP 牵涉痛区域的 COG 坐标内发现了显著差异，牵涉痛在口腔区域更为明显，而在 FMS 中，牵涉痛在颈椎区域更为明显。这项研究表明，在患有 TMD 或 FMS 的女性中，从活动 TrP 引出的牵涉痛与常见疼痛症状具有相似的模式，但牵涉痛区的 TrP 患病率和位置存在明显差异。牵涉痛区位置的差异可能有助于临床医生确定每个疼痛综合征中最相关的 TrP，尽管疼痛区域存在重叠。
