Kothari S F, Baad-Hansen L, Andersen K, Svensson P
Section of Clinical Oral Physiology, Department of Dentistry, Aarhus University, Denmark.
Section of Clinical Oral Physiology, Department of Dentistry, Aarhus University, Denmark.
Int J Oral Maxillofac Surg. 2014 Sep;43(9):1096-103. doi: 10.1016/j.ijom.2014.05.010. Epub 2014 Jun 12.
Somatosensory sensitivity and postoperative endogenous pain modulation have not been investigated in temporomandibular joint (TMJ) prosthesis patients. The objectives of this study were to assess somatosensory function at the TMJ and examine possible differences in conditioned pain modulation (CPM) between patients with total TMJ prostheses (n=7) and a reference group of healthy controls (n=20). Somatosensory abnormalities were assessed using quantitative sensory testing (QST), which encompasses thermal and mechanical testing procedures. CPM was tested by comparing pressure pain thresholds (PPT) before (baseline), during, and after the application of painful and non-painful cold stimuli. PPTs were measured at the TMJ and thenar eminence (control). The effect of CPM on PPT values was tested with analysis of variance. Three patients exhibited mixed somatosensory loss (i.e., decreased thermal and mechanical detection) with mixed hyperalgesia (i.e., increased sensitivity to thermal and mechanical pain) and two patients exhibited mixed loss with only mechanical hyperalgesia. There was a significant decrease in pressure pain sensitivity at both sites during painful cold application in healthy controls (P<0.001) but not in patients (P=0.476). In conclusion, QST measures demonstrated somatosensory abnormalities in patients with total TMJ prostheses. Noxious conditioning cold stimuli evoked CPM-like effects in healthy subjects but not in patients with TMJ reconstruction.
尚未对颞下颌关节（TMJ）假体患者的体感敏感性和术后内源性疼痛调节进行研究。本研究的目的是评估TMJ处的体感功能，并检查全TMJ假体患者（n = 7）与健康对照参考组（n = 20）之间在条件性疼痛调节（CPM）方面可能存在的差异。使用定量感觉测试（QST）评估体感异常，该测试包括热测试和机械测试程序。通过比较在施加疼痛和非疼痛冷刺激之前（基线）、期间和之后的压力疼痛阈值（PPT）来测试CPM。在TMJ和鱼际隆起处（对照）测量PPT。使用方差分析测试CPM对PPT值的影响。三名患者表现出混合性体感丧失（即热觉和机械觉检测减少）并伴有混合性痛觉过敏（即对热痛和机械痛的敏感性增加），两名患者表现出混合性丧失且仅伴有机械性痛觉过敏。在健康对照中，在施加疼痛冷刺激期间，两个部位的压力疼痛敏感性均显著降低（P < 0.001），但在患者中未出现这种情况（P = 0.476）。总之，QST测量显示全TMJ假体患者存在体感异常。有害的条件性冷刺激在健康受试者中诱发了类似CPM的效应，但在TMJ重建患者中未诱发。
