Costa Y M, Porporatti A L, Stuginski-Barbosa J, Bonjardim L R, Speciali J G, Conti P C R
Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
Department of Dentistry, Section of Orofacial Pain and Jaw Function, Aarhus University, Aarhus, Denmark.
J Oral Rehabil. 2016 Mar;43(3):161-8. doi: 10.1111/joor.12357. Epub 2015 Oct 6.
There is no clear evidence on how a headache attributed to temporomandibular disorder (TMD) can hinder the improvement of facial pain and masticatory muscle pain. The aim of this study was to measure the impact of a TMD-attributed headache on masticatory myofascial (MMF) pain management. The sample was comprised of adults with MMF pain measured according to the revised research diagnostic criteria for temporomandibular disorders (RDC/TMD) and additionally diagnosed with (Group 1, n = 17) or without (Group 2, n = 20) a TMD-attributed headache. Both groups received instructions on how to implement behavioural changes and use a stabilisation appliance for 5 months. The reported facial pain intensity (visual analogue scale--VAS) and pressure pain threshold (PPT--kgf cm(-2)) of the anterior temporalis, masseter and right forearm were measured at three assessment time points. Two-way anova was applied to the data, considering a 5% significance level. All groups had a reduction in their reported facial pain intensity (P < 0·001). Mean and standard deviation (SD) PPT values, from 1·33 (0·54) to 1·96 (1·06) kgf cm(-2) for the anterior temporalis in Group 1 (P = 0·016), and from 1·27 (0·35) to 1·72 (0·60) kgf cm(-2) for the masseter in Group 2 (P = 0·013), had significant improvement considering baseline versus the 5th-month assessment. However, no differences between the groups were found (P > 0·100). A TMD-attributed headache in patients with MMF pain does not negatively impact pain management, but does change the pattern for muscle pain improvement.
关于归因于颞下颌关节紊乱症（TMD）的头痛如何阻碍面部疼痛和咀嚼肌疼痛的改善，目前尚无明确证据。本研究的目的是测量归因于TMD的头痛对咀嚼肌筋膜（MMF）疼痛管理的影响。样本包括根据颞下颌关节紊乱症修订研究诊断标准（RDC/TMD）测量有MMF疼痛的成年人，另外还诊断出有（第1组，n = 17）或无（第2组，n = 20）归因于TMD的头痛。两组均接受了关于如何实施行为改变以及使用稳定矫治器5个月的指导。在三个评估时间点测量了报告的颞肌前部、咬肌和右前臂的面部疼痛强度（视觉模拟量表——VAS）和压痛阈值（PPT——kgf cm⁻²）。对数据应用双向方差分析，显著性水平为5%。所有组报告的面部疼痛强度均有所降低（P < 0.001）。第1组颞肌前部的平均和标准差（SD）PPT值从1.33（0.54）kgf cm⁻²提高到1.96（1.06）kgf cm⁻²（P = 0.016），第2组咬肌的PPT值从1.27（0.35）kgf cm⁻²提高到1.72（0.60）kgf cm⁻²（P = 0.013），与基线相比，在第5个月评估时有显著改善。然而，两组之间未发现差异（P > 0.100）。MMF疼痛患者中归因于TMD的头痛不会对疼痛管理产生负面影响，但会改变肌肉疼痛改善的模式。
