Chaves Thais C, Dach Fabíola, Florencio Lidiane L, Carvalho Gabriela F, Gonçalves Maria C, Bigal Marcelo E, Speciali José G, Bevilaqua-Grossi Débora
*Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School †Department of Biomechanics, Medicine and Rehabilitation, Ribeirão Preto Medical School, Rehabilitation and Functional Performance Program, University of São Paulo, Ribeirão Preto, São Paulo, Brazil ‡Labrys Biologics Inc., Doylestown, PA.
Clin J Pain. 2016 Oct;32(10):882-8. doi: 10.1097/AJP.0000000000000369.
The aim of this study was to assess differences in the levels of hyperalgesia and cutaneous allodynia (CA) among women with migraine, temporomandibular disorders (TMD), or both.
Eighty women participated in the study. Mean ages for the control group, TMD group, migraine group, and migraine+TMD group were 26.15 (95% confidence interval [CI], 28.73 to 23.57), 31.65 (95% CI, 37.82 to 25.48), 35.05 (95% CI, 40.37 to 29.73), and 34.20 (95% CI, 37.99 to 30.41) years, respectively. The 12-item Allodynia Symptom Checklist was administered to assess CA. All participants underwent the Quantitative Sensory Test to determine the cold-pain and heat-pain thresholds. Mechanical pain thresholds were assessed using Semmes-Weinstein monofilaments. One-way analysis of variance and χ tests were used for statistical analysis. Alpha was set at 0.05 level for statistical significance.
For all sites evaluated, the mean cold-pain threshold values were significantly lower in the TMD, migraine, and TMD+migraine groups compared with the control group. However, the mean heat-pain threshold values in the extracephalic region were significantly smaller only for the TMD+migraine group compared with the control group (41.94°C; 95% CI, 40.54 to 43.34 vs. 44.79°C; 95% CI, 43.45 to 46.12; P=0.03). Mechanical hyperalgesia in orofacial and neck sites was significantly lower in the TMD and TMD+migraine groups compared with the control group. Mean total 12-item Allodynia Symptom Checklist score in the TMD+migraine group was significantly higher than in the migraine group (9.53; 95% CI, 7.45 to 11.60 vs. 6.95; 95% CI, 5.35 to 8.55; P=0.02).
More pronounced levels of hyperalgesia and CA were found in patients with both TMD and migraine. Thus, it is suggested that the concomitant presence of TMD and migraine may be related to intensification of central sensitization.
本研究旨在评估偏头痛、颞下颌关节紊乱症（TMD）或两者皆有的女性在痛觉过敏和皮肤异常性疼痛（CA）水平上的差异。
80名女性参与了本研究。对照组、TMD组、偏头痛组和偏头痛 + TMD组的平均年龄分别为26.15岁（95%置信区间[CI]，28.73至23.57）、31.65岁（95%CI，37.82至25.48）、35.05岁（95%CI，40.37至29.73）和34.20岁（95%CI，37.99至30.41）。采用12项异常性疼痛症状检查表评估CA。所有参与者均接受定量感觉测试以确定冷痛和热痛阈值。使用Semmes-Weinstein单丝评估机械性疼痛阈值。采用单因素方差分析和χ检验进行统计分析。设定α水平为0.05以确定统计学显著性。
在所有评估部位，TMD组、偏头痛组和TMD + 偏头痛组的平均冷痛阈值均显著低于对照组。然而，与对照组相比，仅TMD + 偏头痛组的颅外区域平均热痛阈值显著更低（41.94°C；95%CI，40.54至43.34，对比44.79°C；95%CI，43.45至46.12；P = 0.03）。与对照组相比，TMD组和TMD + 偏头痛组在口面部和颈部部位的机械性痛觉过敏显著更低。TMD + 偏头痛组的12项异常性疼痛症状检查表总分平均值显著高于偏头痛组（9.53；95%CI，7.45至11.60，对比6.95；95%CI，5.35至8.55；P = 0.02）。
在TMD和偏头痛患者中发现了更明显的痛觉过敏和CA水平。因此，提示TMD和偏头痛同时存在可能与中枢敏化增强有关。
