Campi L B, Jordani P C, Tenan H L, Camparis C M, Gonçalves D A G
Araraquara School of Dentistry, Universidade Estadual Paulista - UNESP, Araraquara, Sao Paulo, Brazil.
Araraquara School of Dentistry, Universidade Estadual Paulista - UNESP, Araraquara, Sao Paulo, Brazil.
Int J Oral Maxillofac Surg. 2017 Jan;46(1):104-110. doi: 10.1016/j.ijom.2016.07.005. Epub 2016 Aug 21.
The objective was to investigate the presence of cutaneous allodynia and hyperalgesia in the trigeminal and extra-trigeminal areas, as a surrogate for central sensitization (CS), in women with a painful temporomandibular disorder (TMD) and without other painful conditions. Painful TMDs, depression, and non-specific physical symptoms (NSPS) were classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The amount of pain in the trigeminal and extra-trigeminal areas was determined using a visual analogue scale (0-100mm) after the application of a vibrotactile stimulus and assessment of the pressure pain threshold (PPT). Statistical tests (Fisher's, χ, and Mann-Whitney) were performed, with a significance level of 5%. The sample comprised 45 women (mean age 37.5 years; 16 with a painful TMD) who were free of any headache, fibromyalgia, or other painful condition. Painful TMD was associated with higher pain sensitivity and lower PPT values in the trigeminal (P<0.01) and extra-trigeminal regions (P<0.01). The presence of depression contributed significantly to increased pain sensitivity. The presence of hyperalgesia and allodynia in both the trigeminal and extra-trigeminal regions among women with a painful TMD indicated the presence of CS. Changes involving the central nervous system should be considered during the evaluation and management of patients with a painful TMD.
目的是调查患有疼痛性颞下颌关节紊乱病(TMD)且无其他疼痛病症的女性在三叉神经和三叉神经外区域是否存在皮肤异常性疼痛和痛觉过敏,以此作为中枢敏化(CS)的替代指标。根据颞下颌关节紊乱病研究诊断标准(RDC/TMD)对疼痛性TMD、抑郁和非特异性躯体症状(NSPS)进行分类。在施加振动触觉刺激并评估压力疼痛阈值(PPT)后,使用视觉模拟量表(0 - 100mm)确定三叉神经和三叉神经外区域的疼痛程度。进行了统计检验(Fisher检验、χ检验和Mann - Whitney检验),显著性水平为5%。样本包括45名女性(平均年龄37.5岁;16名患有疼痛性TMD),她们没有任何头痛、纤维肌痛或其他疼痛病症。疼痛性TMD与三叉神经区域(P<0.01)和三叉神经外区域(P<0.01)更高的疼痛敏感性及更低的PPT值相关。抑郁的存在显著导致疼痛敏感性增加。患有疼痛性TMD的女性在三叉神经和三叉神经外区域均存在痛觉过敏和异常性疼痛,这表明存在中枢敏化。在对疼痛性TMD患者进行评估和管理时,应考虑涉及中枢神经系统的变化。
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