La Touche Roy, Paris-Alemany Alba, Hidalgo-Pérez Amanda, López-de-Uralde-Villanueva Ibai, Angulo-Diaz-Parreño Santiago, Muñoz-García Daniel
Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.
Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.
Pain Pract. 2018 Mar;18(3):388-409. doi: 10.1111/papr.12604. Epub 2017 Jul 11.
Several authors have evaluated different pain measurements, including quantitative sensory testing (QST), temporal summation (TS), and conditioned pain modulation (CPM) in order to determine the presence of central sensitization (CS) and its influence on patients with temporomandibular disorders (TMD). Since there are no convincing studies about this topic, the purpose of this study was to conduct a review of the studies involving CS-related measures in TMD patients.
A meta-analysis of case-control and cohort/cross sectional studies was conducted. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated for relevant QST outcomes and pooled in a meta-analysis using the random effects model. Twenty-two studies (eleven case-control and eleven cross sectional studies) met the inclusion criteria; eight were included in the meta-analysis (five cross-sectional and three case-control). Patients with TMD had decreased pressure pain thresholds in both trigeminal (five studies; n = 1,985; SMD = -1.55, 95% CI -2.23 to -0.77; P < 0.01) and remote areas (five studies; n = 1,985; SMD = -1.92, 95% CI -2.95 to -0.89; P < 0.01). When analyzing for thermal hyperalgesia (hot and cold pain thresholds), differences were not found in trigeminal areas or remote areas in patients with TMD. The TS qualitative analysis showed strong evidence of spinal hyperexcitability for mechanically evoked pain.
These meta-analyses support the existence of differences in widespread pressure pain sensitivity in patients with TMD when compared with asymptomatic subjects. Spinal and central hyperexcitability can be found in TMD patients as shown by an increase in mechanical TS.
几位作者评估了不同的疼痛测量方法，包括定量感觉测试（QST）、时间总和（TS）和条件性疼痛调制（CPM），以确定中枢敏化（CS）的存在及其对颞下颌关节紊乱病（TMD）患者的影响。由于关于该主题尚无令人信服的研究，本研究的目的是对涉及TMD患者CS相关测量的研究进行综述。
对病例对照研究和队列/横断面研究进行荟萃分析。计算相关QST结果的标准化平均差（SMD）和95%置信区间（CI），并使用随机效应模型汇总到荟萃分析中。22项研究（11项病例对照研究和11项横断面研究）符合纳入标准；8项纳入荟萃分析（5项横断面研究和3项病例对照研究）。TMD患者在三叉神经区域（5项研究；n = 1985；SMD = -1.55，95% CI -2.23至-0.77；P < 0.01）和远隔区域（5项研究；n = 1985；SMD = -1.92，95% CI -2.95至-0.89；P < 0.01）的压痛阈值均降低。在分析热痛觉过敏（热痛和冷痛阈值）时，TMD患者在三叉神经区域或远隔区域未发现差异。TS定性分析显示，对于机械诱发的疼痛，有强有力的证据表明脊髓兴奋性过高。
这些荟萃分析支持TMD患者与无症状受试者相比，在广泛的压痛敏感性方面存在差异。如机械性TS增加所示，TMD患者可出现脊髓和中枢兴奋性过高。
