Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA.
Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA.
J Dent Res. 2022 Sep;101(10):1165-1171. doi: 10.1177/00220345221099885. Epub 2022 Jun 16.
Chronic pain associated with temporomandibular disorders (TMDs) may reflect muscle mechanoreceptor afferent barrage and dysregulated sensory processing. This observational study tested for associations between Characteristic Pain Intensity (CPI), physical symptoms (Patient Health Questionnaire-15 [PHQ-15]), and cumulative jaw muscle motor load (mVs). In accordance with institutional review board oversight and Strengthening the Reporting of Observational Studies in Epidemiology guidelines, adult subjects gave informed consent and were identified via Diagnostic Criteria for TMD (DC-TMD) examination and research protocols. Subjects were assigned to ±Pain groups using DC-TMD criteria for myalgia. CPI scores characterized pain intensity. PHQ-15 scores were surrogate measures of dysregulated sensory processing. Laboratory tests were performed to quantify masseter and temporalis muscle activities (mV) per bite force (N) for each subject. In their natural environments, subjects recorded day- and nighttime electromyography from which cumulative jaw muscle motor loads (mVs) were determined for activities consistent with bite forces of >1 to ≤2 and >2 to ≤5 N. Data were assessed using univariate analysis of variance, simple effects tests, K-means cluster classification, and 3-dimensional regression analyses. Of 242 individuals screened, 144 enrolled, and 125 with complete data from study protocols, there were 35 females and 15 males for +Pain and 35 females and 40 males for -Pain. Subjects produced 324 daytime and 341 nighttime recordings of average duration 6.9 ± 1.7 and 7.6 ± 1.7 h, respectively. Overall, +Pain compared to -Pain subjects had significantly higher (all ≤ 0.002) CPI and PHQ-15 scores. Cumulative jaw muscle motor loads showed significant between-subject effects for time, diagnostic group, and sex (all < 0.003), where motor loads tended to be higher for daytime versus nighttime, +Pain versus -Pain groups, and males versus females. Two clusters were identified, and regression relations showed associations of low-magnitude daytime masseter motor load, PHQ-15, and CPI scores for cluster 1 ( = 105, = 0.44) and cluster 2 ( = 18, = 0.80). Furthermore, these regression relations showed thresholds of motor load and PHQ-15 scores, above which there were nonlinear increases in reported pain.
与颞下颌关节紊乱（TMD）相关的慢性疼痛可能反映了肌肉机械感受器传入的激增和感觉处理的失调。这项观察性研究旨在测试特征性疼痛强度（CPI）、身体症状（患者健康问卷-15 [PHQ-15]）和累积咀嚼肌运动负荷（mVs）之间的关联。根据机构审查委员会的监督和《加强观察性研究报告的流行病学指南》的规定，成年受试者在 TMD 诊断标准（DC-TMD）检查和研究方案的指导下，自愿签署知情同意书并被识别。根据 DC-TMD 肌痛标准，将受试者分为 ±疼痛组。CPI 评分用于描述疼痛强度。PHQ-15 评分是感觉处理失调的替代测量指标。对每位受试者进行实验室测试，以量化咀嚼肌和颞肌的运动（mV）与每咬力（N）的关系。在自然环境中，受试者记录白天和夜间的肌电图，根据累积的咀嚼肌运动负荷（mVs）来确定咬力大于等于 1 到小于等于 2 和大于等于 2 到小于等于 5N 的活动。使用单变量方差分析、简单效应检验、K-均值聚类分类和 3 维回归分析对数据进行评估。在 242 名被筛查的个体中，有 144 名入组，125 名完成了研究方案的完整数据，其中 +疼痛组有 35 名女性和 15 名男性，-疼痛组有 35 名女性和 40 名男性。受试者白天共记录了 324 次，夜间共记录了 341 次，平均持续时间分别为 6.9 ± 1.7 和 7.6 ± 1.7 小时。总体而言，与 -疼痛组相比，+疼痛组的 CPI 和 PHQ-15 评分显著更高（所有 ≤ 0.002）。累积咀嚼肌运动负荷在时间、诊断组和性别方面均存在显著的受试者间效应（所有 < 0.003），其中白天的运动负荷高于夜间，+疼痛组高于 -疼痛组，男性高于女性。确定了两个聚类，回归关系显示出低幅度日间咀嚼肌运动负荷、PHQ-15 和 CPI 评分与聚类 1（ = 105， = 0.44）和聚类 2（ = 18， = 0.80）之间的关联。此外，这些回归关系显示出运动负荷和 PHQ-15 评分的阈值，高于该阈值，报告的疼痛会呈非线性增加。
