Santiago Vivian, Janal Malvin N, Cook Dane B, Raphael Karen G
Department of Oral & Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, New York, NY, USA.
Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA.
J Pain Res. 2022 Oct 19;15:3275-3286. doi: 10.2147/JPR.S381640. eCollection 2022.
Mechanisms underlying myofascial temporomandibular disorder (mTMD) are poorly understood. One theory is dysfunction in the central mediation of pain, specifically in enhanced facilitatory pain modulation. Because mechanisms leading to central sensitization may differ for joint and muscle pain, this study of mTMD addressed phenotypic heterogeneity by temporomandibular (TM) joint pain in the examination of quantitative sensory testing (QST).
The stimulus dependent increase in second pain (temporal summation (TS)) and associated aftersensations (AS) were examined across groups of women with mTMD with TM joint pain and without, and a demographically matched control group.
TS was slightly more evident in mTMD without joint pain vs with (p = 0.035), but AS were most robustly persistent in the group with joint pain vs without (p < 0.002).
While both subgroups demonstrated evidence of central sensitization relative to controls on one of two measures, differences in QST results, if replicated, may point to possible differences in the mechanisms that yield central sensitization. Alternatively, it may represent methodological artifacts that need to be addressed. Therefore, greater consideration should be given to symptom-based phenotypes in studies examining TS and AS.
肌筋膜性颞下颌关节紊乱病(mTMD)的潜在机制尚不清楚。一种理论认为是疼痛的中枢调节功能障碍,特别是增强的易化性疼痛调制。由于导致中枢敏化的机制在关节痛和肌痛中可能不同,本项针对mTMD的研究在定量感觉测试(QST)检查中,通过颞下颌(TM)关节疼痛来探讨表型异质性。
对患有和未患有TM关节疼痛的mTMD女性组以及人口统计学匹配的对照组,检查了依赖刺激的二次疼痛增加(时间总和(TS))和相关的后感觉(AS)。
在没有关节疼痛的mTMD中,TS比有关节疼痛的mTMD中略更明显(p = 0.035),但在有关节疼痛的组中,AS比没有关节疼痛的组中持续存在的情况最为显著(p < 0.002)。
虽然两个亚组在两种测量方法中的一种上相对于对照组都显示出中枢敏化的证据,但如果QST结果的差异得到重复,可能表明产生中枢敏化的机制存在差异。或者,这可能代表需要解决的方法学假象。因此,在研究TS和AS时,应更多地考虑基于症状的表型。