Maixner W, Fillingim R, Kincaid S, Sigurdsson A, Harris M B
Department of Endodontics, School of Dentistry, University of North Carolina, Chapel Hill 27599-7455, USA.
Psychosom Med. 1997 Sep-Oct;59(5):503-11. doi: 10.1097/00006842-199709000-00007.
Patients experiencing temporomandibular disorders (TMD) show greater sensitivity to painful stimuli than age- and gender-matched control subjects. This enhanced pain sensitivity may result, at least in part, from an alteration in pain regulatory systems that are influenced by resting arterial blood pressure. In this study, we examined the relationship between resting systolic blood pressure and pain perception in 64 female TMD and 23 age-matched pain-free female subjects.
Resting arterial blood pressure and measures of thermal and ischemic pain threshold and tolerance were determined for each participant. Subjective ratings of thermal pain evoked by suprathreshold noxious thermal stimuli (45-49 degrees C) using a magnitude matching procedure were also obtained for both groups.
TMD patients had lower thermal and ischemic pain thresholds and tolerances than pain-free subjects (ps < .05). Both groups provided equivalent intensity ratings to suprathreshold noxious thermal stimuli. A median split of each group based on resting systolic blood pressure revealed an influence of blood pressure on both thermal and ischemic pain perception for the Pain-Free group. The Pain-Free high resting blood pressure subgroup had higher thermal pain tolerances, higher ischemic pain thresholds, and provided lower magnitude estimates of the intensity of graded heat pulses compared with the Pain-Free low blood pressure subgroup. A trend toward a significant effect of blood pressure level on ischemic pain tolerance was also observed for the Pain-Free group. In contrast to the Pain-Free group, blood pressure level did not influence ischemic or thermal pain perception for TMD patients. Similar to the lack of effect of resting blood pressure on experimental pain perception in TMD patients, resting blood pressure was not related to measures of clinical orofacial pain in TMD patients.
These findings confirm our previous findings that TMD patients are more sensitive to noxious stimuli and suggest that painful TMD may result, at least in part, from an impairment in central pain regulatory systems that are influenced by resting arterial blood pressure.
患有颞下颌关节紊乱症（TMD）的患者对疼痛刺激的敏感性高于年龄和性别匹配的对照受试者。这种增强的疼痛敏感性可能至少部分是由于受静息动脉血压影响的疼痛调节系统的改变所致。在本研究中，我们检查了64名女性TMD患者和23名年龄匹配的无疼痛女性受试者的静息收缩压与疼痛感知之间的关系。
测定每位参与者的静息动脉血压以及热痛和缺血性疼痛阈值及耐受性。两组还采用量级匹配程序获得了由阈上有害热刺激（45 - 49摄氏度）诱发的热痛主观评分。
TMD患者的热痛和缺血性疼痛阈值及耐受性低于无疼痛受试者（p值 <.05）。两组对阈上有害热刺激的强度评分相当。根据静息收缩压对每组进行中位数划分，结果显示血压对无疼痛组的热痛和缺血性疼痛感知均有影响。与无疼痛低血压亚组相比，无疼痛高静息血压亚组具有更高的热痛耐受性、更高的缺血性疼痛阈值，并且对分级热脉冲强度的量级估计更低。在无疼痛组中还观察到血压水平对缺血性疼痛耐受性有显著影响的趋势。与无疼痛组不同，血压水平对TMD患者的缺血性或热痛感知没有影响。与静息血压对TMD患者实验性疼痛感知缺乏影响相似，静息血压与TMD患者的临床口面部疼痛测量指标也无关。
这些发现证实了我们之前的发现，即TMD患者对有害刺激更敏感，并表明疼痛性TMD可能至少部分是由于受静息动脉血压影响的中枢疼痛调节系统受损所致。
