Bilateral Widespread Mechanical Pain Sensitivity in Women With Myofascial Temporomandibular Disorder: Evidence of Impairment in Central Nociceptive Processing

Our aim was to investigate bilateral, widespread pressure-pain hypersensitivity in nerve, muscle, and joint tissues in women with myofascial temporomandibular disorders (TMD) without concomitant comorbid conditions. Twenty women with myofascial TMD (aged 20 to 28 years old), and 20 healthy matched women (aged 20 to 29 years), were recruited. Pressure-pain thresholds (PPT) were bilaterally assessed over supra-orbital (V1), infra-orbital (V2), mental (V3) nerves, median (C5), radial (C6) and ulnar (C7) nerve trunks, the C5-C6 zygapophyseal joint, the lateral pole of the temporo mandibular joint (TMJ), and the tibialis anterior muscle in a blinded design. The results showed that PPTs were significantly decreased bilaterally over the supra-orbital, infra-orbital, and mental nerves, median, ulnar, and radial nerve trunks, the lateral pole of the TMJ, the C5-C6 zygapophyseal joint, and the tibialis anterior muscle in patients with myofascial TMD as compared to healthy controls (all sites: P < .001). There were no significant differences in the magnitude of PPT decreases between the trigeminal and extratrigeminal test sites. PPT over the mental nerve, the TMJ, C5-C6 zygapophyseal joint and tibialis anterior muscle were negatively correlated to both duration of pain symptoms and TMD pain intensity (P < .05). Our findings revealed bilateral, widespread pressure hypersensitivity in women presenting with myofascial TMD, suggesting that widespread central sensitization is involved in myofascial TMD women.

Perspective

This article reveals the presence of bilateral and widespread pressure-pain hypersensitivity in women with myofascial TMD, suggesting that widespread central sensitization is involved in myofascial TMD. This finding has implications for development of management strategies.     

Correlation Between Severity of Temporomandibular Disorder,Pain Intensity,and Pressure Pain Threshold

Objective

The aim of the present study was to correlate the severity of temporomandibular disorder (TMD) with the pressure pain threshold over the temporomandibular joint and masticatory muscles.

Pain Expectancy and Positive Affect Mediate the day-to-day Association Between Objectively Measured Sleep and Pain Severity Among Women With Temporomandibular Disorder

The majority of individuals with temporomandibular disorders (TMD) experience sleep disturbance, which can maintain and exacerbate chronic pain. However, the factors underlying the sleep-pain link have not been fully elucidated, especially beyond the laboratory. Sleep deprivation can induce threat interpretation bias, as well as impairment in positive affective functioning. Using both actigraphy and daily diaries, we examined whether morning pain expectancy and positive affect mediate the association between previous night's sleep disturbance and next-day overall pain severity. Total sleep time (TST) was selected as the primary measure of sleep. The sample included 144 women (mean age = 36 [SD = 11.1]) with TMD who displayed at least subclinical insomnia. Sleep was assessed for 14 days using actigraphy which was validated by concurrent sleep diaries. Daily diary assessments of pain-related experiences and affective states were conducted twice per day (ie, once upon participants’ waking and the other prior to going to sleep) for the same 14-day period. Multilevel structural equation modeling revealed that both morning pain expectancy (95% CI: -.0004, -.00003) and positive affect (95% CI: -.0005, -.000001) mediated the association between previous night's TST and next-day's overall pain severity, such that shorter previous night TST was associated with higher next-morning pain expectancy and lower positive affect, which in turn were associated with a greater level of next-day's overall pain severity while controlling for morning pain severity. Reducing exaggerated daily pain expectancy and up-regulating positive affect may be important intervention targets for disengaging the sleep-pain link among individuals with co-occurring TMD and sleep disturbance.PerspectiveThe daily link between previous night sleep duration and next day pain severity is mediated by morning pain expectancy and positive affect among women with temporomandibular disorder and sleep disturbance. Reducing pain expectancy and increasing positive affect may serve an important role in improving self-management of chronic pain.     

颞下颌关节紊乱病的MRI表现与疼痛关系的研究

[目的]研究颞下颌关节紊乱病(TMD)的MRI表现与颞下颌关节疼痛的关系,探讨MRI在TMD诊断和治疗中的价值.[方法]对30例具有疼痛主诉的TMD患者的60侧颞下颌关节(TMJ)行开、闭口冠状位和矢状位T1加权、T2加权和质子加权扫描.[结果]MRI观察到37个疼痛关节中,发现关节盘移位34个(91.9%),关节盘变形33个(89.2%),关节渗液31个(83.8%);23个非疼痛关节中,关节盘移位12个(52.2%),关节盘变形3个(13%),关节渗液1个(4.5%).经统计学分析,疼痛与关节盘移位、变形和关节渗液的出现有关系(P＜0.01).[结论]MRI能清楚显示TMJ关节盘及周围组织变化,能反映TMJ的变化与疼痛的关系,在TMD的诊断和治疗方面均具有重要价值.     

Referred Pain from Muscle Trigger Points in the Masticatory and Neck-Shoulder Musculature in Women With Temporomandibular Disoders

Our aim was to describe the referred pain patterns and size of areas of trigger points (TrPs) in the masticatory and neck-shoulder muscles of women with myofascial temporomandibular disorders (TMD). Twenty-five women with myofascial TMD and 25 healthy matched women participated. Bilateral temporalis, deep masseter, superficial masseter, sternocleidomastoid, upper trapezius and suboccipital muscles were examined for TrPs by an assessor blinded to the subjects' condition. TrPs were identified with manual palpation and categorized into active and latent according to proposed criteria. The referred pain areas were drawn on anatomical maps, digitalized, and measured. The occurrence of active (P < .001) and latent TrPs (P = .04) were different between groups. In all muscles, there were significantly more active and latent TrP in patients than controls (P < .001). Significant differences in referred pain areas between groups (P < .001) and muscles (P < .001) were found: the referred pain areas were larger in patients (P < .001), and the referred pain area elicited by suboccipital TrPs was greater than the referred pain from other TrPs (P < .001). Referred pain areas from neck TrPs were greater than the pain areas from masticatory muscle TrPs (P < .01). Referred pain areas of masticatory TrPs were not different (P > .703). The local and referred pain elicited from active TrPs in the masticatory and neck-shoulder muscles shared similar pain pattern as spontaneous TMD, which supports the concept of peripheral and central sensitization mechanisms in myofascial TMD.     

Evidence for indirect effects of pain catastrophizing on clinical pain among myofascial temporomandibular disorder participants: the mediating role of sleep disturbance

Sleep disturbance and pain catastrophizing are important mediators of the chronic pain experience. To date, these factors have not been considered concurrently despite compelling theoretical rationale to do so. In the present study, we examined whether pain catastrophizing not only has direct effects on clinical pain and pain-related interference, but also indirect effects through its association with sleep disturbance. We evaluated this hypothesis using a cohort (n=214) of myofascial temporomandibular disorder participants using a statistical bootstrapping technique recommended for tests of indirect effects. Results suggested that pain catastrophizing was associated with greater sleep disturbance, and that a significant portion of variance in clinical pain severity and pain-related interference attributable to pain catastrophizing was mediated by sleep disturbance. Supplementary analyses revealed that the rumination component of catastrophizing seemed to be indirectly related to clinical outcomes through sleep disturbance. No evidence for indirect effects was observed for helplessness and magnification components. These results suggest that rumination about pain may contribute to clinical pain indirectly through alterations in sleep. Prospective studies are needed to examine lagged associations between these constructs. These findings have important theoretical and clinical implications. Critically, interventions that reduce pain catastrophizing may concurrently improve sleep and clinical pain.     

Relationship Between Sleep,Pain, and Disability in Patients With Spinal Pathology

Objective

To characterize sleep and its relationship with disability and pain in patients with spine pathology.

Design

A survey study.

Setting

A university-based hospital spine clinic.

Participants

Subjects (N=121) with mixed-etiology spine pathology.

Interventions

Not applicable.

Main Outcome Measures

Self-reported disability (Oswestry Disability Index [ODI]), back and leg pain intensity, the effect of back or leg pain on function, and sleep (Pittsburgh Sleep Quality Index [PSQI]) assessments were completed.

Results

Severe disability was evident with a mean ODI ± SD of 54.9±14, with mean pain intensities ± SD of 50±30mm and 54±27mm of 100mm for the leg and back, respectively. The mean PSQI ± SD was 10.4±5.3, with 87% of participants scoring greater than the sleep-disordered threshold of 5. PSQI was correlated to ODI (r=.53, P<.001), and ODI without the sleep component (r=.47, P<.001). Six of the subscales of PSQI were all also significantly correlated to ODI (.25<r<.42, P<.05). Stepwise regression (ODI dependent variables; PSQI, pain intensity and function, age, body mass index as independent variables) was performed. PSQI was retained in the model along with 2 pain measures (r²=.50, P<.001). Substitution of the 7 subscales for the overall PSQI score revealed 2 subscales (sleep quality, use of sleep medications) as predictors of ODI (r²=.490, P<.001).

Conclusions

Despite its being intuitive that sleep disorders will be present in patients with spinal disorders, it was surprising that sleep quality was an independent predictor of disability along with pain. Furthermore, sleep quality is more closely correlated to disability than leg pain, which is the current focus of medical interventions.     

颞下颌关节磁共振成像与X线关节造影的对比性研究

目的　为口腔医学临床上颞下颌关节紊乱综合征 (TMJDS)的诊断提供更好的影像学参考。方法　在国产磁共振系统上 ,采用自行研制的颞下颌关节MRI表面线圈完成颞下颌关节区的MRI成像 ,并与关节造影进行了对比性研究。结果　MRI成像效果良好 ,更能清晰地显示出关节盘及其相关组织的结构状态 ,同时 ,由于对人体无任何放射性损害 ,无侵犯性操作 ,这些均是X线平片关节造影、CT无法比拟的。结论　采用本技术完成的颞下颌关节MRI成像 ,更有助于临床TMJDS的诊断。     

Association Between Pretreatment Sleep Disturbance and Radiation Therapy-Induced Pain in 573 Women With Breast Cancer

ContextPain can be a debilitating side effect of radiation therapy (RT). Data from the general population have shown that sleep disturbance can influence pain incidence and severity; however, less is known about this relationship in patients with breast cancer receiving RT.ObjectivesThis secondary analysis examined the association of pretreatment moderate/severe levels of sleep disturbance with subsequent RT-induced pain after adjusting for pre-RT pain.MethodsWe report on 573 female patients with breast cancer undergoing RT from a previously completed Phase II clinical trial for radiation dermatitis. Sleep disturbance, total pain, and pain subdomains—sensory pain, affective pain, and perceived pain intensity were assessed at pre-RT and post-RT. At pre-RT, patients were dichotomized into two groups: those with moderate/severe sleep disturbance (N = 85) vs. those with no/mild sleep disturbance (control; N = 488).ResultsAt pre-RT, women with moderate/severe sleep disturbance were younger, less likely to be married, more likely to have had mastectomy and chemotherapy, and more likely to have depression/anxiety disorder and fatigue than the control group (all Ps < 0.05). Generalized estimating equations model, after controlling for pre-RT pain and other covariates (e.g., trial treatment condition and covariates that were significantly correlated with post-RT pain), showed that women with moderate/severe sleep disturbance at pre-RT vs. control group had significantly higher mean post-RT total pain as well as sensory, affective, and perceived pain (effect size = 0.62, 0.60, 0.69, and 0.52, respectively; all Ps < 0.05).ConclusionThese findings suggest that moderate/severe disturbed sleep before RT is associated with increased pain from pre-to-post-RT in patients with breast cancer.     

Unravelling the Relationship Between Parent and Child PTSD and Pediatric Chronic Pain: the Mediating Role of Pain Catastrophizing

Clinically elevated rates of post-traumatic stress disorder (PTSD) symptoms are found among many youth with chronic pain and their parents and are linked to worse child pain outcomes. Conceptual models of mutual maintenance in pediatric PTSD and chronic pain posit that child and parent pain catastrophizing are key mechanisms underlying this co-occurrence. To our knowledge, the current study is the first to examine child and parent pain catastrophizing as potential mediators in the child PTSD-child pain and parent PTSD-child pain relationships among a cohort of youth with chronic pain. One hundred two children (72.5% female, mean age=13.5 years), recruited from a tertiary level chronic pain program, and 1 of their parents participated. At intake, parents completed psychometrically sound self-report measures of PTSD symptoms and catastrophizing about child pain. Children completed self-report measures of PTSD symptoms, pain catastrophizing, pain interference, and pain intensity. Findings revealed that relationships between child PTSD and child pain as well as parent PTSD and child pain were mediated by child (but not parent) pain catastrophizing. This suggests that children's catastrophic thinking about pain may explain how child and parent PTSD symptoms influence children's experience of chronic pain and is a potential target in family-based interventions to improve pain and mental health outcomes.

The Effect of Fibromyalgia and Widespread Pain on the Clinically Significant Temporomandibular Muscle and Joint Pain Disorders—A Prospective 18-Month Cohort Study

Although most cases of temporomandibular muscle and joint disorders (TMJD) are mild and self-limiting, about 10% of TMJD patients develop severe disorders associated with chronic pain and disability. It has been suggested that fibromyalgia and widespread pain play a significant role in TMJD chronicity. This paper assessed the effects of fibromyalgia and widespread pain on clinically significant TMJD pain (GCPS II-IV). Four hundred eighty-five participants recruited from the Minneapolis/St. Paul area through media advertisements and local dentists received examinations and completed the Graded Chronic Pain Scale (GCPS) at baseline and at 18 months. Baseline widespread pain (OR: 2.53, P = .04) and depression (OR: 5.30, P = .005) were associated with onset of clinically significant pain (GCPS II-IV) within 18 months after baseline. The risk associated with baseline fibromyalgia was moderate, but not significant (OR: 2.74, P = .09). Persistence of clinically significant pain was related to fibromyalgia (OR: 2.48, P = .02) and depression (OR: 2.48, P = .02). These results indicate that these centrally generated pain conditions play a role in the onset and persistence of clinically significant TMJD.     

Depressive and Anxiety Symptoms as Risk Factors for Temporomandibular Joint Pain: A Prospective Cohort Study in the General Population

Previous studies have associated depression and temporomandibular joint disorders (TMDs). The temporality, however, remains to be clarified. Most patient studies have selected subjects from treatment facilities, whereas in epidemiological studies a clinical examination has not been performed. In this study the 5-year follow-up data of the population-based Study of Health in Pomerania (SHIP) were analyzed. To estimate the effect of symptoms of depression and those of anxiety on the risk of TMD pain, the Composite International Diagnostic-Screener (CID-S) and a clinical functional examination with palpation of the temporomandibular joint and the masticatory muscles were used. After exclusion of subjects having joint pain at baseline, a sample of 3,006 Caucasian participants with a mean age of 49 years resulted. Of those, 122 participants had signs of TMD joint pain upon palpation. Subjects with symptoms of depression had an increased risk of TMD joint pain upon palpation (rate ratio: 2.1; 95% confidence interval: 1.5–3.0; P < .001). Anxiety symptoms were associated with joint and with muscle pain. The diagnosis, prevention, and therapy of TMD pain should also consider symptoms of depression and those of anxiety, and appropriate therapies if necessary.     

Relationship Between Fibromyalgia and Obesity in Pain,Function, Mood,and Sleep

Fibromyalgia syndrome (FMS) is a prevalent and disabling chronic pain disorder. Past research suggests that obesity is a common comorbidity and may be related to the severity of FMS. The main objective of the present study was to evaluate the relationships between FMS and obesity in the multiple FMS-related domains: hyperalgesia, symptoms, physical abilities, and sleep. A total of 215 FMS patients completed a set of self-report inventories to assess FMS-related symptoms and underwent the tender point (TP) examination, physical performance testing, and 7-day home sleep assessment. Forty-seven percent of our sample was obese and an additional 30% was overweight. Obesity was related significantly to greater pain sensitivity to TP palpation particularly in the lower body areas, reduced physical strength and lower-body flexibility, shorter sleep duration, and greater restlessness during sleep. The results confirmed that obesity is a prevalent comorbidity of FMS that may contribute to the severity of the problem. Potential mechanisms underlying the relationship are discussed.     

Accuracy and Reliability of Infrared Thermography in the Diagnosis of Arthralgia in Women With Temporomandibular Disorder

ObjectiveThe purpose of this study was to determine the accuracy and reliability of infrared thermography in the diagnosis of arthralgia in women with temporomandibular disorder.MethodsThirty women aged between 18 and 40 years were recruited for the study. The Research Diagnostic Criteria for Temporomandibular Disorders was used to allocate the volunteers to the control group (n = 15) and arthralgia group (n = 15). Both groups were submitted to infrared thermography of the temporomandibular joint (TMJ), followed by a punctual analysis of the images. The Mann-Whitney U test was used for the comparison of skin surface temperature between groups. The intraclass correlation coefficient was calculated to determine the reliability of the infrared image analysis. The receiver operating characteristic curve was used to determine the accuracy of the diagnosis.ResultsSkin temperature was significantly greater over the left (P = .004) and right (P = .012) TMJ in the arthralgia group. The intraclass correlation coefficient ranged from 0.841 to 0.874. The area under the receiver operating characteristic curve ranged from 0.598 to 0.675.ConclusionExcellent intrarater and interrater reliability was found in the analysis of the infrared images of the TMJ. However, infrared thermography demonstrated a low accuracy in the diagnosis of arthralgia in women with temporomandibular disorder.     

On the Self-Regulation of a Health Threat:Cognitions, Coping, and Emotions Among Women Undergoing Treatment for Infertility

The Self-regulation Model (SRM) proposed by Leventhal and colleagues (H. Leventhal, Meyer, & Nerenz, 1980) argues that cognitive representations of a health threat guide coping with the threat, which in turn affects physical and emotional outcomes. The current study tested these hypothesized relationships between cognitive perceptions of infertility, ways of coping with infertility and its treatment, and emotional outcomes, in a sample of 310 women undergoing treatment for infertility. The data provided evidence for direct and indirect relationships between cognitions and emotions and underscored the importance of examining illness cognitions and attending to both positive and negative emotions in research and therapy.     

The Moderating Role of Attention Control in the Relationship Between Pain Catastrophizing and Negatively-Biased Pain Memories in Youth With Chronic Pain

The present study examined the role of attention control in understanding the development of negatively-biased pain memories as well as its moderating role in the relationship between pain catastrophizing and negatively-biased pain memories. Youth with chronic pain (N = 105) performed a cold pressor task (CPT) and completed self-report measures of state/trait pain catastrophizing and attention control, with the latter comprising both attention focusing and attention shifting. Two weeks after the CPT, youth's pain-related memories were elicited via telephone allowing to compute pain and anxiety memory bias indices (ie, recalling pain intensity or pain-related anxiety, respectively, as higher than initially reported). Results indicated no main effects of attention control and pain catastrophizing on pain memories. However, both components of attention control (ie, attention focusing and attention shifting) moderated the impact of pain catastrophizing on youth's memory bias, with opposite interaction effects. Specifically, whereas high levels of attention shifting buffered the influence of high pain catastrophizing on the development of pain memory bias, high levels of attention focusing strengthened the influence of high pain catastrophizing on the development of anxiety memory bias. Interaction effects were confined to trait catastrophizing (ie, not state catastrophizing). Theoretical and clinical implications are discussed.PerspectiveThis article investigates the role of attention control in the development of negatively-biased pain memories in children with chronic pain. Findings underscore the importance of targeting differential components of attention control and can inform intervention efforts to minimize the development of negatively biased pain memories in youth with chronic pain.     

Catastrophizing,Solicitous Responses From Significant Others,and Function in Individuals With Neuropathic Pain,Osteoarthritis, or Spinal Pain in the General Population

That certain psychological factors are negatively associated with function in patients with chronic pain is well established. However, few studies have evaluated these factors in individuals with chronic pain from the general population. The aims of this study were to: 1) evaluate the unique associations between catastrophizing and perceived solicitous responses and psychological function, physical function, and insomnia severity in individuals with neuropathic pain, osteoarthritis, or spinal pain in the general population; and 2) determine if diagnosis moderates the associations found. Five hundred fifty-one individuals from the general population underwent examinations with a physician and physiotherapist, and a total of 334 individuals were diagnosed with either neuropathic pain (n?=?34), osteoarthritis (n?=?78), or spinal pain (n?=?222). Results showed that catastrophizing was significantly associated with reduced psychological and physical function, explaining 24% and 2% of the variance respectively, whereas catastrophizing as well as perceived solicitous responding were significantly and uniquely associated with insomnia severity, explaining 8% of the variance. Perceived solicitous responding was significantly negatively associated with insomnia severity. Moderator analyses indicated that: 1) the association between catastrophizing and psychological function was greater among individuals with spinal pain and neuropathic pain than those with osteoarthritis, and 2) the association between catastrophizing and insomnia was greater among individuals with spinal pain and osteoarthritis than those with neuropathic pain. No statistically significant interactions including perceived solicitous responses were found. The findings support earlier findings of an association between catastrophizing and function among individuals with chronic pain in the general population, and suggest that diagnosis may serve a moderating role in some of these associations.

Sleep Mediates the Association Between PTSD Symptoms and Chronic Pain in Youth

Symptoms of post-traumatic stress disorder (PTSS) and chronic pain have been shown to co-occur at high rates in adolescents and this co-occurrence is linked to worse pain and quality of life. Sleep disturbance has been posited as a mechanism underlying this co-occurrence in conceptual models of mutual maintenance. This study examined the mediating role of sleep in the relationship between PTSS and pain in youth (aged 10–17 years) with chronic pain. Ninety-seven participants completed measures of PTSS, pain (intensity and interference), anxiety symptoms, and sleep quality, in addition to demographic characteristics. Mediation models were conducted. Findings revealed that, over and above the influence of associated demographic characteristics (age, race) and anxiety symptoms, sleep quality partially mediated the relationships between PTSS and pain intensity and interference for youth with chronic pain. Specifically, higher levels of PTSS was linked to higher levels of pain intensity and pain interference, and these relationships were partially explained by poor sleep quality. Findings highlight the potential mechanistic role of sleep in explaining the co-occurrence of chronic pain and PTSS and suggest sleep might be an important target in future interventions.

Number and Type of Post-Traumatic Stress Disorder Symptom Domains Are Associated With Patient-Reported Outcomes in Patients With Chronic Pain

Post-traumatic stress disorder (PTSD) commonly accompanies complex chronic pain, yet PTSD is often overlooked in chronic pain management. Using the 4-item Primary Care (PC)-PTSD screening tool, we evaluated the relationship between the number and type of PC-PTSD symptoms endorsed and a set of patient-reported outcomes, including: pain intensity and interference, function, mood, quality of life, and substance abuse risk in a consecutive sample of patients with chronic pain (n?=?4,402). Patients completed PainTracker, a Web-based patient-reported outcome tool that provides a multidimensional evaluation of chronic pain, as part of their intake evaluation at a specialty pain clinic in a community setting. Twenty-seven percent of the sample met PC-PTSD screening criteria for PTSD by endorsing 3 of the 4 symptom domains. Significant ordinal trends were observed between increasing number of PTSD symptoms and all outcomes evaluated. The occurrence of even 1 PTSD symptom was associated with overall poorer outcomes, suggesting that subsyndromal PTSD is clinically significant in the context of chronic pain. Among the 4 PTSD domains assessed, “numbness/detachment” was most strongly associated with negative pain outcomes in relative weight analysis. Results from this cross-sectional study suggest that a range of pain-related outcomes may be significantly related to comorbid PTSD.

护理干预在改善孕妇妊娠末期睡眠质量及负性情绪中的作用

目的:研究在常规产科指导基础上,再给予妊娠末期孕妇护理干预的效果.方法:选取2016年12月至2017年12月福建省厦门市翔安区妇幼保健院收治的妊娠末期孕妇110例作为研究对象,按照随机数字表法分为对照组和观察组,每组55例.对照组实施常规产科指导,观察组实施针对性护理干预,统计并比较2种护理方式下孕妇的睡眠质量和心理状态情况.结果:护理前组间睡眠质量各指标评分差异无统计学意义(P>0.05),护理后2组各指标评分均降低,但观察组比对照组更低,差异有统计学意义(P<0.05);护理前组间SAS、SDS评分,差异无统计学意义(P>0.05),护理后2组SAS、SDS评分均降低,但观察组比对照组更低,差异有统计学意义(P<0.05).结论:在常规产科指导基础上,再给予妊娠末期孕妇针对性护理干预,可以改善孕妇睡眠质量,利于孕妇良好心理状态的构建.