Bilateral thermal hyperalgesia in trigeminal and extra-trigeminal regions in patients with myofascial temporomandibular disorders
Bilateral thermal hyperalgesia in trigeminal and extra-trigeminal regions in patients with myofascial temporomandibular disorders
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DOI：
10.1007/s00221-009-2121-x
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发表时间：
2010-04-01
影响因子：
2
通讯作者：
Svensson, Peter
中科院分区：
文献类型：
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作者：
Fernandez-de-las-Penas, Cesar;Galan-del-Rio, Fernando;Svensson, Peter
我们的目的是评估与年龄匹配的对照组相比，肌筋膜颞下颌紊乱（TMD）患者三叉神经和三叉外区域的热敏性，但没有合并症。根据研究诊断标准诊断为肌筋膜TMD的女性20例（年龄24 +/- 3岁）和健康女性20例（年龄24 +/- 4岁）。在咬肌和额肌（三叉区）以及手腕（三叉外区）两侧评估热、冷检测阈值（分别为WDT和CDT）以及热、冷疼痛阈值（分别为HPT和CPT）。计算每个位点三次测定的平均值并用于分析。试验地点的顺序是随机的。采用双向方差分析（two-way ANOVA）检验各组和侧方（最痛/对侧；显性/非显性）之间的差异。三叉和三叉外区域WDT和CDT组间差异无统计学意义（方差分析P < 0.389）。HPT和CPT在三叉和三叉外区域的组间有显著差异，但两侧间无显著差异（方差分析，P < 0.001）。三叉区的CPT （P < 0.001）与疼痛强度和疼痛症状持续时间呈正相关：疼痛史越长或疼痛强度越大，三叉区的CPT（即更大的冷痛觉过敏）越高。我们的研究结果显示，与健康对照相比，患有肌筋膜TMD的女性双侧热痛觉过敏（HPT较低和CPT较高），但三叉神经和三叉外区域的WDT和CDT正常。三叉和三叉外区的双侧热/冷痛觉过敏可能反映了肌筋膜TMD患者的热通道功能障碍，这是外周致敏、中枢伤害性加工的促进和/或下降抑制减弱的某种组合的结果。
Our aim was to assess thermal sensitivity in both trigeminal and extra-trigeminal regions in patients with myofascial temporomandibular disorder (TMD) but without comorbid conditions as compared to age-matched controls. Twenty women (age 24 +/- A 3 years) diagnosed with myofascial TMD according to the research diagnostic criteria for TMD and 20 healthy women (age 24 +/- A 4 years) were included. Warm and cold detection thresholds (WDT and CDT, respectively) and heat and cold pain thresholds (HPT and CPT, respectively) were bilaterally assessed over the masseter and frontalis muscles (trigeminal regions) and the wrist (extra-trigeminal region). The mean of three determinations at each site was calculated and used for analysis. The order of the test sites was randomized. A two-way ANOVA was used to test for differences between groups and sides (most painful/contra-lateral side; dominant/non-dominant). No significant differences between groups for WDT or CDT in trigeminal and extra-trigeminal regions (ANOVA, P > 0.389) were found. There were significant differences between groups, but not between sides, for HPT and CPT in both trigeminal and extra-trigeminal areas (ANOVA, P < 0.001). CPT (P < 0.001) over the trigeminal area was positively correlated with both pain intensity and duration of pain symptoms: the longer the history of pain or the greater the pain intensity, the higher the CPT (i.e., the greater cold hyperalgesia) over the trigeminal region. Our findings revealed bilateral thermal hyperalgesia (lower HPT and higher CPT) but normal WDT and CDT in trigeminal and extra-trigeminal regions in women with myofascial TMD as compared to healthy controls. Bilateral heat/cold hyperalgesia in trigeminal and extra-trigeminal areas may reflect a dysfunction of thermal channels in myofascial TMD patients as result of some combination of peripheral sensitization, facilitation of central nociceptive processing and/or decreased descending inhibition.