Thermal temporal summation and decay of after-sensations in temporomandibular myofascial pain patients with and without comorbid fibromyalgia.
Thermal temporal summation and decay of after-sensations in temporomandibular myofascial pain patients with and without comorbid fibromyalgia.
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DOI：
10.2147/jpr.s109038
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发表时间：
2016
影响因子：
2.7
通讯作者：
Staud R
中科院分区：
文献类型：
--
作者：
Janal MN;Raphael KG;Cook DB;Sirois DA;Nemelivsky L;Staud R
慢性肌筋膜颞下颌疾病（TMD）可能有多种病因和维持因素。一个潜在因素，即中枢疼痛敏化，在这里被量化为对时间求和（TS）范式的反应，并在病例组和对照组之间比较该反应。先前的研究表明，20% 的 TMD 患者诊断出纤维肌痛 (FM)，目标 1 确定是否优先在以口面部疼痛作为 FM 区域表现的肌筋膜 TMD 病例中发现中枢敏化。目标 2 确定 TS 后的后感觉 (AS) 报告是否会根据重复刺激是否被评定为越来越疼痛而变化。对 168 名女性、43 名对照组、100 名仅肌筋膜 TMD 病例和 25 名肌筋膜 TMD + FM 病例进行了热温暖和疼痛阈值、热 TS 和热 AS 衰减的比较。所有病例均符合 TMD 研究诊断标准；合并症病例也符合 1990 年美国风湿病学会 FM 标准。所有组的疼痛阈值和 TS 相似。当达到 TS（约 60%）时，在肌筋膜 TMD 病例中，在第一个刺激后间隔内，AS 水平明显高于对照组，并且随着时间的推移，AS 衰减得更慢。相比之下，各组在稳定状态或对重复刺激的反应减弱后表现出相似的 AS 衰减模式。在这项病例对照研究中，所有肌筋膜 TMD 病例都具有类似的 AS 衰减延迟的特征。因此，这一中枢敏化指标未能表明有或没有 FM 的肌筋膜 TMD 病例中不同的疼痛维持因素。
Chronic myofascial temporomandibular disorders (TMD) may have multiple etiological and maintenance factors. One potential factor, central pain sensitization, was quantified here as the response to the temporal summation (TS) paradigm, and that response was compared between case and control groups. As previous research has shown that fibromyalgia (FM) is diagnosed iñ20% of TMD patients, Aim 1 determined whether central sensitization is found preferentially in myofascial TMD cases that have orofacial pain as a regional manifestation of FM. Aim 2 determined if the report of after-sensations (AS) following TS varied depending on whether repeated stimuli were rated as increasingly painful. One hundred sixty-eight women, 43 controls, 100 myofascial TMD-only cases, and 25 myofascial TMD + FM cases, were compared on thermal warmth and pain thresholds, thermal TS, and decay of thermal AS. All cases met Research Diagnostic Criteria for TMD; comorbid cases also met the 1990 American College of Rheumatology criteria for FM. Pain thresholds and TS were similar in all groups. When TS was achieved (~60%), significantly higher levels of AS were reported in the first poststimulus interval, and AS decayed more slowly over time, in myofascial TMD cases than controls. By contrast, groups showed similar AS decay patterns following steady state or decreasing responses to repetitive stimulation. In this case–control study, all myofascial TMD cases were characterized by a similar delay in the decay of AS. Thus, this indicator of central sensitization failed to suggest different pain maintenance factors in myofascial TMD cases with and without FM.