Sleep Bruxism and Central Sensitization in Myofascial Face Pain

描述(申请人提供)：肌筋膜面部疼痛(MFP)是最常见的颞下颌关节紊乱病(TMD)，其发病机制仍存在争议。其中一个关键的争议是关于睡眠磨牙症(SB)的作用。虽然相对较弱的SB测量方法支持SB在至少一些MFP患者中的作用，但还没有进行基于实验室的睡眠研究来明确解决这个问题。本申请的主要目的是对Sb在MFP维护中的作用进行权威性研究，其中将研究研磨和咬合的单独作用。我们还将探索SB与应激诱导的磨牙症之间的关系，以及遗传异常在调节SB患者疼痛风险方面的作用。第二个目标是评估中枢敏化(CS)在维持MFP中的作用。支持CS在MFP中的作用的证据一直受到患者和解剖部位采样偏差的限制。因此，我们将在更具代表性的MFP患者和对照样本中检查CS在MFP中的作用，并对三叉神经外区和三叉神经区的CS进行评估。这两个区域CS的差异可能暗示了不同的疼痛维持机制。在为这两个目标服务时收集的数据然后允许实现第三个目标，了解MFP中SB和CS之间的关系，包括SB和CS的升高可能定义不同疼痛维持机制在其中起作用的亚组。这些目标可以在120名MFP患者和60名人口统计学上匹配的对照的病例对照研究的背景下实现。追求这些目标将为SB在MFP中的作用提供确凿的证据，并将促进对SB和CS之间关系的理解。这一理解有望支持我们的长期目标，即通过针对潜在的疼痛维持机制进行治疗来改善MFP的临床治疗。

DESCRIPTION (provided by applicant): The pathogenesis of myofascial face pain (MFP), the most prevalent type of temporomandibular disorder (TMD), remains controversial. One of the key controversies concerns the role of sleep bruxism (SB). While relatively weak measures of SB have supported a role of SB in at least some MFP patients, no laboratory based sleep study has been undertaken to resolve this issue definitively. This application proposes as its main aim the conduct of the definitive study of SB in MFP maintenance, in which the separate role of grinding and clenching would be examined. We would also explore the relationship between SB and stress induced bruxism, as well as the role of genetic anomalies in modulating the risk of pain among those with SB. A second aim would evaluate the role of central sensitization (CS) in the maintenance of MFP. Evidence supporting a role for CS in MFP has been limited by biases in the sampling of both patients and anatomic sites. Therefore, we would examine the role of CS in MFP in a more representative sample of MFP patients and controls, as well as conduct an evaluation of CS in both extratrigeminal and trigeminal regions. Differences in CS in these two areas might suggest different pain maintenance mechanisms. Data collected in the service of these two aims then allows the achievement a third aim, understanding the relationships between SB and CS in MFP, including the possibility that elevations in SB and CS may define subgroups in which different pain maintenance mechanisms are operative. These aims can be achieved in the context of a case-control study of 120 MFP patients and 60 demographically-matched controls. Pursuit of these aims will provide firm evidence regarding the role of SB in MFP and will advance understanding of the relationship between SB and CS. This understanding is expected to support our long-term goal of improving clinical treatment of MFP by targeting treatment to underlying pain-maintenance mechanisms.