Background & Aims

Temporomandibular Disorder (TMD) is characterized by a complex interplay of psychophysical, clinical, and psychological factors, the full understanding of which remains elusive. Despite widespread acknowledgment of the influence of these elements on nociceptive profiles associated with TMD, the nature of this relationship continues to pose a challenge. This study aims to investigate whether variables of psychosocial, psychophysical, or clinical nature can enhance the likelihood of patients with painful TMD belonging to a specific anti/pro-nociceptive profile, based on endogenous pain modulation and/or temporal summation.

Methods

In this cross-sectional study, 77 patients diagnosed with painful Temporomandibular Disorder (DC/TMD) were included to explore anti/pro-nociceptive profiles using Conditioned Pain Modulation (CPM) and Wind-Up ratio (WUR) tests in the masseter muscle. Temporal summation was classified as either increased or normal based on the upper limit of the 95% confidence interval for WUR (2.38). Pain modulation was categorized as normal or impaired depending on the percentage value of CPM relative to 18%. Patients were grouped into Dual Pronociception, Inhibitory Pronociception, Facilitatory Pronociception, and Antinociception. Mechanical Pain Threshold, Pressure Pain Threshold in trigeminal and extra-trigeminal regions, Perceived Stress Scale, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Pittsburgh Sleep Quality Index, average monthly pain intensity (Visual Analog Scale), and the number of painful comorbidities were assessed. Multinomial logistic regression analysis was done

Results

After the formation of the groups, 21 individuals belonged to the Antinociceptive group, 13 to the Dual Pronociception group, 6 to the Facilitatory Pronociception group, and 37 to the Inhibitory Pronociception group. In the correlation, multicollinearity among the data was detected, leading to the exclusion of variables related to anxiety, stress, and PPT in the tenar region from the regression analysis. In the multinomial logistic regression, a higher pressure pain threshold (PPT) in the masseter had a 4.93 times greater likelihood of belonging to the Dual Pronociception group (p = 0.049). The presence of a greater number of painful comorbidities increased the probability of belonging to the Facilitatory Pronociception group by 2.9 times (p = 0.039). Sleep emerged as a factor that increased the likelihood of belonging to the Inhibitory Pronociception group by 1.2 times compared to the Antinociceptive group (p = 0.037), as did a higher PPT in the masseter region (p = 0.006 – 5.5x).

Conclusions

This study provides a comprehensive insight into the influence of psychophysical, clinical, and psychological variables on individuals’ propensity for different nociceptive profiles, highlighting the quality of sleep as a potential factor to be evaluated in increasing the likelihood of individuals belonging to the pro-nociception group related to conditioned pain modulation and the presence of numerous painful comorbidities, especially in the context of pro-nociception with temporal summation. Additionally, pressure pain thresholds proved to be relevant in determining these profiles, enhancing the understanding of the underlying complexity of TMD (Temporomandibular Disorders).

References

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Presenting Author

Rafaela Stocker Salbego

Poster Authors

Rafaela Salbego

MSc

Universidade de São Paulo

Lead Author

E-mail

Matheus Herreira-Ferreira

University of São Paulo

Lead Author

E-mail

Beatriz Lima-Netto; DDS

Master's Degree student

University of São Paulo

Lead Author

E-mail

Yuri M. Costa. DDS

Ph.D

University of Campinas

Lead Author

E-mail

Paulo Conti

University of São Paulo

Lead Author

E-mail

Leonardo Bonjardim

University of São Paulo

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Orofacial Pain