Background & Aims

The referred pain is a common phenomenon in patients with temporomandibular dysfunction (TMD) and has been associated with a more severe clinical picture from a biopsychosocial perspective. Thus, the aim of this study was to compare psychosocial and psychophysical variables among patients with masticatory myofascial pain with referral (MMPR) or local myalgia (LM) and a group of asymptomatic individuals.

Methods

In this cross-sectional study, secondary data from individuals diagnosed with LM (n=20), MMPR (n=39) based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and asymptomatic control individuals (CA, n=101) were utilized. All participants completed questionnaires to measure psychosocial characteristics, including perceived stress (Perceived Stress Scale-PSS), anxiety and depression (Hospital Anxiety and Depression Scale-HADS), catastrophizing (Pain Catastrophizing Scale-PCS), and sleep quality (Pittsburgh Sleep Quality Index-PSQI). Additionally, psychophysical variables such as mechanical pain threshold (MPT), wind-up ratio (WUR), pressure pain threshold (PPT), and conditioned pain modulation (CPM) were assessed in both trigeminal (masseter) and extra-trigeminal (thenar) regions. Data with normal distribution were analyzed using ANOVA, while non-normally distributed data were analyzed using its non-parametric counterpart, KRUSKAL-WALLIS.

Results

Among all assessed psychosocial variables, only catastrophizing showed a significant difference between groups (p < .001), with the highest values found in LM group (CA = 15; LM = 39; MMPR = 25.5). Anxiety(p = 0.002) and depression symptoms (p < .001) were statistically different from control group but not between the LM and MMPR groups. Sleep quality were only different between the CA and MMPR (p < 0.001). Stress symptoms did not differ between groups (p = 0.065). Of all the assessed psychophysical variables, only MPT and PPT had statistical differences, namely: the MPT of masseter and hand were different between the CA group and the muscle pain groups (p <.001), but without a difference between the LM and MMPR groups for masseter (p=0.556) and thenar (p=0.937). The hand PPT showed no difference between groups (p=0.267), but the masseter PPT differed between CA and MMPR groups (p=0.002), but not between CA and LM (p=0.391) or between LM and MMPR (p=0.551)

Conclusions

The results of the present study suggest that, overall, patients with local myalgia (LM) and masticatory myofascial pain with referral (MMPR) do not exhibit psychosocial and psychophysical characteristics that can differentiate the severity of these diagnoses.

References

Fernández-de-las-Peñas C, Dommerholt J. Myofascial trigger points: peripheral or central phenomenon? Curr Rheumatol Rep. 2014;16(1):395.
Varun S, Anderson GC, Hodges JS, Zhang L, Schiffman EL. A Controlled Study of Biopsychosocial Differences Observed in Masticatory Myalgia With and Without Pain Referral. J Oral Facial Pain Headache. 2023 Spring;37(2):131-138. doi: 10.11607/ofph.3317. PMID: 37389839; PMCID: PMC10642503.
Winocur-Arias, Orit et al. “Local myalgia compared to myofascial pain with referral according to the DC/TMD: Axis I and II results.” BMC oral health vol. 22,1 27. 4 Feb. 2022, doi:10.1186/s12903-022-02048-x

Presenting Author

Ana Conti

Poster Authors

Ana Conti

PhD

University of Sao Paulo

Lead Author

E-mail

Beatriz Amaral de Lima Netto Master's student

University of Sao Paulo

Lead Author

E-mail

Matheus Ferreira DDS

Ms

Bauru School of Dentistry

Lead Author

E-mail

Rafaela Salbego DDS

MSc

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