Are central sensitization symptoms and psychosocial alterations interfering in the association between painful TMD, migraine, and headache attributed to TMD?

Author(s)

Guilherme Vinícius do Vale Braido

• Document type: Doctoral Thesis
• Press: Araraquara. 2021-11-10.
• Institution: Universidade Estadual Paulista (Unesp). Faculdade de Odontologia. Araraquara
• Defense date: 2021-09-27
• Advisor: Daniela Aparecida de Godoi Gonçalves

Abstract

Introduction: Temporomandibular disorder (TMD) is one of the most frequent pain conditions in the orofacial region and its pathophysiology involves peripheral and central sensitization processes. This condition is often associated with other comorbidities, such as migraine (MIG) and headache attributed to TMD (h-TMD). Central Sensitization (CS) is often present in cases involving comorbidities. Somatosensory changes in CS can be assessed through Quantitative Sensory Test (QST). Aim: To investigate whether somatosensory functions, somatic symptoms related to CS and psychosocial aspects differ according to the presence of MIG or MIG + h-TMD in individuals with painful TMD. Material and Methods: This is an observational, cross-sectional study, carried out in a sample of adult individuals aged 20 to 65 years. The sample was stratified into three groups: 1) painful TMD; 2) painful TMD + MIG and 3) painful TMD + MIG + h-TMD. TMD classification was performed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Axis II of the RDC/TMD was used to assess psychosocial changes related to pain. For the identification of CS, the Central Sensitization Inventory (CSI) was used, the temporal summation of pain (TS), pressure pain threshold (algometry - PPT) and conditioned pain modulation tests (CPM). The identification of migraine was performed according to the criteria of the International Classification of Headaches – 3rd edition. The h-TMD was identified according to the criteria proposed by Schiffman et al. 2012. Descriptive analyzes were performed to characterize the sample. Quantitative variables were evaluated using the Kruskall Wallis test and qualitative variables using the Chi-square and Fisher's exact test. To analyze the QSTs and CSI-BP, the ANCOVA test was applied. A significance level of 5% was considered. Results: The final sample consisted of 92 individuals, of which 18 had only TMD, 38 had TMD and MIG and 36 had TMD, MIG and h-TMD simultaneously. A difference was found between the groups regarding gender (p=0.028), with women being the majority in all studied groups. Regarding the QSTs, no associations were found between the groups for the TS in the trigeminal area (Tg) (F=1.425; p=0.248) and in the extratrigeminal area (ETg) (F=0.862; p=0.428). Differences were found between the groups for the PPT test in the Tg area (F=6.148; p=0.003) and in the ETg area (F=7.398; p=0.001). No statistical differences were found for the CPM test in the Tg area (F=1.879, p=0.159) and in the ETg area (F=2.140, p=0.124). There was also no difference in group scores in relation to the CSI-BP. Furthermore, no differences were found between the groups regarding symptoms of depression (p=0.800) and anxiety (p=0.918). The TMD + MIG + h-TMD group had higher Characteristic Pain Intensity (p=0.001), Disability Points (p=0.045), Graduated Chronic Pain Scales (p=0.007) and higher somatization scores (p=0.012), when compared to the other groups. Conclusion: Measurements of the CPM and ST test did not indicate differences between groups, while mechanical hyperalgesia (PPT) was more pronounced in the group with TMD, Migraine and h-TMD. Furthermore, this group showed greater psychosocial alterations (CPI, DP, GCPS, NSPS). The somatosensory alteration can only partially explain the pathophysiological mechanisms of painful TMD and its 21 comorbidities, in addition to pointing to additive effects, mainly psychosocial, in face of the presence of headaches associated with TMD. (AU)

• FAPESP's process: 18/00411-4 - Central sensitization associated with a presence of painful TMD, migraine and TMD-attributed headache
• Grantee: Guilherme Vinícius do Vale Braido
• Support Opportunities: Scholarships in Brazil - Doctorate