Clinical features of chronic primary pain in individuals presenting painful temporomandibular disorder and comorbidities.

BACKGROUND: The diagnosis of chronic primary pain (CPP), according to the recently released International Classification of Disease (ICD-11) criteria, refers to conditions with complex aetiologies. CPP is characterized by specific clinical features such as generalized sensory hypersensitivity and widespread pain, and is associated with functional disability and emotional distress. OBJECTIVE: This study investigated clinical features of CPP in individuals with painful temporomandibular disorders (TMD) and comorbidities (fibromyalgia, migraine and/or tension-type headache). METHODS: This cross-sectional study was conducted with a sample of 129 individuals. Painful TMD, fibromyalgia and primary headaches were evaluated based on well-established international criteria. Generalized sensory hypersensitivity was assessed using psychophysical tests. Symptoms of anxiety and depression were assessed by the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. The Central Sensitization Inventory was applied to assess central sensitization-related symptoms and the Pittsburg Sleep Quality Index to evaluate the quality of sleep. The presence of widespread pain was assessed using a body map. The sample was stratified into three groups: control (n = 25), TMD-painful TMD only (n = 35) and TMD + Cm-painful TMD and comorbidities (n = 69). Statistical analysis was performed using one-way ANOVA, chi-squared test and ANCOVA, considering gender as a covariate (α = .05). RESULTS: Compared to controls, individuals presenting painful TMD and comorbidities showed lower pressure pain thresholds in all evaluated areas (p ≤ .012) and a higher number of painful areas in the body (p = .001). They presented more symptoms of anxiety (p = .040) and depression (p = .018), and a higher score in the Central Sensitization Inventory (p ≤ .006) than the other groups. CONCLUSION: Individuals with painful TMD and comorbidities presented more clinical features of CPP compared to those affected by TMD only.

Widespread Pain and Central Sensitization in Adolescents with Signs of Painful Temporomandibular Disorders.

AIMS: To investigate the associations between signs of painful temporomandibular disorders (TMD) and number of tender points (TPs) and fibromyalgia in adolescents, as well as the relationship between TPs and pressure-pain threshold (PPT) in individuals presenting with local, regional, or widespread pain as a way to investigate the presence of central sensitization (CS). METHODS: The sample consisted of 690 Brazilian adolescents with and without signs of painful TMD, aged 12 to 14 years old. Painful TMD was classified according to the Research Diagnostic Criteria for TMD (RDC/TMD) Axis I. The criteria established by Yunus were applied to assess juvenile fibromyalgia and TPs. Mann-Whitney and chi-square tests were applied to test the associations between signs of painful TMD and demographic variables. Regression models were used to estimate the association between signs of painful TMD and number of TPs and to determine which additional predictive variables were associated with TPs. Regression analyses were performed to test the associations between PPT values and number of TPs. Fisher test was used to estimate the association between signs of painful TMD and FM. RESULTS: Significant associations between signs of painful TMD and the number of TPs (P < .001), as well as between TPs and the PPT values for local, regional, and widespread pain (P < .001), were found. No association between signs of painful TMD and fibromyalgia was found (P = .158). CONCLUSION: Individuals with signs of painful TMD presented with more TPs compared to pain-free adolescents. Moreover, the higher the number of TPs, the lower the PPT. This finding suggests that adolescents with signs of painful TMD are at increased risk of presenting with CS.

Temporomandibular disorder, body pain and systemic diseases: assessing their associations in adolescents

Abstract Painful temporomandibular disorders (TMD) in children and adolescents may impact negatively the individual´s life. The presence of comorbidities associated with TMD tends to increase the persistence of pain and to facilitate its chronification. Objective To investigate the presence of other painful conditions and systemic diseases and their association with painful TMD. Methodology In this cross-sectional study, 690 adolescents aged between 12-14 years old were evaluated through questionnaires and clinical examinations. Results Painful TMD was found in 16.2% of the sample, with a significant association with bronchitis (OR= 2.5; p=0.003) and asthma (OR=3.1; p=0.013), reported by the parents/legal guardians of the participants. Adolescents with regional and widespread pain were 2.7 (95% CI: 1.65-4.55) and 3.6 (95% CI: 1.29-10.14) more likely to also present painful TMD. Painful TMD was associated with a higher number of body pain sites in the last 12 months (4.26 vs. 2.90; p<0.001), as well as a higher number of systemic diseases (1.48 vs. 1.18; p=0.048), when compared to adolescents without painful TMD. Conclusion The findings of this study point out the importance of considering the presence of comorbid conditions in the diagnosis and management of painful TMD in adolescents. A multidisciplinary approach would contribute to better control of painful TMD and decrease its chronification risk.

Influência de abordagens biopsicossociais e autocuidados no controle das disfunções temporomandibulares crônicas / Influence of biopsychosocial approaches and self-care to control chronic pain and temporomandibular disorders

BACKGROUND AND OBJECTIVES: Temporomandibular joint disorder (TMD), which is a musculoskeletal condition of the masticatory system, may become chronic and further worsen quality of life (QL) of patients. Due to the interrelation between physical and emotional symptoms, there is increasing search for the integrative model, which includes psychosocial approaches for the treatment of painful conditions. This study aimed at reviewing in the literature the impact of education and simple self-care modalities on pain and disorders related to chronic painful TMD. CONTENTS: Psychosocial factors are often involved with pain chronicity, making bio-behavioral approaches increasingly more indicated to change pain perception and to decrease distress and psychosocial changes which go along with persistent pain. CONCLUSION: Current literature, although not extensive, indicates positive results of education and self-care methods for chronic painful TMD. Further studies are needed to reinforce such findings and spread the application of such approaches to control chronic and TMD pain.

JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular (DTM), condição musculoesquelética do sistema mastigatório, pode se tornar crônica, causando maior comprometimento na qualidade de vida (QV) dos pacientes. Devido à inter-relação entre sintomas físicos e emocionais, há uma crescente busca pelo modelo integrativo, o qual inclui abordagens psicossociais para o tratamento de condições dolorosas. O objetivo deste estudo foi realizar uma revisão de literatura sobre o impacto da educação e modalidades simples de autocuidados podem ter na dor e na disfunção relacionadas à DTM dolorosa crônica. CONTEÚDO: Os fatores psicossociais estão frequentemente envolvidos na cronificação da dor, tornando as abordagens biocomportamentais cada vez mais indicadas para mudar a percepção da dor, reduzir o sofrimento e as alterações psicossociais que acompanham as dores persistentes. CONCLUSÃO: A literatura existente, apesar de não ser vasta, indica resultados positivos da aplicação de métodos de educação e autocuidados em DTM dolorosa crônica. Mais estudos são necessários para reforçar tais achados e disseminar a aplicação de tais abordagens no controle da dor crônica e da DTM.