Influence of psychometric and sleep quality features on painful mechanical sensitivity and pain modulation in patients with temporomandibular disorders.

Investigating the collective impact of psychometric properties and sleep quality on pain sensitivity in temporomandibular disorder (TMD) patients could improve clinical management strategies. OBJECTIVE: Assessing whether combined psychometric properties and sleep quality impact painful mechanical sensitivity and pain modulation in TMD patients. MATERIALS AND METHODS: A cross-sectional study using secondary data analysis of 77 TMD patients and 101 controls. All participants completed questionnaires characterizing their psychometric profile (anxiety, depression, stress and catastrophizing) and sleep quality, alongside psychophysical tests for painful mechanical sensory (mechanical pain threshold (MPT), pressure pain threshold (PPT), and wind-up ratio (WUR)) and conditioned pain modulation (CPM). Participants were grouped into "High distress" or "Low distress" categories based on psychometric properties and sleep quality using hierarchical cluster and k-means analyses. Multiple linear regression evaluated the influence of TMD, age, and the distress cluster on MPT, WUR, PPT, and CPM in masseter and thenar muscles. Differences were statistically significant when p < 0.05. RESULTS: The presence of TMD was the strongest predictor of mechanical painful sensitivity in the trigeminal region (MPT[F(3,174) = 51.902;p < .001;R2 = .463]; TMD presence (ß = -.682) / PPT[F(3,174) = 15.573;p < .001;R2 = .198] TMD presence (ß = -.452), and extra-trigeminal (MPT[F(3,174) = 35.897;p < .001;R2 = .382] TMD (ß = -.647) / CPM [F(3,174) = 4.106;p < .05;R2 = .050] TMD presence (ß = .197). Furthermore, neither the high distress group nor the low distress group were able to significantly influence the variation of the values of any of the psychophysical variables evaluated (p > .05). CONCLUSIONS: There is not a significant influence of impairment clusters based on psychological variables and sleep quality on painful mechanical sensitivity and pain modulation, regardless of the presence of TMD. CLINICAL RELEVANCE: This outcome suggests that psychosocial factors and sleep quality may not play a decisive role in the sensory-discriminative aspect of pain, particularly concerning painful TMD.

Prediction of duloxetine efficacy in addition to self-management in painful temporomandibular disorders: A randomised, placebo-controlled clinical trial.

BACKGROUND: Conditioned pain modulation (CPM) is a potential predictor of treatment response that has not been studied in temporomandibular disorders (TMD). OBJECTIVES: We conducted a randomised, double-blind, placebo-controlled trial (RCT) of duloxetine in addition to self-management (SM) strategies to investigate its efficacy to reduce pain intensity in painful TMD patients. Moreover, we investigated whether baseline CPM would predict the duloxetine efficacy to reduce TMD pain intensity. METHODS: Eighty participants were randomised to duloxetine 60 mg or placebo for 12 weeks. The primary outcomes were the change in the pain intensity from baseline to week-12 and CPM-sequential paradigm at baseline. Safety, physical and emotional functioning outcomes were also evaluated. RESULTS: Of 80 participants randomised, 78 were included in intention-to-treat analysis. Pain intensity decreased for SM-duloxetine and SM-placebo but did not differ between groups (p = .82). A more efficient CPM was associated with a greater pain intensity reduction regardless of the treatment group (p = .035). Physical and emotional functioning did not differ between groups, but adverse events (p = .014), sleep impairment (p = .003) and catastrophizing symptoms (p = .001) were more prevalent in SM-duloxetine group. CONCLUSION: This study failed to provide evidence of a beneficial effect of adding duloxetine to SM strategies for treatment of painful TMD. Nonetheless, this RCT has shown the feasibility of applying pain modulation assessment to predict short-term treatment response in painful TMD patients, which confirms previous finds that CPM evaluation may serve a step forward in individualising pain treatment.

Influence of genetic polymorphisms on mechanical pain sensitivity and endogenous pain modulation of trigeminal and spinal areas.

BACKGROUND: Previous evidence indicates significant association between genetic polymorphisms and phenotypes related to pain sensitivity in patients with temporomandibular disorders (TMD). Despite the important advances in cataloguing diverse factors such as sleep disorders, anxiety and depression, the interrelated mechanisms of painful TMD aetiopathogenesis still need investigation. OBJECTIVES: This case-control study aimed to evaluate the influence of genetic polymorphisms (rs6296, rs6295, rs1799971, rs4680, rs4633, rs4818) and psychosocial factors on the mechanical pain sensitivity and endogenous pain modulation in women with painful TMD and asymptomatic controls. METHODS: We evaluated six independent variables: anxiety levels, depression, stress, sleep quality, pain catastrophising and genetic polymorphisms, and four dependent variables: mechanical pain threshold (MPT), pressure pain threshold (PPT), wind-up ratio (WUR) and conditioned pain modulation (CPM) collected at masseter (trigeminal) and hand (spinal) areas in a sample of 95 painful TMD patients and 85 controls. A regression model was used to test the possible effect of the independent variables on dependent variables. RESULTS: The regression model was significant for MPT (F11,168  = 9.772; R2  = .390). Painful TMD diagnoses and sleep quality were associated with trigeminal MPT (B coefficient = -.499; and B coefficient = -.211, respectively). WUR was associated with rs6295 and rs6746030, respectively, for the spinal and the trigeminal area. CONCLUSION: Genetic polymorphisms had a slight contribution to endogenous pain modulation as indicated by the significant association with WUR but did not contribute to mechanical pain sensitivity. On the other hand, the presence of painful TMD and the sleep quality contributed significantly to mechanical pain sensitivity.

Metallic frames of removable partial denture: a planning proposal / Armações Metálicas de Próteses Parciais Removíveis: Proposta de Planejamento

Objective: Removable partial denture (RPD) is an important oral rehabilitation resource with an acceptable result even over a very long observation period. However, it is still difficult for many clinicians to make an appropriate RPD. One of the main causes of RPD failure is the missing or incorrect planning of the metal frame. Perhaps, this lack of planning occurs because of the difficulty that clinicians have to choose the components for the metallic frame among the enormous number of possibilities that exist. Thus, the present article aims to propose a simple sequence for the planning of metallic frames of the RPD following five steps: I) Classification of partially edentulous arches; II) Choice of the retainer (direct and indirect, when needed); III) Saddle drawing; IV) Choice of the major connector; and, V) Minor connector drawing. (AU)

Objetivo: A prótese parcial removível (PPR) é um importante recurso na reabilitação oral, apresentando resultados aceitáveis mesmo durante um longo período de acompanhamento. No entanto, ainda é difícil para muitos clínicos fazer uma PPR apropriada. Uma das principais causas de falha em PPR é o planejamento ausente ou incorreto da estrutura metálica. Possivelmente, essa deficiência no planejamento ocorra devido à dificuldade na escolha dos componentes para a armação metálica entre o enorme número de possibilidades existentes. Assim, o presente artigo tem como objetivo propor uma sequência simples para o planejamento de armações metálicas de PPR seguindo cinco etapas: I) Classificação de arcos parcialmente desdentados; II) Escolha do retentor (direto e indireto, quando necessário); III) Desenho de sela; IV) Escolha do conector maior; e, V) Desenho do conector menor. (AU)

Análise de biomarcadores de dor na saliva de pacientes diagnosticados com dor miofascial e submetidos ao tratamento cognitivo e fisioterápico / Analysis of biomarkers of pain in saliva of patients diagnosed with myofascial pain and submitted to cognitive and physiotherapeutic treatment

A dor miofascial é caracterizada por sintomas sensoriais, motores e autonômicos complexos causados por pontos de gatilho, que podem levar à dor, redução de movimento e diminuição do fluxo salivar, afetando a qualidade de vida. A terapia cognitivo-fisioterápica é uma modalidade de tratamento para dor miofascial, visando o controle da dor e melhora nos parâmetros funcionais da articulação temporomandibular. Os efeitos de tal terapia no fluxo salivar e na expressão salivar de mediadores de dor como IL-6, IL-1¿, glutamato, substância P e ROS são desconhecidos. Neste trabalho, foi investigada a taxa de fluxo salivar juntamente com os níveis salivares de IL-6, IL-1¿, substância P, glutamato e ROS em pacientes com dor miofascial antes e durante o tratamento cognitivo-fisioterápico. Além disso, a associação da intensidade da dor com a concentração de biomarcadores também foi estudada. Todos os indivíduos que aceitaram participar do estudo responderam à versão validada na língua portuguesa do questionário RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders). A saliva de pacientes diagnosticados com dor miofascial foi coletada antes do tratamento cognitivo-fisioterápico e durante o tratamento (quatro e oito semanas). Dos 34 indivíduos que concordaram participar do estudo e que iniciaram o tratamento, 19 compareceram aos 03 momentos de coleta, constituindo a amostra final. Não foi encontrada alteração significativa dos níveis de expressão dos biomarcadores avaliados, nem da taxa de fluxo salivar ao longo do tempo. Também, não foi encontrada associação entre a intensidade da dor e os parâmetros moleculares avaliados em qualquer um dos três momentos. Em conclusão, os biomarcadores avaliados e as taxas de fluxo salivar não mudaram durante oito semanas de intervenção cognitiva e fisioterápica na amostra avaliada