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.

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

OBJECTIVE: To determine if somatosensory function and symptoms related to central sensitization (CS) differed in individuals with painful temporomandibular disorders (TMD) according to the presence of migraine (MIG) or MIG + headache attributed to TMD (HAT). MATERIALS AND METHODS: This study evaluated 92 adults (20-65 years), presenting painful TMD. Standard diagnostic criteria were applied to classification of painful TMD, MIG, and HAT. CS was assessed through the central sensitization inventory (CSI), wind-up ratio (WUR), pressure pain thresholds (PPT), and the conditioned pain modulation test (CPM). Psychosocial factors were evaluated by validated instruments. RESULTS: There was a significant difference regarding gender, with more women in the group TMD + MIG + HAT (p = 0.028). TMD + MIG and TMD + MIG + HAT had significantly lower PPTs than the TMD group. No group differences were found for the WUR, CPM, or CSI. TMD + MIG + HAT had higher chronic pain intensity (p = 0.001), disability points (p = 0.045), graded chronic pain scale (p = 0.007), and higher somatization (NSPS) scores (p = 0.012), compared to the other groups. CONCLUSION: Mechanical hyperalgesia was more pronounced in the group with the highest pain and somatization scores, while CPM and WUR did not differ between groups. Altered somatosensory function and CS may partially underlie the pathophysiology of overlapping TMD pain conditions, pointing towards additive effects of comorbid head pains. CLINICAL RELEVANCE: Our results demonstrate the importance of considering the association of primary and secondary headaches during TMD assessment and its implications for maintaining the signs and symptoms of CS. This can influence the conduct of treatment, which must be multidisciplinary, and must include management of mechanisms related to CS.

Translation and cross-cultural adaptation of the Headache Screening Questionnaire into Brazilian Portuguese.

BACKGROUND: The Headache Screening Questionnaire (HSQ) was created and validated to enable health professionals to screen for migraine and tension-type headaches. OBJECTIVES: The objective of this study was to translate and cross-culturally adapt the HSQ, creating the Brazilian version of the HSQ (HSQ-BR). DESIGN: This was a cross-sectional study. METHOD: The Brazilian version of the HSQ was developed following the processes of translation, synthesis, back-translation, expert committee review, and pre-testing. The translation phase involved two independent translators whose mother language was Brazilian Portuguese and who also were fluent in Dutch. The back-translation phase involved two independent translators whose mother language was Dutch and who also were fluent in Portuguese. The expert committee based their decisions on semantic, idiomatic, experiential, and conceptual equivalences. To verify the comprehension of the questionnaire, 60 subjects (73.3% women) with headaches with a mean age of 32.8 ± 12.0 years, participated in the pre-test phase. RESULTS: During the translation process, some terms and expressions were changed to obtain cultural equivalence to the original HSQ. The process of translation and cross-cultural adaptation of the HSQ to the Brazilian culture and Portuguese language, including its scoring algorithms for migraine and tension-type headache, was successfully concluded, as the comprehension of each item of the questionnaire was over 90% on the pre-test. CONCLUSION: The HSQ-BR has been created.

Temporomandibular Disorders in a Young Adolescent Brazilian Population: Epidemiologic Characterization and Associated Factors.

AIMS: To carry out an epidemiologic characterization of the most common subtypes of temporomandibular disorders (TMD) and to identify associated factors in a Brazilian sample of young adolescents. METHODS: From a population of public schoolchildren (12 to 14 years of age), 3,117 students were randomly invited to participate in this study. TMD was assessed according to the Research Diagnostic Criteria for TMD (RDC/TMD) Axis I, in addition to some questions of the Axis II history questionnaire. The associated factors, ie, difficulty with concentration/attention, anger, sadness, anxiety, headache complaints, oral parafunctions, diurnal jaw clenching, tooth grinding at night, and parents not living together, were assessed based on the responses of the adolescents and their parents to structured questions. For the statistical analyses, descriptive statistics, chi-square tests, odds ratio, and logistic regression models were used, adopting a 95% confidence interval and 5% level of significance. RESULTS: The sample consisted of 1,307 individuals (response rate of 41.9%), 56.8% (n = 742) girls. Overall, 397 (30.4%) adolescents presented with TMD, of whom 330 (25.2%) had painful TMD diagnoses. The majority of these had painful TMD of muscular origin (13.1%) and comprised chronic cases (14.9%). Girls presented higher frequencies of TMD overall, painful TMD, painful combined TMD, and chronic painful TMD diagnoses The final multivariate logistic regression model revealed that headache complaints (odds ratio 2.87; confidence intervals 2.21-3.72), oral parafunctions (2.08; 1.26-3.44), tooth grinding at night (2.05; 1.56-2.70), diurnal jaw clenching (1.96; 1.50-2.55), and parents not living together (1.38; 1.07-1.80) were the factors significantly associated with a TMD (overall) diagnosis. CONCLUSION: About 25% of the adolescents evaluated presented painful TMD, and the majority of these comprised muscular and chronic cases. Some factors, such as reports of headache complaints, oral parafunctions, tooth grinding at night, and parents not living together, were associated with this condition among young Brazilian adolescents. Special attention should be given to these factors among adolescents with TMD.

Association between painful temporomandibular disorders, sleep bruxism and tinnitus.

The present cross-sectional study was designed to investigate the association between sleep bruxism (SB), tinnitus and temporomandibular disorders (TMD). The sample consisted of 261 women (mean age of 37.0 years). The Research Diagnostic Criteria for Temporomandibular Disorders were used to classify TMD and self-reported tinnitus. SB was diagnosed by clinical criteria proposed by the American Academy of Sleep Medicine. The results showed an association between painful TMD and tinnitus (OR=7.3; 95%CI=3.50-15.39; p<0.001). With regard to SB, the association was of lower magnitude (OR=1.9; 95%CI=1.16-3.26; p<0.0163). When the sample was stratified by the presence of SB and painful TMD, only SB showed no association with tinnitus. The presence of painful TMD without SB was significantly associated with tinnitus (OR=6.7; 95%CI=2.64-17.22; p<0.0001). The concomitant presence of painful TMD and SB was associated with a higher degree of tinnitus severity (OR=7.0; 95%CI=3.00-15.89; p<0.0001). It may be concluded that there is an association between SB, painful TMD and self-reported tinnitus; however, no relationship of a causal nature could be established.

Relationship between levels of neuropeptide Substance P in periodontal disease and chronic pain: a literature review.

The aim of the current review was to investigate the relationship between levels of neuropeptide Substance P in periodontal disease and chronic pain. Substance P is a neuropeptide that is directly related with pain. In periodontal disease, it is expressed during the inflammatory process, and is one of the factors responsible for bone resorption. Studies have shown that Substance P levels are highest in the gingival crevicular fluid from sites with active periodontal disease and bone loss. The persistence of these substances could be sufficient to stimulate neurogenic inflammation in susceptible tissues, and cause pain. The scientific literature shows that Substance P expressed during periodontal disease can be a risk factor for patients with systemic inflammatory pathologies, such as chronic arthritis or rheumatoid arthritis. Additional research is needed to confirm the participation of this substance in the origin of some types of chronic pain.