Journal
PAIN
Volume 155, Issue 10, Pages 2134-2143Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1016/j.pain.2014.08.007
Keywords
Temporomandibular disorder; Epidemiology; Pressure pain thresholds; Algometry; Longitudinal studies
Categories
Funding
- National Institutes of Health
- National Institutes of Dental and Cranial Research [U01DE17018, R03-DE022595]
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Central sensitization elicits pain hypersensitivity and is thought to be causally implicated in painful temporomandibular disorder (TMD). This causal inference is based on cross-sectional evidence that people with TMD have greater sensitivity than controls to noxious stimuli. We tested this inference in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) prospective cohort study of 3258 adults with no lifetime history of TMD when enrolled (visit 1). During 5 years of follow-up, 1 group labeled ''persistent TMD cases'' (n = 72) developed first-onset TMD by visit 2 that persisted >= 6 months until visit 3. Another group labeled ''transient TMD cases'' (n = 75) developed first-onset TMD at visit 2, which resolved by visit 3. Randomly sampled ''controls'' (n = 126) remained TMD-free throughout all 3 visits. At each visit, pressure pain thresholds (PPTs) were measured by algometry at 10 cranial and bodily sites. In persistent TMD case patients, mean PPTs reduced 43 kPa (P < .0001) between visits 1 and 2 and thereafter did not change significantly. In transient TMD case patients, mean PPTs reduced 41 kPa (P < .001) between visits 1 and 2, and then increased 20 kPa (P < .001) by visit 3. These patterns were similar after excluding cranial sites symptomatic for TMD. Importantly, visit 1 PPTs had no clinically useful prognostic value in predicting first-onset TMD (odds ratio [OR] = 1.07, P = .15). Among first-onset case patients, visit 2 PPTs were modest predictors of persistent TMD (OR = 1.36, P = .002). In this longitudinal study, PPTs reduced when TMD developed then rebounded when TMD resolved. However, premorbid PPTs poorly predicted TMD incidence, countering the hypothesis that PPTs signify mechanisms causing first-onset TMD. (C) 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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