Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. de Leeuw R, Klasser GD, American Academy of Orofacial Pain (2018) Orofacial pain: guidelines for assessment, diagnosis, and management, 6a. Quintessence Publishing Co, New York

    Google Scholar 

  2. Dahan H, Shir Y, Velly A, Allison P (2015) Specific and number of comorbidities are associated with increased levels of temporomandibular pain intensity and duration. J Headache Pain 16:528. https://doi.org/10.1186/s10194-015-0528-2

  3. Bonato LL, Quinelato V, De Felipe Cordeiro PC et al (2017) Association between temporomandibular disorders and pain in other regions of the body. J Oral Rehabil 44:9–15. https://doi.org/10.1111/joor.12457

    Article  Google Scholar 

  4. Velly AM, Look JO, Schiffman E et al (2010) The effect of fibromyalgia and widespread pain on the clinically significant temporomandibular muscle and joint pain disorders - prospective 18-month cohort study. J Pain 11:1155–1164. https://doi.org/10.1016/j.jpain.2010.02.009

    Article  Google Scholar 

  5. Kindler LL, Bennett RM, Jones KD (2011) Central sensitivity syndromes: mounting pathophysiologic evidence to link fibromyalgia with other common chronic pain disorders. Pain Manag Nurs 12:15–24. https://doi.org/10.1016/j.pmn.2009.10.003.Central

    Article  Google Scholar 

  6. Tchivileva IE, Ohrbach R, Fillingim RB et al (2017) Temporal change in headache and its contribution to the risk of developing first-onset temporomandibular disorder in the orofacial pain: prospective evaluation and risk assessment (OPPERA) study. Pain 158:120–129. https://doi.org/10.1097/j.pain.0000000000000737.Temporal

    Article  Google Scholar 

  7. Velly AM, Look JO, Carlson C et al (2011) The effect of catastrophizing and depression on chronic pain - a prospective cohort study of temporomandibular muscle and joint pain disorders. Pain 152:2377–2383. https://doi.org/10.1016/j.pain.2011.07.004

    Article  Google Scholar 

  8. Fillingim RB, Ohrbach R, Greenspan JD et al (2013) Psychological factors associated with development of TMD: the OPPERA prospective cohort study. J Pain 14:T75–T90. https://doi.org/10.1016/j.jpain.2013.06.009

    Article  Google Scholar 

  9. Fillingim RB, Slade GD, Greenspan JD et al (2018) Long-term changes in biopsychosocial characteristics related to temporomandibular disorder. Pain 159:2403–2413. https://doi.org/10.1097/j.pain.0000000000001348

    Article  Google Scholar 

  10. Tchivileva IE, Ohrbach R, Fillingim RB et al (2021) Clinical, psychological, and sensory characteristics associated with headache attributed to temporomandibular disorder in people with chronic myogenous temporomandibular disorder and primary headaches. J Headache Pain 421:1–11. https://doi.org/10.1186/s10194-021-01255-1

  11. Gonçalves DAG, Camparis CM, Speciali JG et al (2011) Temporomandibular disorders are differentially associated with headache diagnoses: a controlled study. Clin J Pain 27:611–615. https://doi.org/10.1097/AJP.0b013e31820e12f5

    Article  Google Scholar 

  12. Chichorro JG, Porreca F, Sessle B (2017) Mechanisms of craniofacial pain. Cephalalgia 37:613–626. https://doi.org/10.1177/0333102417704187

    Article  Google Scholar 

  13. Woolf CJ (2011) Central sensitization: implications for the diagnosis and treatment of pain. Pain 152:1–31. https://doi.org/10.1016/j.pain.2010.09.030.Central

    Article  Google Scholar 

  14. Chaves TC, Dach F, Florencio LL et al (2016) Concomitant migraine and temporomandibular disorders are associated with higher heat pain hyperalgesia and cephalic cutaneous allodynia. Clin J Pain 32:882–888. https://doi.org/10.1097/AJP.0000000000000369

    Article  Google Scholar 

  15. Anderson GC, John MT, Ohrbach R et al (2011) Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain. Pain 152:765–771. https://doi.org/10.1016/j.pain.2010.11.007

    Article  Google Scholar 

  16. Svensson P, Eliav E, Benoliel R (2013) Quantitative sensory testing of pain responsiveness. In: Greene CS, Laskin DM (eds) Treatment of TMDs: Bridging the Gap Between Advances in Research and Clinical Patient Managment. Quintessence, pp 79–89

  17. Granot M, Weissman-Fogel I, Crispel Y et al (2008) Determinants of endogenous analgesia magnitude in a diffuse noxious inhibitory control (DNIC) paradigm: do conditioning stimulus painfulness, gender and personality variables matter? Pain 136:142–149. https://doi.org/10.1016/j.pain.2007.06.029

    Article  Google Scholar 

  18. Yarnitsky D, Bouhassira D, Drewes AM et al (2015) Recommendations on practice of conditioned pain modulation (CPM) testing. Eur J Pain 19:805–806. https://doi.org/10.1002/ejp.605

    Article  Google Scholar 

  19. Mayer TG, Neblett R, Cohen H et al (2012) The development and psychometric validation of the central sensitization inventory. Pain Pract 12:276–285. https://doi.org/10.1111/j.1533-2500.2011.00493.x

    Article  Google Scholar 

  20. Neblett R, Hartzell MM, Mayer TG et al (2017) Establishing clinically relevant severity levels for the central sensitization inventory. Pain Pract 17:166–175. https://doi.org/10.1111/papr.12440

    Article  Google Scholar 

  21. Proença JS, Baad-Hansen L, Braido GVV et al (2021) Lack of correlation between central sensitization inventory and psychophysical measures of central sensitization in individuals with painful temporomandibular disorder. Arch Oral Biol 124:105063. https://doi.org/10.1016/j.archoralbio.2021.105063

    Article  Google Scholar 

  22. Neblett R, Cohen H, Choi Y et al (2013) The central sensitization inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain 14:438–445. https://doi.org/10.1016/j.jpain.2012.11.012

    Article  Google Scholar 

  23. Hilgenberg-Sydney PB, Kowacs PA, Conti PCR (2016) Somatosensory evaluation in dysfunctional syndrome patients. J Oral Rehabil 43:89–95. https://doi.org/10.1111/joor.12344

    Article  Google Scholar 

  24. Associação Brasileira de Empresas de Pesquisa (2015) Critério de classificação econômica Brasil. http://www.abep.org/criterio-brasil1–6. Accessed 10 Dec 2017

  25. Dworkin SFLL (1992) Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 6:301–355

    Google Scholar 

  26. Derogatis LR, Lipman RS, Covi L (1973) SCL-90: An outpatient psychiatric rating scale - preliminary report. Psychopharmacol Bull 9:13–28

    Google Scholar 

  27. Headache Classification Committee of the International Headache Society (2018) The international classification of headache disorders, 3rd edition. Cephalalgia 38:1–211. https://doi.org/10.1177/0333102417738202

  28. Schiffman E, Ohrbach R, List T et al (2012) Diagnostic criteria for headache attributed to temporomandibular disorders. Cephalalgia 32:683–692. https://doi.org/10.1177/0333102412446312

    Article  Google Scholar 

  29. Santos IS, Tavares BF, Munhoz TN et al (2013) Sensibilidade e Especificidade do Patient Health Questionnaire-9 (PHQ-9) Entre Adultos da População Geral. Cad Saude Publica 29:1533–1543. https://doi.org/10.1590/0102-311X00144612

    Article  Google Scholar 

  30. Moreno AL, DeSousa DA, Souza AMFLP et al (2016) Factor structure, reliability, and item parameters of the brazilian-portuguese version of the GAD-7 questionnaire. Temas em Psicologia 24:367–376. https://doi.org/10.9788/TP2016.1-25

    Article  Google Scholar 

  31. Kothari SF, Baad-Hansen L, Oono Y, Svensson P (2015) Somatosensory assessment and conditioned pain modulation in temporomandibular disorders pain patients. Pain 156:2545–2555. https://doi.org/10.1097/j.pain.0000000000000325

    Article  Google Scholar 

  32. Caumo W, Antunes LC, Elkfury JL et al (2017) The central sensitization inventory validated and adapted for a brazilian population: psychometric properties and its relationship with brain-derived neurotrophic factor. J Pain Res 10:2109–2122. https://doi.org/10.2147/JPR.S131479

    Article  Google Scholar 

  33. Smith AB (2018) Feel the power: sample size and meaningful effects. Br J Oral Maxillofac Surg 56:650–652. https://doi.org/10.1016/j.bjoms.2018.07.008

    Article  Google Scholar 

  34. Sales Pinto LM, de Carvalho JJF, Cunha CO et al (2013) Influence of myofascial pain on the pressure pain threshold of masticatory muscles in women with migraine. Clin J Pain 29:362–365. https://doi.org/10.1097/AJP.0b013e31826232f6

    Article  Google Scholar 

  35. Bender SD (2014) Orofacial pain and headache: a review and look at the commonalities. Curr Pain Headache Rep 18(3):400 https://doi.org/10.1007/s11916-013-0400-5

  36. Rolke R, Magerl W, Campbell KA et al (2006) Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain 10:77–88. https://doi.org/10.1016/j.ejpain.2005.02.003

    Article  Google Scholar 

  37. Maier C, Baron R, Tölle TR et al (2010) Quantitative sensory testing in the german research network on neuropathic pain (DFNS): somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes. Pain 150:439–450. https://doi.org/10.1016/j.pain.2010.05.002

    Article  Google Scholar 

  38. La Touche R, Paris-Alemany A, Hidalgo-Pérez A et al (2018) Evidence for central sensitization in patients with temporomandibular disorders: a systematic review and meta-analysis of observational studies. Pain Pract 18:388–409. https://doi.org/10.1111/papr.12604

    Article  Google Scholar 

  39. Costa YM, Morita-Neto O, de Araújo-Júnior ENS et al (2017) Test-retest reliability of quantitative sensory testing for mechanical somatosensory and pain modulation assessment of masticatory structures. J Oral Rehabil 44:197–204. https://doi.org/10.1111/joor.12477

    Article  Google Scholar 

  40. Geber C, Klein T, Azad S et al (2011) Test–retest and interobserver reliability of quantitative sensory testing according to the protocol of the German research network on neuropathic pain (DFNS): a multi-centre study. Pain 152:548–556. https://doi.org/10.1016/j.pain.2010.11.013

    Article  Google Scholar 

  41. Svensson P, Baad-Hansen L, Pigg M et al (2011) Guidelines and recommendations for assessment of somatosensory function in orofacial pain conditions - a taskforce report. J Oral Rehabil 38:366–394. https://doi.org/10.1111/j.1365-2842.2010.02196.x

    Article  Google Scholar 

  42. Spano VE, Imbriglio T V., Ho KC (Jeremy) et al (2021) Increased somatosensory amplification is associated with decreased pressure pain thresholds at both trigeminal and extra‐trigeminal locations in healthy individuals. J Oral Rehabil 48:10–17. https://doi.org/10.1111/joor.13101

  43. Slade GD, Sanders AE, Ohrbach R et al (2014) Pressure pain thresholds fluctuate with, but do not usefully predict, the clinical course of painful temporomandibular disorder. Pain 155:2134–2143. https://doi.org/10.1016/j.pain.2014.08.007

    Article  Google Scholar 

  44. Campi L, Visscher C, Ongaro P et al (2019) Widespread pain and central sensitization in adolescents with signs of painful temporomandibular disorders. J Oral Facial Pain Headache 34(1):83–91. https://doi.org/10.11607/ofph.2288

  45. Hara K, Shinozaki T, Okada-Ogawa A et al (2016) Headache attributed to temporomandibular disorders and masticatory myofascial pain. J Oral Sci 58:195–204. https://doi.org/10.2334/josnusd.15-0491

    Article  Google Scholar 

  46. Exposto FG, Bendixen KH, Ernberg M et al (2021) Assessment of pain modulatory and somatosensory profiles in chronic tension-type headache patients. Pain Med. https://doi.org/10.1093/pm/pnab084

    Article  Google Scholar 

  47. Manfredini D, Winocur E, Ahlberg J et al (2010) Psychosocial impairment in temporomandibular disorders patients. RDC/TMD Axis II Findings From a Multicentre Study. J Dent 38:765–772. https://doi.org/10.1016/j.jdent.2010.06.007

    Article  Google Scholar 

  48. Fritz CO, Morris PE, Richler JJ (2012) Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen 141:2–18. https://doi.org/10.1037/a0024338

    Article  Google Scholar 

Download references

Acknowledgements

The data herein presented is part of the theses from the first author to obtain the Ph.D. in Oral Rehabilitation. We thank Juliana Homem Padilha and Leticia Bueno Campi for their help during data collection, and all the volunteers for their valuable contribution to this study.

Funding

The first author received a scholarship from the São Paulo Research Foundation (FAPESP) [grant number 2018/00411–4].

Author information

Authors and Affiliations

  1. Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil

    Guilherme Vinícius do Vale Braido, Juliana dos Santos Proença, Fernanda Gruninger Mercante, Giovana Fernandes & Daniela Aparecida de Godoi Gonçalves

  2. Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark

    Peter Svensson

  3. Faculty of Odontology, Malmø University, Malmö, Sweden

    Peter Svensson

  4. Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark

    Peter Svensson

Authors
  1. Guilherme Vinícius do Vale Braido
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Svensson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juliana dos Santos Proença
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fernanda Gruninger Mercante
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giovana Fernandes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniela Aparecida de Godoi Gonçalves
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guilherme Vinícius do Vale Braido.

Ethics declarations

Ethical approval

This study was approved by the Research Ethics Committee of FOAR-UNESP (CAAE number: 64396617.5.0000.5416) and followed the Helsinki Declaration.

Consent to participate

The volunteers signed an informed written consent form after receiving information about TMD and the methodology used in this study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vale Braido, G.V.d., Svensson, P., dos Santos Proença, J. et al. Are central sensitization symptoms and psychosocial alterations interfering in the association between painful TMD, migraine, and headache attributed to TMD?. Clin Oral Invest 27, 681–690 (2023). https://doi.org/10.1007/s00784-022-04783-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-022-04783-5

Keywords

Search

Navigation