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Somatosensory abnormalities in Chinese patients with painful temporomandibular disorders.

Yang G, Baad-Hansen L, Wang K, Fu K, Xie QF, Svensson P - J Headache Pain (2016)

Bottom Line: The most frequent abnormalities were somatosensory gain to pinprick (35.0 %) and pressure (35.0 %) stimuli, somatosensory loss to pinprick (25.0 %), cold (22.5 %), and heat (15.0 %) nociceptive stimuli.The most frequent loss/gain score was L0G2 (no somatosensory loss combined with a gain of mechanical somatosensory function) for both the facial (40.0 %) and hand (27.5 %) regions.The individual variations in somatosensory abnormalities indicate a possible need for development of individualized TMD pain management.

View Article: PubMed Central - PubMed

Affiliation: Department of Prosthodontics and Center for Oral Functional Diagnosis, Treatment and Research, Peking University School and Hospital of Stomatology, Zhongguancun Nandajie 22, 100081, Beijing, China.

ABSTRACT

Background: The somatosensory phenotype of Chinese temporomandibular disorders (TMD) patients is not sufficiently studied with the use of contemporary techniques and guidelines.

Methods: A standardized quantitative sensory testing (QST) battery consisting of 13 parameters with a stringent statistical protocol developed by the German Research Network on Neuropathic Pain was performed over the most painful and corresponding contralateral sites as well as the right hand of 40 Chinese patients with TMD and pain classified according to the Diagnostic Criteria for TMD (DC/TMD). The same QST protocol was performed bilaterally over the infraorbital, mental, and hand regions of 70 age- and gender-stratified healthy Chinese controls. Z-scores and loss/gain scores were computed for each TMD patient.

Results: For patients, 82.5 % had somatosensory abnormalities in the painful facial region, while 60.0 % had abnormalities confined to the right hand. The most frequent abnormalities were somatosensory gain to pinprick (35.0 %) and pressure (35.0 %) stimuli, somatosensory loss to pinprick (25.0 %), cold (22.5 %), and heat (15.0 %) nociceptive stimuli. The most frequent loss/gain score was L0G2 (no somatosensory loss combined with a gain of mechanical somatosensory function) for both the facial (40.0 %) and hand (27.5 %) regions. Involving side-to-side differences in the evaluation increased the diagnostic sensitivity by 2.5-25.0 % across different parameters.

Conclusions: Somatosensory abnormalities were commonly detected in Chinese TMD pain patients both within and outside the primary painful region, strongly indicating disturbances in the central processing of somatosensory stimuli. The individual variations in somatosensory abnormalities indicate a possible need for development of individualized TMD pain management.

No MeSH data available.


Related in: MedlinePlus

The battery of quantitative sensory testing (QST). The standardized QST protocol consists of 7 tests (A-G) to assess the 13 parameters. a Thermal testing comprises detection and pain thresholds for cold, warm and hot stimuli (C and A-delta fiber mediated): cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT) and heat pain threshold (HPT) with inter-stimulus interval of 20 s; number of paradoxical heat sensations (PHS) during the thermal sensory limen procedure (TSL) for alternating warm and cold stimuli. b Mechanical detection threshold (MDT) test using von Frey-filaments (A-beta fiber mediated) with inter-stimulus interval of ~10 s. c Mechanical pain threshold (MPT) for pinprick stimuli (mediated by A-delta fiber) assessing hyper- or hypoalgesia with inter-stimulus interval of ~10 s. d Stimulus–response-functions: mechanical pain sensitivity (MPS) assess A-delta fiber mediated sensitivity to sharp stimuli (pinprick) and dynamic mechanical allodynia (DMA) assess A-beta fiber mediated pain sensitivity to stroking light touch (CW = cotton wisp; QT = cotton wool tip; BR = brush), with inter-stimulus interval of ~10 s. e Wind-up ratio (WUR) compares the numerical ratings within three trains of a single pinprick stimulus (a) with a series (b) of 10 repetitive pinprick stimuli to calculate WUR as the ratio: b/a, with ~10 s intervals between single and series stimulus. f Vibration detection threshold (VDT) tests for A-beta fiber function using a Rydel–Seiffer 64 Hz tuning fork with intervals of ~10 s. g Pressure pain threshold (PPT) is the only test for deep pain sensitivity, most probably mediated by muscle C- and A-delta fibers, with inter-stimulus interval of 60 s. ISI = Inter-Stimulus-Interval, In = Instruction
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Fig1: The battery of quantitative sensory testing (QST). The standardized QST protocol consists of 7 tests (A-G) to assess the 13 parameters. a Thermal testing comprises detection and pain thresholds for cold, warm and hot stimuli (C and A-delta fiber mediated): cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT) and heat pain threshold (HPT) with inter-stimulus interval of 20 s; number of paradoxical heat sensations (PHS) during the thermal sensory limen procedure (TSL) for alternating warm and cold stimuli. b Mechanical detection threshold (MDT) test using von Frey-filaments (A-beta fiber mediated) with inter-stimulus interval of ~10 s. c Mechanical pain threshold (MPT) for pinprick stimuli (mediated by A-delta fiber) assessing hyper- or hypoalgesia with inter-stimulus interval of ~10 s. d Stimulus–response-functions: mechanical pain sensitivity (MPS) assess A-delta fiber mediated sensitivity to sharp stimuli (pinprick) and dynamic mechanical allodynia (DMA) assess A-beta fiber mediated pain sensitivity to stroking light touch (CW = cotton wisp; QT = cotton wool tip; BR = brush), with inter-stimulus interval of ~10 s. e Wind-up ratio (WUR) compares the numerical ratings within three trains of a single pinprick stimulus (a) with a series (b) of 10 repetitive pinprick stimuli to calculate WUR as the ratio: b/a, with ~10 s intervals between single and series stimulus. f Vibration detection threshold (VDT) tests for A-beta fiber function using a Rydel–Seiffer 64 Hz tuning fork with intervals of ~10 s. g Pressure pain threshold (PPT) is the only test for deep pain sensitivity, most probably mediated by muscle C- and A-delta fibers, with inter-stimulus interval of 60 s. ISI = Inter-Stimulus-Interval, In = Instruction

Mentions: The standardized QST battery developed by DFNS and modified for the trigeminal region was used in this study [8–12, 15]. All QST measures were performed in a quiet room at 21–23 °C. The QST protocol consists of 7 tests measuring a total of 13 thermal and mechanical parameters: A. Thermal testing comprises detection and pain thresholds for cold, warm, and hot stimuli (mediated by C- and A-delta fibers): cold detection threshold (CDT); warm detection threshold (WDT); number of paradoxical heat sensations (PHS) during the thermal sensory limen procedure (TSL) for alternating warm and cold stimuli; cold pain threshold (CPT); and heat pain threshold (HPT). B. Mechanical detection threshold (MDT) tests for A-beta fiber function using von Frey filaments. C. Mechanical pain threshold (MPT) tests for A-delta fiber-mediated hyper- or hypo-algesia to pinprick stimuli. D. Stimulus–response-functions: mechanical pain sensitivity (MPS) to pinprick stimuli and dynamic mechanical allodynia (DMA) assessment of A-delta fiber-mediated sensitivity to sharp stimuli (pinprick), as well as A-beta fiber-mediated pain sensitivity to stroking light touch (CW, cotton wisp; QT, cotton-wool tip; BR, brush). E. Wind-up ratio (WUR) compares the numerical ratings within three trials of a single pinprick stimulus (a) with a series (b) of 10 repetitive pinprick stimuli to calculate WUR as the ratio b/a. F. Vibration detection threshold (VDT) tests for A-beta fiber function using a Rydel–Seiffer 64-Hz tuning fork. G. Pressure pain threshold (PPT) is the only test for deep-pain sensitivity, most probably mediated by muscle C- and A-delta fibers [13, 15]. The investigator in this study was carefully instructed and trained according to the latest guidelines [9]. The full QST protocol took approximately 30 min per test site (Fig. 1). All the tests were performed following the sequence suggested by DFNS.Fig. 1


Somatosensory abnormalities in Chinese patients with painful temporomandibular disorders.

Yang G, Baad-Hansen L, Wang K, Fu K, Xie QF, Svensson P - J Headache Pain (2016)

The battery of quantitative sensory testing (QST). The standardized QST protocol consists of 7 tests (A-G) to assess the 13 parameters. a Thermal testing comprises detection and pain thresholds for cold, warm and hot stimuli (C and A-delta fiber mediated): cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT) and heat pain threshold (HPT) with inter-stimulus interval of 20 s; number of paradoxical heat sensations (PHS) during the thermal sensory limen procedure (TSL) for alternating warm and cold stimuli. b Mechanical detection threshold (MDT) test using von Frey-filaments (A-beta fiber mediated) with inter-stimulus interval of ~10 s. c Mechanical pain threshold (MPT) for pinprick stimuli (mediated by A-delta fiber) assessing hyper- or hypoalgesia with inter-stimulus interval of ~10 s. d Stimulus–response-functions: mechanical pain sensitivity (MPS) assess A-delta fiber mediated sensitivity to sharp stimuli (pinprick) and dynamic mechanical allodynia (DMA) assess A-beta fiber mediated pain sensitivity to stroking light touch (CW = cotton wisp; QT = cotton wool tip; BR = brush), with inter-stimulus interval of ~10 s. e Wind-up ratio (WUR) compares the numerical ratings within three trains of a single pinprick stimulus (a) with a series (b) of 10 repetitive pinprick stimuli to calculate WUR as the ratio: b/a, with ~10 s intervals between single and series stimulus. f Vibration detection threshold (VDT) tests for A-beta fiber function using a Rydel–Seiffer 64 Hz tuning fork with intervals of ~10 s. g Pressure pain threshold (PPT) is the only test for deep pain sensitivity, most probably mediated by muscle C- and A-delta fibers, with inter-stimulus interval of 60 s. ISI = Inter-Stimulus-Interval, In = Instruction
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4829566&req=5

Fig1: The battery of quantitative sensory testing (QST). The standardized QST protocol consists of 7 tests (A-G) to assess the 13 parameters. a Thermal testing comprises detection and pain thresholds for cold, warm and hot stimuli (C and A-delta fiber mediated): cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT) and heat pain threshold (HPT) with inter-stimulus interval of 20 s; number of paradoxical heat sensations (PHS) during the thermal sensory limen procedure (TSL) for alternating warm and cold stimuli. b Mechanical detection threshold (MDT) test using von Frey-filaments (A-beta fiber mediated) with inter-stimulus interval of ~10 s. c Mechanical pain threshold (MPT) for pinprick stimuli (mediated by A-delta fiber) assessing hyper- or hypoalgesia with inter-stimulus interval of ~10 s. d Stimulus–response-functions: mechanical pain sensitivity (MPS) assess A-delta fiber mediated sensitivity to sharp stimuli (pinprick) and dynamic mechanical allodynia (DMA) assess A-beta fiber mediated pain sensitivity to stroking light touch (CW = cotton wisp; QT = cotton wool tip; BR = brush), with inter-stimulus interval of ~10 s. e Wind-up ratio (WUR) compares the numerical ratings within three trains of a single pinprick stimulus (a) with a series (b) of 10 repetitive pinprick stimuli to calculate WUR as the ratio: b/a, with ~10 s intervals between single and series stimulus. f Vibration detection threshold (VDT) tests for A-beta fiber function using a Rydel–Seiffer 64 Hz tuning fork with intervals of ~10 s. g Pressure pain threshold (PPT) is the only test for deep pain sensitivity, most probably mediated by muscle C- and A-delta fibers, with inter-stimulus interval of 60 s. ISI = Inter-Stimulus-Interval, In = Instruction
Mentions: The standardized QST battery developed by DFNS and modified for the trigeminal region was used in this study [8–12, 15]. All QST measures were performed in a quiet room at 21–23 °C. The QST protocol consists of 7 tests measuring a total of 13 thermal and mechanical parameters: A. Thermal testing comprises detection and pain thresholds for cold, warm, and hot stimuli (mediated by C- and A-delta fibers): cold detection threshold (CDT); warm detection threshold (WDT); number of paradoxical heat sensations (PHS) during the thermal sensory limen procedure (TSL) for alternating warm and cold stimuli; cold pain threshold (CPT); and heat pain threshold (HPT). B. Mechanical detection threshold (MDT) tests for A-beta fiber function using von Frey filaments. C. Mechanical pain threshold (MPT) tests for A-delta fiber-mediated hyper- or hypo-algesia to pinprick stimuli. D. Stimulus–response-functions: mechanical pain sensitivity (MPS) to pinprick stimuli and dynamic mechanical allodynia (DMA) assessment of A-delta fiber-mediated sensitivity to sharp stimuli (pinprick), as well as A-beta fiber-mediated pain sensitivity to stroking light touch (CW, cotton wisp; QT, cotton-wool tip; BR, brush). E. Wind-up ratio (WUR) compares the numerical ratings within three trials of a single pinprick stimulus (a) with a series (b) of 10 repetitive pinprick stimuli to calculate WUR as the ratio b/a. F. Vibration detection threshold (VDT) tests for A-beta fiber function using a Rydel–Seiffer 64-Hz tuning fork. G. Pressure pain threshold (PPT) is the only test for deep-pain sensitivity, most probably mediated by muscle C- and A-delta fibers [13, 15]. The investigator in this study was carefully instructed and trained according to the latest guidelines [9]. The full QST protocol took approximately 30 min per test site (Fig. 1). All the tests were performed following the sequence suggested by DFNS.Fig. 1

Bottom Line: The most frequent abnormalities were somatosensory gain to pinprick (35.0 %) and pressure (35.0 %) stimuli, somatosensory loss to pinprick (25.0 %), cold (22.5 %), and heat (15.0 %) nociceptive stimuli.The most frequent loss/gain score was L0G2 (no somatosensory loss combined with a gain of mechanical somatosensory function) for both the facial (40.0 %) and hand (27.5 %) regions.The individual variations in somatosensory abnormalities indicate a possible need for development of individualized TMD pain management.

View Article: PubMed Central - PubMed

Affiliation: Department of Prosthodontics and Center for Oral Functional Diagnosis, Treatment and Research, Peking University School and Hospital of Stomatology, Zhongguancun Nandajie 22, 100081, Beijing, China.

ABSTRACT

Background: The somatosensory phenotype of Chinese temporomandibular disorders (TMD) patients is not sufficiently studied with the use of contemporary techniques and guidelines.

Methods: A standardized quantitative sensory testing (QST) battery consisting of 13 parameters with a stringent statistical protocol developed by the German Research Network on Neuropathic Pain was performed over the most painful and corresponding contralateral sites as well as the right hand of 40 Chinese patients with TMD and pain classified according to the Diagnostic Criteria for TMD (DC/TMD). The same QST protocol was performed bilaterally over the infraorbital, mental, and hand regions of 70 age- and gender-stratified healthy Chinese controls. Z-scores and loss/gain scores were computed for each TMD patient.

Results: For patients, 82.5 % had somatosensory abnormalities in the painful facial region, while 60.0 % had abnormalities confined to the right hand. The most frequent abnormalities were somatosensory gain to pinprick (35.0 %) and pressure (35.0 %) stimuli, somatosensory loss to pinprick (25.0 %), cold (22.5 %), and heat (15.0 %) nociceptive stimuli. The most frequent loss/gain score was L0G2 (no somatosensory loss combined with a gain of mechanical somatosensory function) for both the facial (40.0 %) and hand (27.5 %) regions. Involving side-to-side differences in the evaluation increased the diagnostic sensitivity by 2.5-25.0 % across different parameters.

Conclusions: Somatosensory abnormalities were commonly detected in Chinese TMD pain patients both within and outside the primary painful region, strongly indicating disturbances in the central processing of somatosensory stimuli. The individual variations in somatosensory abnormalities indicate a possible need for development of individualized TMD pain management.

No MeSH data available.


Related in: MedlinePlus