Sinais e sintomas de sensibilização central avaliados por diferentes métodos em pacientes com disfunção temporomandibular dolorosa
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2020-09-16
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Universidade Estadual Paulista (Unesp)
Resumo
A fisiopatologia da disfunção temporomandibular (DTM) pode envolver mecanismos de sensibilização central (SC). Dentre os métodos para sua avaliação estão os testes quantitativos sensoriais (Quantitative Sensory Testing – QST) e o teste de modulação condicionada da dor (Conditioned Pain Modulation – CPM). O inventário de sensibilização central (Central Sensitization Inventory – CSI) tem sido sugerido como um meio de investigar sintomas relacionados à SC e tem sido correlacionado a questionários que avaliam fatores psicossociais. Objetivos: Avaliar a presença de sintomas relacionados à SC em indivíduos com DTM dolorosa através do CSI, bem como correlacionar os resultados deste com os obtidos nos testes psicofísicos e questionários para avaliação psicossocial. Ainda, avaliar as características clínicas da dor primária crônica de acordo com a presença de DTM dolorosa e comorbidades. Material e métodos: Neste estudo observacional transversal, a DTM foi classificada pelo Research Diagnostic Criteria for Temporomandibular Disorders eixo I (RDC/TMD). Os testes wind-up ratio, limiar de dor à pressão (LDP) e CPM foram os testes psicofísicos realizados. O CSI foi aplicado para avaliar sintomas relacionados à SC e o sofrimento emocional associado à dor. Foram também avaliadas as características sociodemográficas, fatores psicossociais, comorbidades, qualidade do sono e dor espalhada pelo corpo. A amostra foi composta por 146 adultos, estratificados em dois grupos: 1) Controle (n=31); 2) DTM dolorosa (n=115). Em relação às características da dor primária crônica, a amostra foi de 129 participantes, divididos em três grupos: 1) Controle (n=25); DTM dolorosa (n=35); DTM dolorosa+comorbidades (n=69). As variáveis qualitativas foram testadas pelos testes de Qui-quadrado e Exato de Fisher. As variáveis quantitativas foram analisadas pelo teste t de Student e de Mann Whitney U. Por meio de uma curva ROC (Receiver Operating Characteristic) foi identificado um ponto de corte para o CSI, tendo como parâmetro a graduação da gravidade da dor crônica (RDC/TMD eixo II). A correlação entre o CSI e os testes psicofísicos e questionários psicossociais foi avaliada pelos coeficientes de correlação de Pearson e de Spearman. As características da dor primária crônica foram avaliadas pela análise de variância a um fator, teste de Kruskal-Wallis e de Qui-quadrado (α=5%). Resultados: O grupo DTM dolorosa mostrou maior escore do CSI (p<0,001) e menor LDP (p≤0,020) comparado aos controles. O valor 28 mostrou-se o ponto de corte mais adequado para distinguir indivíduos com DTM dolorosa crônica de participantes livres de dor crônica. O escore do CSI foi significativamente e positivamente correlacionado somente aos questionários psicossociais (p<0,001). Indivíduos com DTM dolorosa e comorbidades apresentaram menor LDP (p≤0,015) e maior número de áreas doloridas no corpo (p=0,001) comparados aos controles. Eles também mostraram mais sintomas de depressão (p=0,018), de ansiedade (p=0,040) e maior escore no CSI (p<0,001) que os grupos controle e DTM dolorosa. Conclusão: O escore do CSI foi maior para os participantes com DTM dolorosa. Ele não foi correlacionado aos resultados dos testes psicofísicos, mas mostrou uma correlação significativa com os questionários para avaliação psicossocial. Finalmente, participantes com DTM dolorosa e comorbidades apresentaram mais características clínicas da dor primária crônica.
Temporomandibular disorder (TMD) pathophysiology may involve central sensitization (CS) mechanisms. The methods to measure CS are the Quantitative Sensory Testing (QST) and the Conditioned Pain Modulation (CPM) test. Central Sensitization Inventory (CSI) has been suggested as a way to assess CS-related symptoms and has been correlated with questionnaires that evaluate psychosocial factors. Aims: To evaluate the presence of CS-related symptoms in individuals with painful TMD using the CSI, and to correlate its results with those obtained from the psychophysical tests and the questionnaires for psychosocial evaluation. Moreover, to assess the features of chronic primary pain according to the presence of painful TMD and comorbidities. Methods: In this cross-sectional study, TMD was classified using the Research Diagnostic Criteria for Temporomandibular Disorders Axis I (RDC/TMD). Wind-up ratio, pressure pain threshold (PPT), and CPM were used as psychophysical tests. CSI was applied to evaluate CS-related symptoms and emotional distress. We also assessed sociodemographic characteristics, psychosocial factors, comorbidities, sleep quality, and widespread pain. The sample was composed by 146 adults that were stratified into two groups: 1) Control (n=31); 2) Painful TMD (n=115). Regarding the features of chronic primary pain, the sample was composed by 129 individuals, divided into three groups: 1) Control (n=25); Painful TMD (n=35); Painful TMD+comorbidities (n=69). Qualitative variables were compared using Chi-Square test and Fisher’s Exact test. Quantitative variables were analyzed using Student’s t-test and Mann Whitney U test. A ROC (Receiver Operating Characteristic) curve was built to identify a CSI cutoff point using the graded chronic pain severity (RDC/TMD Axis II). We analyzed the correlation between the CSI and the psychophysical tests and psychosocial questionnaires using Pearson´s and Spearman´s correlation coefficients. The features of chronic primary pain were assessed using the one-way analysis of variance, Kruskal-Wallis test, and Chi-square test (α=5%). Results: The painful TMD group presented higher scores of the CSI (p<0.001) and lower PPT values (p≤0.020) compared to the controls. The value of 28 was a good cut-off point for discriminating individuals with chronic painful TMD from participants free of chronic pain. The CSI score was significantly and positively correlated only with psychosocial questionnaires (p<0.001). Individuals with painful TMD and comorbidities presented lower PPT (p≤0.015) and a higher number of painful areas in the body (p=0.001) compared to the controls. They also showed more depressive symptoms (p=0.018), anxiety symptoms (p=0.040), and a higher score of the CSI (p<0.001) compared to the control and painful TMD groups. Conclusion: The CSI score was higher for participants with painful TMD. The inventory was not correlated with the results from psychophysical tests but showed a significant correlation with questionnaires for psychosocial evaluation. Finally, participants with painful TMD and comorbidities presented more clinical features of chronic primary pain.
Temporomandibular disorder (TMD) pathophysiology may involve central sensitization (CS) mechanisms. The methods to measure CS are the Quantitative Sensory Testing (QST) and the Conditioned Pain Modulation (CPM) test. Central Sensitization Inventory (CSI) has been suggested as a way to assess CS-related symptoms and has been correlated with questionnaires that evaluate psychosocial factors. Aims: To evaluate the presence of CS-related symptoms in individuals with painful TMD using the CSI, and to correlate its results with those obtained from the psychophysical tests and the questionnaires for psychosocial evaluation. Moreover, to assess the features of chronic primary pain according to the presence of painful TMD and comorbidities. Methods: In this cross-sectional study, TMD was classified using the Research Diagnostic Criteria for Temporomandibular Disorders Axis I (RDC/TMD). Wind-up ratio, pressure pain threshold (PPT), and CPM were used as psychophysical tests. CSI was applied to evaluate CS-related symptoms and emotional distress. We also assessed sociodemographic characteristics, psychosocial factors, comorbidities, sleep quality, and widespread pain. The sample was composed by 146 adults that were stratified into two groups: 1) Control (n=31); 2) Painful TMD (n=115). Regarding the features of chronic primary pain, the sample was composed by 129 individuals, divided into three groups: 1) Control (n=25); Painful TMD (n=35); Painful TMD+comorbidities (n=69). Qualitative variables were compared using Chi-Square test and Fisher’s Exact test. Quantitative variables were analyzed using Student’s t-test and Mann Whitney U test. A ROC (Receiver Operating Characteristic) curve was built to identify a CSI cutoff point using the graded chronic pain severity (RDC/TMD Axis II). We analyzed the correlation between the CSI and the psychophysical tests and psychosocial questionnaires using Pearson´s and Spearman´s correlation coefficients. The features of chronic primary pain were assessed using the one-way analysis of variance, Kruskal-Wallis test, and Chi-square test (α=5%). Results: The painful TMD group presented higher scores of the CSI (p<0.001) and lower PPT values (p≤0.020) compared to the controls. The value of 28 was a good cut-off point for discriminating individuals with chronic painful TMD from participants free of chronic pain. The CSI score was significantly and positively correlated only with psychosocial questionnaires (p<0.001). Individuals with painful TMD and comorbidities presented lower PPT (p≤0.015) and a higher number of painful areas in the body (p=0.001) compared to the controls. They also showed more depressive symptoms (p=0.018), anxiety symptoms (p=0.040), and a higher score of the CSI (p<0.001) compared to the control and painful TMD groups. Conclusion: The CSI score was higher for participants with painful TMD. The inventory was not correlated with the results from psychophysical tests but showed a significant correlation with questionnaires for psychosocial evaluation. Finally, participants with painful TMD and comorbidities presented more clinical features of chronic primary pain.
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Palavras-chave
Odontologia, Síndrome da disfunção da articulação temporomandibular, Sistema nervoso central, Dentistry, Temporomandibular joint dysfunction syndrome, Central nervous system