Sintomas de sensibilização central e alterações psicossociais interferem na associação entre DTM dolorosa, migrânea e cefaleia atribuída à DTM?
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Data
2021-09-27
Autores
Braido, Guilherme Vinícius do Vale [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A disfunção temporomandibular (DTM) é uma das condições mais frequentes de dor na região orofacial e sua fisiopatologia envolve processos de sensibilização periféricos e centrais. A DTM está frequentemente associada com outras comorbidades, como a migrânea (MIG) e a cefaleia atribuída a DTM (c-DTM). A Sensibilização Central (SC) está frequentemente presente nos quadros envolvendo comorbidades. As alterações somatossensoriais da SC podem ser avaliadas por meio dos testes quantitativos sensoriais (Quantitative Sensory Testing- QST). Objetivos: Investigar se as funções somatossensoriais, os sintomas somáticos relacionados à SC e os aspectos psicossociais diferem de acordo com a presença de MIG ou MIG + c-DTM em indivíduos com DTM dolorosa. Material e métodos: Trata-se de um estudo observacional, do tipo transversal, realizado em uma amostra de indivíduos adultos com 20 a 65 anos de idade. A amostra foi estratificada em três grupos: 1) DTM dolorosa; 2) DTM dolorosa + MIG e 3) DTM dolorosa + MIG + c-DTM. A classificação da DTM foi realizada por meio do Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). O Eixo II do RDC/TMD foi utilizado para avaliação das alterações psicossociais relacionadas com a dor. Para a identificação de alterações somatossensoriais foram aplicados os testes de somação temporal da dor (ST), limiar de dor à pressão (algometria - LDP) e modulação condicionada da dor (Conditioned Pain Modulation – CPM). Sintomas de SC foram acessados pelo inventário de SC (Central Sensitization Inventory - CSI). A migrânea foi identificada de acordo com os critérios da Classificação Internacional de Cefaleias– 3ª. Edição (CIC-3). E a c-DTM de acordo com os critérios propostos por Schiffman et al. 2012. Análises descritivas foram realizadas para caracterizar a amostra. Variáveis quantitativas foram avaliadas pelo teste de Kruskall Wallis e as variáveis qualitativas pelo teste de Qui-quadrado e Exato de Fisher. Para análise dos QSTs, CPM e CSI-BP foi aplicado o teste de ANCOVA. Foi considerado o nível de significância de 5%. Resultados: A amostra final foi composta por 92 indivíduos (18 apenas DTM, 38 DTM+MIG e 36 DTM+MIG+c-DTM simultaneamente). Houve diferença significante entre os grupos com relação ao sexo (p=0,028), sendo que as mulheres foram maioria em todos os grupos estudados. Não foram encontradas diferenças entre os grupos para a ST na área trigeminal (Tg) (F=0,661; p=0,520) e na área extratrigeminal (ETg) (F=1,372; p=0,261). Foi encontrada diferença entre os grupos para o teste de LDP na área Tg (F=7,027; p=0,001) e ETg (F=9,641; p<0,001). Com relação ao CPM, não foram encontradas diferenças significativas para as médias absolutas na área Tg (F=0,190, p=0,828) e ETg (F=0,211, p=0,810), e nem para as médias relativas destas mesmas áreas (F=0,009, p=0,471 e F=0,529, p=0,591, respectivamente). Também não houve diferença entre os grupos em relação ao CSI-BP (p=0,099); os sintomas de depressão (p=0,800), e de ansiedade (p=0,918). O grupo DTM + MIG + c-DTM apresentou maior Intensidade de Dor Característica (p=0,001), Pontos de Incapacidade (p=0,045), Graduação Dor Crônica (p=0,007) e maiores escores de somatização (p=0,012), quando comparados com os outros grupos. Conclusão: As medidas do teste de CPM e ST não indicaram diferença entre os grupos, enquanto a hiperalgesia mecânica (LDP) foi mais pronunciada no grupo com DTM, Migrânea e c-DTM. Além disso este grupo apresentou maiores alterações psicossociais (Intensidade de Dor Característica, Pontos de Incapacidade, Graduação de Dor Crônica, Sintomas Físicos não-específicos). A alteração somatossensorial pode explicar apenas parcialmente os mecanismos fisiopatológicos da DTM dolorosa e suas comorbidades, além de apontar para efeitos aditivos, principalmente psicossociais, frente a presença de cefaleias associadas à DTM.
Introduction: Temporomandibular disorder (TMD) is one of the most frequent pain conditions in the orofacial region and its pathophysiology involves peripheral and central sensitization processes. This condition is often associated with other comorbidities, such as migraine (MIG) and headache attributed to TMD (h-TMD). Central Sensitization (CS) is often present in cases involving comorbidities. Somatosensory changes in CS can be assessed through Quantitative Sensory Test (QST). Aim: To investigate whether somatosensory functions, somatic symptoms related to CS and psychosocial aspects differ according to the presence of MIG or MIG + h-TMD in individuals with painful TMD. Material and Methods: This is an observational, cross-sectional study, carried out in a sample of adult individuals aged 20 to 65 years. The sample was stratified into three groups: 1) painful TMD; 2) painful TMD + MIG and 3) painful TMD + MIG + h-TMD. TMD classification was performed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Axis II of the RDC/TMD was used to assess psychosocial changes related to pain. For the identification of CS, the Central Sensitization Inventory (CSI) was used, the temporal summation of pain (TS), pressure pain threshold (algometry - PPT) and conditioned pain modulation tests (CPM). The identification of migraine was performed according to the criteria of the International Classification of Headaches – 3rd edition. The h-TMD was identified according to the criteria proposed by Schiffman et al. 2012. Descriptive analyzes were performed to characterize the sample. Quantitative variables were evaluated using the Kruskall Wallis test and qualitative variables using the Chi-square and Fisher's exact test. To analyze the QSTs and CSI-BP, the ANCOVA test was applied. A significance level of 5% was considered. Results: The final sample consisted of 92 individuals, of which 18 had only TMD, 38 had TMD and MIG and 36 had TMD, MIG and h-TMD simultaneously. A difference was found between the groups regarding gender (p=0.028), with women being the majority in all studied groups. Regarding the QSTs, no associations were found between the groups for the TS in the trigeminal area (Tg) (F=1.425; p=0.248) and in the extratrigeminal area (ETg) (F=0.862; p=0.428). Differences were found between the groups for the PPT test in the Tg area (F=6.148; p=0.003) and in the ETg area (F=7.398; p=0.001). No statistical differences were found for the CPM test in the Tg area (F=1.879, p=0.159) and in the ETg area (F=2.140, p=0.124). There was also no difference in group scores in relation to the CSI-BP. Furthermore, no differences were found between the groups regarding symptoms of depression (p=0.800) and anxiety (p=0.918). The TMD + MIG + h-TMD group had higher Characteristic Pain Intensity (p=0.001), Disability Points (p=0.045), Graduated Chronic Pain Scales (p=0.007) and higher somatization scores (p=0.012), when compared to the other groups. Conclusion: Measurements of the CPM and ST test did not indicate differences between groups, while mechanical hyperalgesia (PPT) was more pronounced in the group with TMD, Migraine and h-TMD. Furthermore, this group showed greater psychosocial alterations (CPI, DP, GCPS, NSPS). The somatosensory alteration can only partially explain the pathophysiological mechanisms of painful TMD and its 21 comorbidities, in addition to pointing to additive effects, mainly psychosocial, in face of the presence of headaches associated with TMD.
Introduction: Temporomandibular disorder (TMD) is one of the most frequent pain conditions in the orofacial region and its pathophysiology involves peripheral and central sensitization processes. This condition is often associated with other comorbidities, such as migraine (MIG) and headache attributed to TMD (h-TMD). Central Sensitization (CS) is often present in cases involving comorbidities. Somatosensory changes in CS can be assessed through Quantitative Sensory Test (QST). Aim: To investigate whether somatosensory functions, somatic symptoms related to CS and psychosocial aspects differ according to the presence of MIG or MIG + h-TMD in individuals with painful TMD. Material and Methods: This is an observational, cross-sectional study, carried out in a sample of adult individuals aged 20 to 65 years. The sample was stratified into three groups: 1) painful TMD; 2) painful TMD + MIG and 3) painful TMD + MIG + h-TMD. TMD classification was performed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Axis II of the RDC/TMD was used to assess psychosocial changes related to pain. For the identification of CS, the Central Sensitization Inventory (CSI) was used, the temporal summation of pain (TS), pressure pain threshold (algometry - PPT) and conditioned pain modulation tests (CPM). The identification of migraine was performed according to the criteria of the International Classification of Headaches – 3rd edition. The h-TMD was identified according to the criteria proposed by Schiffman et al. 2012. Descriptive analyzes were performed to characterize the sample. Quantitative variables were evaluated using the Kruskall Wallis test and qualitative variables using the Chi-square and Fisher's exact test. To analyze the QSTs and CSI-BP, the ANCOVA test was applied. A significance level of 5% was considered. Results: The final sample consisted of 92 individuals, of which 18 had only TMD, 38 had TMD and MIG and 36 had TMD, MIG and h-TMD simultaneously. A difference was found between the groups regarding gender (p=0.028), with women being the majority in all studied groups. Regarding the QSTs, no associations were found between the groups for the TS in the trigeminal area (Tg) (F=1.425; p=0.248) and in the extratrigeminal area (ETg) (F=0.862; p=0.428). Differences were found between the groups for the PPT test in the Tg area (F=6.148; p=0.003) and in the ETg area (F=7.398; p=0.001). No statistical differences were found for the CPM test in the Tg area (F=1.879, p=0.159) and in the ETg area (F=2.140, p=0.124). There was also no difference in group scores in relation to the CSI-BP. Furthermore, no differences were found between the groups regarding symptoms of depression (p=0.800) and anxiety (p=0.918). The TMD + MIG + h-TMD group had higher Characteristic Pain Intensity (p=0.001), Disability Points (p=0.045), Graduated Chronic Pain Scales (p=0.007) and higher somatization scores (p=0.012), when compared to the other groups. Conclusion: Measurements of the CPM and ST test did not indicate differences between groups, while mechanical hyperalgesia (PPT) was more pronounced in the group with TMD, Migraine and h-TMD. Furthermore, this group showed greater psychosocial alterations (CPI, DP, GCPS, NSPS). The somatosensory alteration can only partially explain the pathophysiological mechanisms of painful TMD and its 21 comorbidities, in addition to pointing to additive effects, mainly psychosocial, in face of the presence of headaches associated with TMD.
Descrição
Palavras-chave
Síndrome da Disfunção da Articulação Temporomandibular, Sensibilização do Sistema Nervoso Central, Cefaleia, Temporomandibular Joint Dysfunction Syndrome, Sensitization of the Central Nervous System, Headache