Pain Sensitivity and Autonomic Factors Associated With Development of TMD: The OPPERA Prospective Cohort Study

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• 作者：Joel D. Greenspan ; Gary D. Slade ; Eric Bair ; Ronald Dubner ; Roger B. Fillingim ; Richard Ohrbach ; Charles Knott ; Luda Diatchenko ; Qian Liu ; William Maixner
• 关键词：Quantitative sensory testing ; temporomandibular disorder ; orofacial pain ; heat pain ; pressure pain ; cardiovascular measures
• 刊名：The Journal of Pain
• 出版年：December, 2013
• 年：2013
• 卷：14
• 期：12_supp_S
• 页码：T63-T74.e6
• 全文大小：867 K

文摘

Multiple studies report that individuals with chronic temporomandibular disorder (TMD) have enhanced sensitivity to experimental pain. Additionally, chronic TMD cases show altered autonomic function, including elevated heart rate and reduced heart rate variability. However, causal inferences regarding the association between TMD and pain sensitivity and autonomic function cannot be drawn from these cross-sectional observations. The prospective Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study examines whether measures of pain sensitivity or cardiac autonomic function provide predictive value in TMD incidence. A cohort of 2,737 initially TMD-free participants was followed for up to 5.2聽years, during which time 260 developed first-onset TMD. Fourteen of 39 experimental pain measures produced significant hazard ratios, such that greater pain sensitivity was associated with greater TMD incidence. A single autonomic measure鈥攈eart rate at rest鈥攚as also associated significantly with greater TMD incidence. In contrast, using the same measures of pain sensitivity and cardiac autonomic function, we previously reported a larger group of variables that was significantly associated with chronic TMD in the OPPERA case-control study. Future studies should investigate whether premorbid pain sensitivity or autonomic function more specifically predicts risk of developing chronic TMD than first-onset TMD.

Perspective

Our previous case-control studies showed that associations with both pain sensitivity and cardiac autonomic function are profound in chronic TMD cases. Here we show that some measures of enhanced pain sensitivity contribute modestly to the risk of developing TMD whereas autonomic dysregulation appears to confer little or no risk for TMD incidence.