title: Pressure pain threshold in the detection of masticatory myofascial pain: an algometer-based study.
abstract: OBJECTIVE
  To compare pressure pain threshold (PPT) values for masticatory muscles in patients with signs and symptoms of myofascial pain and in asymptomatic individuals.
  
  
  METHODS
  Fifty women with masticatory myofascial pain comprised the symptomatic group (group 1), while 49 TMD symptom-free women were selected as controls (group 2). The PPT was obtained with the aid of an algometer by applying pressure to the masseter and to the anterior, middle, and posterior temporalis. A 90.8% specificity value was used to determine the appropriate PPT cutoff values for all 4 muscles studied. Receiver operator characteristic (ROC) curve areas and the likelihood ratio (LR) were also evaluated.
  
  
  RESULTS
  The 3-way ANCOVA test (group, muscle, and side) revealed a significantly lower PPT for all muscles in the symptomatic group (P < .001). The lowest overall PPT was found for the masseter muscle, followed by the anterior, middle, and posterior temporalis (P < .001). The 90.8% specificity was obtained with PPT values of 1.5 kgf/cm2 for the masseter, 2.47 kgf/cm2 for the anterior temporalis, 2.75 kgf/cm2 for the middle temporalis, and 2.77 kgf/cm2 for the posterior temporalis. The anterior temporalis had the highest LR. ROC curve areas of 0.84, 0.92, 0.90, and 0.90 were obtained for the masseter, anterior, middle, and posterior temporalis, respectively.
  
  
  CONCLUSIONS
  The masseter and temporalis muscles require different pressures for distinguishing masticatory myofascial pain patients from asymptomatic individuals. Because the highest sensitivity (77%) and LR were found for the anterior temporalis, this muscle was considered to have the most suitable discriminative capacity.
authors.affiliation: Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil. rafsasi@uol.com.br
authors.forename: Rafael dos
authors.initials: R S
authors.lastname: Santos Silva
authors.forename: Paulo César Rodrigues
authors.initials: PC
authors.lastname: Conti
authors.forename: José Roberto Pereira
authors.initials: JR
authors.lastname: Lauris
authors.forename: Renato Oliveira Ferreira
authors.initials: RO
authors.lastname: da Silva
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Pegoraro
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D004192:Discrimination, Psychological; D005157:Facial Pain / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008410:Masticatory Muscles / Q000503:physiopathology*; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000503:physiopathology*