title: Pain sensitivity risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case control study.
abstract: Many studies report that people with temporomandibular disorders (TMD) are more sensitive to experimental pain stimuli than TMD-free controls. Such differences in sensitivity are observed in remote body sites as well as in the orofacial region, suggesting a generalized upregulation of nociceptive processing in TMD cases. This large case-control study of 185 adults with TMD and 1,633 TMD-free controls measured sensitivity to painful pressure, mechanical cutaneous, and heat stimuli, using multiple testing protocols. Based on an unprecedented 36 experimental pain measures, 28 showed statistically significantly greater pain sensitivity in TMD cases than controls. The largest effects were seen for pressure pain thresholds at multiple body sites and cutaneous mechanical pain threshold. The other mechanical cutaneous pain measures and many of the heat pain measures showed significant differences, but with lesser effect sizes. Principal component analysis (PCA) of the pain measures derived from 1,633 controls identified 5 components labeled: 1) heat pain ratings; 2) heat pain aftersensations and tolerance; 3) mechanical cutaneous pain sensitivity; 4) pressure pain thresholds; and 5) heat pain temporal summation. These results demonstrate that compared to TMD-free controls, chronic TMD cases are more sensitive to many experimental noxious stimuli at extracranial body sites, and provide for the first time the ability to directly compare the case-control effect sizes of a wide range of pain sensitivity measures.
  
  
  CONCLUSIONS
  This article describes experimental pain sensitivity differences between a large sample of people with chronic TMD and non-TMD controls, using multiple stimulus modalities and measures. Variability in the magnitude and consistency of case-control differences highlight the need to consider multiple testing measures to adequately assess pain processing alterations in chronic pain conditions.
authors.affiliation: Department of Neural and Pain Sciences, and Brotman Facial Pain Center, University of Maryland Dental School, Baltimore, Maryland 21201, USA. jgreenspan@umaryland.edu
authors.forename: Joel D
authors.initials: JD
authors.lastname: Greenspan
authors.forename: Gary D
authors.initials: GD
authors.lastname: Slade
authors.forename: Eric
authors.initials: E
authors.lastname: Bair
authors.forename: Ronald
authors.initials: R
authors.lastname: Dubner
authors.forename: Roger B
authors.initials: RB
authors.lastname: Fillingim
authors.forename: Richard
authors.initials: R
authors.lastname: Ohrbach
authors.forename: Charlie
authors.initials: C
authors.lastname: Knott
authors.forename: Flora
authors.initials: F
authors.lastname: Mulkey
authors.forename: Rebecca
authors.initials: R
authors.lastname: Rothwell
authors.forename: William
authors.initials: W
authors.lastname: Maixner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D059350:Chronic Pain / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000379:methods; D010147:Pain Measurement / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D055815:Young Adult
references.citation: J Pain. 2009 May;10(5):447-85
references.pmid: 19411059
references.citation: Pain. 2006 Aug;123(3):226-230
references.pmid: 16777329
references.citation: Clin J Pain. 2004 Jul-Aug;20(4):227-39
references.pmid: 15218407
references.citation: Pain. 2008 Aug 31;138(2):286-291
references.pmid: 18243556
references.citation: J Pain. 2011 Nov;12(11 Suppl):T4-11.e1-2
references.pmid: 22074751
references.citation: Pain. 1994 Oct;59(1):45-53
references.pmid: 7854801
references.citation: Pain. 2003 Jan;101(1-2):167-74
references.pmid: 12507711
references.citation: J Orofac Pain. 2009 Winter;23(1):54-64
references.pmid: 19264036
references.citation: Pain. 2005 Jan;113(1-2):20-6
references.pmid: 15621360
references.citation: Pain. 2002 Apr;96(3):227-237
references.pmid: 11972994
references.citation: J Orofac Pain. 2004 Winter;18(1):41-55
references.pmid: 15029872
references.citation: Pain. 1994 Sep;58(3):403-411
references.pmid: 7838590
references.citation: Pain. 2003 Apr;102(3):221-226
references.pmid: 12670662
references.citation: Pain. 1998 Mar;75(1):121-127
references.pmid: 9539681
references.citation: Pain. 2001 Jun;92(3):399-409
references.pmid: 11376913
references.citation: Neurosci Lett. 1994 Oct 10;180(1):46-50
references.pmid: 7877759
references.citation: Pain. 1998 May;76(1-2):71-81
references.pmid: 9696460
references.citation: Psychosom Med. 1997 Sep-Oct;59(5):503-11
references.pmid: 9316183
references.citation: Am J Psychol. 1962 Sep;75:485-91
references.pmid: 13881416
references.citation: J Pain. 2007 Jan;8(1):2-10
references.pmid: 17207739
references.citation: J Neurophysiol. 1997 Aug;78(2):992-1002
references.pmid: 9307129
references.citation: J Neurophysiol. 2000 Apr;83(4):2179-91
references.pmid: 10758127
references.citation: J Pain. 2011 Nov;12(11 Suppl):T12-26
references.pmid: 22074749
references.citation: J Neurophysiol. 1996 Mar;75(3):1177-89
references.pmid: 8867127
references.citation: Eur J Neurosci. 1995 Mar 1;7(3):431-7
references.pmid: 7773440
references.citation: Pain. 2006 Aug;123(3):231-243
references.pmid: 16697110
references.citation: J Neurophysiol. 2008 Oct;100(4):2026-37
references.pmid: 18701750
references.citation: J Craniomandib Disord. 1992 Fall;6(4):301-55
references.pmid: 1298767
references.citation: Pain. 2007 May;129(1-2):177-84
references.pmid: 17296267
references.citation: Pain. 2005 Aug;116(3):227-237
references.pmid: 15964682
references.citation: J Pain. 2005 Sep;6(9):604-11
references.pmid: 16139779
references.citation: J Pain. 2004 Mar;5(2):77-82
references.pmid: 15042515
references.citation: Pain. 1998 Jun;76(3):297-307
references.pmid: 9718248
references.citation: Pain. 1995 Dec;63(3):341-351
references.pmid: 8719535
references.citation: Pain. 1977 Aug;3(4):353-365
references.pmid: 909713