Central sensitization
in orofacial pain
Emma McCormick
Magdalena Sjöwall
Supervisor: Per Alstergren, Department of Orofacial Pain and Jaw Function
Master thesis (30 ECTS) Programme in Odontology February, 2015
Orofacial Pain Unit Faculty of Odontology Malmö University, Sweden
Abstract
Objective. The aim of this study was to retrospectively investigate the relation between referred
pain, as a clinical finding, and psychosocial factors versus central sensitization in patients with myofascial pain with referral (MPR) as assessed according to DC/TMD. The study also aimed to investigate differences regarding psychosocial factors between patients demonstrating myofascial pain with referral (MPR) and patients diagnosed with the DC/TMD muscle diagnose local myalgia (LM) as well as OFP/TMD patients without masticatory muscular diagnose (WMD) as control patients.
Material and methods. Patients’ medical records of 85 patients examined at the Orofacial Pain
Unit at Malmö University during September 2012 till the end of 2013 were retrospectively examined for DC/TMD data. Examined variables included pain intensity, pain-related disability, psychosocial factors (depression, anxiety and stress) and referred pain. The patients were divided into groups based on DC/TMD muscle diagnosis as well as extension of pain. Non-parametric statistics were used and a probability level of P < 0.05 was considered as significant.
Results. Patients with MPR demonstrated significant correlations between the total number of
referred pain sites and disability score (rs = 0.43, n = 49, p = 0.002), depression (rs = 0.32, n =
49, p = 0.023) as well as stress (rs = 0.39, n = 49, p = 0.006). Patients with generalized pain
distribution demonstrated a significantly higher degree of stress (p = 0.020) as well as higher number of referred pain sites (p = 0.019) than patients with local and/or regional orofacial pain.
Conclusion. This study indicates that the degree of central sensitization can be estimated by
the extent of referred pain, as assessed according to DC/TMD, in patients with myofascial pain with referred pain in the orofacial region. This study could not detect a difference in psychosocial factors between the three groups, myofascial pain with referral (MPR), local myalgia (LM) and no masticatory muscle diagnosis (WMD).
Sammanfattning
Syfte. Att retrospektivt undersöka relationen mellan central sensitisering i det orofaciala
området och refererad smärta, som kliniskt fynd, samt psykosociala faktorer hos patienter med DC/TMD-muskeldiagnosen myofasciell smärta med refererad smärta (MPR). Studien syftade även till att undersöka skillnader gällande psykosociala faktorer mellan patienter som diagnostiserats med DC/TMD muskeldiagnoserna myofasciell smärta med refererad smärta (MPR), lokal myalgi (LM) och patienter med orofacial smärta eller käkdysfunktion men ej käkmuskeldiagnos (WMD) som kontrollgrupper.
Material och metod. Information från 85 patienters DC/TMD-undersökning utförd på
Orofaciala smärtenheten vid Malmö högskola mellan september 2012 till årsslutet 2013 insamlades retrospektivt. Undersökta variabler inkluderade smärtintensitet, smärt-relaterad dysfunktion, psykosociala faktorer (depression, ångest och stress) samt refererad smärta. Patienterna indelades i grupper baserade på muskeldiagnos enligt DC/TMD samt utbredning av smärta. Non-parametrisk statistik användes och P < 0,05 betraktades som signifikant.
Resultat. Patienter med MPR uppvisade en signifikant korrelation mellan totala antalet
refererade smärtlokalisationer och smärt-relaterad dysfunktion (rs = 0,43, n = 49, p = 0,002),
depression (rs = 0,32, n = 49, p = 0,023) och stress (rs = 0,39, n = 49, p = 0,006). Patienter med
en generell smärtutbredning uppvisade en signifikant högre grad av stress (p = 0,020) samt fler antal refererade smärtlokalisationer (p = 0,019) jämfört med patienter med lokal och/eller regional orofacial smärta.
Konklusion. Studien indikerar att grad av central sensitisering kan bedömas med hjälp av
utbredningen av refererad smärta, undersökt enligt DC/TMD, hos patienter med diagnosen myofasciell smärta med refererad smärta i det orofaciala området. Studien kunde inte påvisa skillnader gällande psykosociala faktorer mellan de undersökta grupperna.
