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Papers of the Week

Papers: 18 Nov 2023 - 24 Nov 2023

2023 Nov 20

J Pain


Examination of conditioned pain modulation in myofascial TMD with consideration of temporal summation.


Santiago V, Janal MN, Cook DB, Raphael KG


Research on myofascial temporomandibular disorder (mTMD) has often focused on potential dysfunction in endogenous pain modulation. However, studies on the specific inhibitory and facilitatory components of endogenous pain modulation using conditioned pain modulation (CPM) and temporal summation of second pain (TSSP) have shown mixed results. This study aimed to: (1) examine whether women with mTMD demonstrated efficient CPM compared to controls; (2) explore the association between independent measures of CPM and TSSP in women with mTMD relative to controls; and (3) whether resulting modulatory profiles differentially predicted pain intensity among cases. All participants were recruited from dental clinics. Cases were women who met research diagnostic criteria for mTMD. Controls did not have facial pain on exam and were selected to be sociodemographically similar to cases. CPM and TSSP were assessed via independent psychophysical protocols. CPM was examined in linear mixed models predicting pain thresholds adjusted for age and stratified by TSSP. Mean CPM was estimated at a 2.2 (SD=2.8) degree increase in pain thresholds (p=<0.001), similar in cases and controls (p=0.67). CPM was less efficient in cases with enhanced TSSP (p=0.031), but not in controls. Although the double-pronociceptive profile of both low CPM and high TSSP trended higher among cases than controls, it did not predict higher levels of pain intensity among cases. This study does not support deficient inhibitory endogenous pain modulation in mTMD, but results suggest that inhibitory and facilitatory pain modulation should be examined concomitantly in the study of endogenous pain modulation. PERSPECTIVE: This manuscript presents a novel examination of inhibitory modulation by level of facilitatory modulation in mTMD. The findings and approach may prove useful for mechanistic researchers studying endogenous pain modulation and clinical researchers seeking to jointly examine conditioned pain modulation and temporal summation in future research on chronic pain.