Experimental pain thresholds and psychosocial features across menstrual cycle in myofascial orofacial pain compared to healthy individuals: cross-sectional study
Limiares de dor experimental e características psicossociais ao longo do ciclo menstrual na dor miofascial orofacial em comparação com indivíduos saudáveis: estudo transversal
Matheus Herreira-Ferreira; Yuri Martins Costa; Carolina Ortigosa Cunha; Ana Claudia de Castro Ferreira Conti; Paulo César Rodrigues Conti; Leonardo Rigoldi Bonjardim
Abstract
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: O impacto do ciclo menstrual na percepção da dor é um foco importante de estudo, sendo necessária uma maior elucidação na disfunção temporomandibular (DTM). Assim, este estudo transversal avaliou limiares de dor experimental, características psicossociais e relatos de dor em mulheres com DTM ao longo do ciclo menstrual, comparadas com controles saudáveis.
MÉTODOS: 220 prontuários de mulheres foram analisados, sendo 80 selecionados para os grupos de controle (saudáveis, n=40) e DTM (dor miofascial, n=40). Nas fases do ciclo menstrual, as pacientes foram divididas nas categorias Pré-Luteal e Luteal. Os instrumentos Escala de Estresse Percebido (PSS), Escala de Pensamentos Catastróficos (PCS), Limiar de Dor Mecânica (MPT), Wind-up Ratio (WUR), Limiar de Dor à Pressão (PPT), Modulação Condicionada da Dor (CPM) e Escala analógica visual (EAV) foram analisados com nível de significância de 5%, pelos testes ANOVA de dois fatores e Tukey post hoc.
RESULTADOS: As escalas PSS e PCS foram significativamente diferentes entre os grupos DTM e controle (p<0,001), independentemente do ciclo menstrual. Indivíduos saudáveis na fase luteal apresentaram MPT maior em comparação com outras fases (p,0,001). O PPT mostrou diferença significativa entre as fases menstruais (p=0,022), sem diferença nas comparações múltiplas. Os valores da EAV não apresentaram diferença entre as fases menstruais (p=376).
CONCLUSÃO: Indivíduos saudáveis na fase luteal têm MPT e PPTl maior na região orofacial. Os relatos de dor em pacientes com DTM não mostraram diferença ao longo do ciclo menstrual, indicando que pequenas alterações nos limiares experimentais podem ser clinicamente relevantes. A presença de dor crônica parece estar mais relacionada com características psicossociais do que com flutuações hormonais.
Palavras-chave
References
1 LeResche L, Mancl L, Sherman JJ, Gandara B, Dworkin SF. Changes in temporomandibular pain and other symptoms across the menstrual cycle. Pain. 2003;106(3):253-61.
2 Slade GD, Fillingim RB, Sanders AE, Bair E, Greenspan JD, Ohrbach R, et al. Summary of Findings From the OPPERA Prospective Cohort Study of Incidence of First-Onset Temporomandibular Disorder: Implications and Slade GD, Fillingim RB, Sanders AE, Bair E, Greenspan JD, Ohrbach R, Dubner R, Diatchenko L, Smith SB, Knott C, Maixner W. Summary of findings from the OPPERA prospective cohort study of incidence of first-onset temporomandibular disorder: implications and future directions. J Pain. 2013;14(12 Suppl):T116-24.
3 Krunic J, Mladenovic I, Radovic I, Stojanovic N. Changes in pulp sensitivity across the menstrual cycle in healthy women and women with temporomandibular disorders. J Oral Rehabil. 2021;48(2):124-31.
4 Maurer AJ, Lissounov A, Knezevic I, Candido KD, Knezevic NN. Pain and sex hormones: a review of current understanding. Pain Manag. 2016;6(3):285-96.
5 Racine M, Tousignant-Laflamme Y, Kloda LA, Dion D, Dupuis G, Choinire M. A systematic literature review of 10 years of research on sex/gender and experimental pain perception - Part 1: Are there really differences between women and men? Pain. 2012;153(3):602-18.
6 Sherman JJ, LeResche L. Does experimental pain response vary across the menstrual cycle? A methodological review. Am J Physiol Regul Integr Comp Physiol. 2006;291(2):R245-56.
7 Paller CJ, Campbell CM, Edwards RR, Dobs AS. Sex-based differences in pain perception and treatment. Pain Med. 2009;10(2):289-99.
8 Athnaiel O, Cantillo S, Paredes S, Knezevic NN. The role of sex hormones in pain-related conditions. Int J Mol Sci. 2023;;24(3):1866-76.
9 Hassan S, Muere A, Einstein G. Ovarian hormones and chronic pain: a comprehensive review. Pain. 2014;155(12):2448-60.
10 Martin VT. Ovarian hormones and pain response: a review of clinical and basic science studies. Gend Med. 2009;6(Part 2):168-92.
11 Aloisi AM, Buonocore M, Merlo L, Galandra C, Sotgiu A, Bacchella L, Ungaretti M, Demartini L, Bonezzi C. Chronic pain therapy and hypothalamic-pituitary-adrenal axis impairment. Psychoneuroendocrinology. 2011;36(7):1032-9.
12 Rhudy JL, Bartley EJ. The effect of the menstrual cycle on affective modulation of pain and nociception in healthy women. Pain. 2010;149(2):365-72.
13 Craft RM. Modulation of pain by estrogens. Pain. 2007;132(Suppl1):S3.
14 Nasser SA, Afify EA. Sex differences in pain and opioid mediated antinociception : Modulatory role of gonadal hormones. Life Sci. 2019;237:116926.
15 Vignolo V, Vedolin GM, de Araujo C dos RP, Rodrigues Conti PC. Influence of the menstrual cycle on the pressure pain threshold of masticatory muscles in patients with masticatory myofascial pain. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodontology. 2008;105(3):308-15.
16 Drobek W, Schoenaers J, De Laat A. Hormone-dependent fluctuations of pressure pain threshold and tactile threshold of the temporalis and masseter muscle. J Oral Rehabil. 2002;29(11):1042-51.
17 Cimino R, Farella M, Michelotti A, Pugliese R, Martina R. Does the ovarian cycle influence the pressure-pain threshold of the masticatory muscles in symptom-free women? J Orofac Pain. 2000;14(2):105-11.
18 Isselée H, De Laat A, De Mot B, Lysens R. Pressure-pain threshold variation in temporomandibular disorder myalgia over the course of the menstrual cycle. J Orofac Pain. 2002;16(2):105-17.
19 Sherman JJ, LeResche L, Mancl LA, Huggins K, Sage JC, Dworkin SF. Cyclic effects on experimental pain response in women with temporomandibular disorders. J Orofac Pain. 2005;19(2):133-43.
20 Vilanova L, Goncalves T, Meirelles L, Garcia R. Hormonal fluctuations intensify temporomandibular disorder pain without impairing masticatory function. Int J Prosthodont. 2015;28(1):72-4.
21 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495-9.
22 Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, List T, Svensson P, Gonzalez Y, Lobbezoo F, Michelotti A, Brooks SL, Ceusters W, Drangsholt M, Ettlin D, Gaul C, Goldberg LJ, Haythornthwaite JA, Hollender L, Jensen R, John MT, De Laat A, de Leeuw R, Maixner W, van der Meulen M, Murray GM, Nixdorf DR, Palla S, Petersson A, Pionchon P, Smith B, Visscher CM, Zakrzewska J, Dworkin SF; International RDC/TMD Consortium Network, International association for Dental Research; Orofacial Pain Special Interest Group, International Association for the Study of Pain. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache. 2014;28(1):6-27.
23 Rolke R, Baron R, Maier C, Tölle TR, Treede -DR, Beyer A, Binder A, Birbaumer N, Birklein F, Bötefür IC, Braune S, Flor H, Huge V, Klug R, Landwehrmeyer GB, Magerl W, Maihöfner C, Rolko C, Schaub C, Scherens A, Sprenger T, Valet M, Wasserka B. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain. 2006;123(3):231-43.
25 Sehn F, Chachamovich E, Vidor LP, Dall-Agnol L, de Souza IC, Torres IL, Fregni F, Caumo W. Cross-cultural adaptation and validation of the Brazilian Portuguese version of the pain catastrophizing scale. Pain Med. 2012;13(11):1425-35.
26 Rolke R, Magerl W, Campbell KA, Schalber C, Caspari S, Birklein F, Treede RD. Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain. 2006;10(1):77-88.
27 Yarnitsky D, Bouhassira D, Drewes AM, Fillingim RB, Granot M, Hansson P, Landau R, Marchand S, Matre D, Nilsen KB, Stubhaug A, Treede RD, Wilder-Smith OH. Recommendations on practice of conditioned pain modulation (CPM) testing. Eur J Pain. 2015;19(6):805-6.
28 Conti PC, de Azevedo LR, de Souza NV, Ferreira FV. Pain measurement in TMD patients: evaluation of precision and sensitivity of different scales. J Oral Rehabil. 2001;28(6):534-9.
29 Mihm M, Gangooly S, Muttukrishna S. The normal menstrual cycle in women. Anim Reprod Sci. 2011;124(3-4):229-36.
30 Turner JA, Mancl L, Huggins KH, Sherman JJ, Lentz G, Leresche L. Targeting temporomandibular disorder pain treatment to hormonal fluctuations: A randomized clinical trial. Pain. 2011;152(9):2074-84.
31 Dao TTT, Knight K, Ton-That V. Modulation of myofascial pain by the reproductive hormones: a preliminary report. J Prosthet Dent. 1998;79(6):663-70.
32 Veldhuijzen DS, Keaser ML, Traub DS, Zhuo J, Gullapalli RP, Greenspan JD. The role of circulating sex hormones in menstrual cycle-dependent modulation of pain-related brain activation. Pain. 2013;154(4):548-59.
33 Hellström B, Anderberg UM. Pain perception across the menstrual cycle phases in women with chronic pain. Percept Mot Skills. 2003;96(1):201-11.
34 Landi N, Lombardi I, Manfredini D, Casarosa E, Biondi K, Gabbanini M, Bosco M. Sexual hormone serum levels and temporomandibular disorders. A preliminary study. Gynecol Endocrinol. 2005;20(2):99-103
35 Jedynak B, Jaworska-Zaremba M, Grzechocińska B, Chmurska M, Janicka J, Kostrzewa-Janicka J. TMD in females with menstrual disorders. Int J Environ Res Public Health. 2021;18(14):1-11.
36 Martin VT, Lee J, Behbehani MM. Sensitization of the trigeminal sensory system during different stages of the rat estrous cycle: Implications for menstrual migraine. Headache. 2007;47(4):552-63.
37 Pogatzki-Zahn EM, Drescher C, Englbrecht JS, Klein T, Magerl W, Zahn PK. Progesterone relates to enhanced incisional acute pain and pinprick hyperalgesia in the luteal phase of female volunteers. Pain. 2019;160(8):1781-93.
Submitted date:
03/07/2022
Accepted date:
06/20/2023
Facebook
Google+
Twitter
LinkedIn
Mendeley
Email