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Association between signs of hyperalgesia and reported frequent pain in jaw-face and head
Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.ORCID-id: 0000-0002-2183-7497
Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.ORCID-id: 0000-0002-8346-5289
2020 (Engelska)Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, nr 8, s. 1054-1065Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To analyze the relationship between different sites of elicited pain to muscle palpation (PtP), and reported frequent pain in jaw-face and head.

Materials and methods: The analysis was based on an epidemiological sample of 1200 randomly selected individuals, of which 779 (65%) both completed a questionnaire and participated in a clinical examination. The questionnaire addressed the presence of pain in the jaw-face region and headache, respectively. Part of the clinical examination entailed palpation of the jaw, neck, shoulder, arm, thumb and calf muscles. Logistic regression was applied with pain and headache as dependent variables. A p-value < .05 determined statistical significance.

Results: Five percent of participants reported frequent pain in jaw-face, and 17% reported frequent headaches. In the regression analysis, frequent headaches were significantly associated with jaw muscle PtP (OR 2.1, CI 1.4–3.4), regional PtP (OR 4.5, CI 2.6–7.6), and generalized PtP (OR 6.1, CI 2.2–17.0). Jaw-face pain was significantly associated with regional PtP (OR 5.3, CI 2.2–13.0) and generalized PtP (OR 30.1, CI 9.3–97.0). The relationship between pain prevalence and PtP showed a dose-response pattern.

Conclusions: The study indicates that frequent jaw-face pain and headache are primarily associated with signs of regional and widespread hyperalgesia, which may be linked to the central sensitization mechanism. Signs of widespread hyperalgesia should be accounted for in the diagnostic algorithms when examining patients with pain in the jaw, face, and head regions.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2020. Vol. 72, nr 8, s. 1054-1065
Nyckelord [en]
Epidemiology, myofascial pain, temporomandibular disorders, headaches, diagnosis
Nationell ämneskategori
Odontologi
Forskningsämne
odontologi
Identifikatorer
URN: urn:nbn:se:umu:diva-175407DOI: 10.1080/00016357.2020.1814963ISI: 000568933300001PubMedID: 32924721Scopus ID: 2-s2.0-85090977631OAI: oai:DiVA.org:umu-175407DiVA, id: diva2:1471167
Forskningsfinansiär
Västerbottens läns landstingTillgänglig från: 2020-09-28 Skapad: 2020-09-28 Senast uppdaterad: 2023-03-23Bibliografiskt granskad
Ingår i avhandling
1. Perspectives on signs and symptoms indicative of temporomandibular disorders among adults
Öppna denna publikation i ny flik eller fönster >>Perspectives on signs and symptoms indicative of temporomandibular disorders among adults
2021 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: The aim of this thesis was to delve deeper into the different aspects of temporomandibular disorders (TMD) as a public health problem among adults. The studies evaluated signs and symptoms indicative of TMD in terms of prevalence, associated factors, treatment need estimate, possible factors underpinning treatment need owing to TMD, as well as possible influences of pain conditions on TMD symptoms and diagnosis in adult populations.

Study populations and Methods: The thesis is comprised of five papers. The first four papers (I-IV) included individuals 35, 50, 65 and, 75 years old living in Västerbotten County, Sweden. The study sample was stratified based on the area of residence – coast (mainly urban area) and inland (mainly rural area). Scrutiny constituted a questionnaire and a clinical examination. Of 1200 individuals contacted (300 in each age group), 987 (82%) returned a filled-out questionnaire and 779 (65%) participated in the clinical examination. Distribution of signs and symptoms indicative of TMD in the different age groups, associations between different factors and TMD signs, symptoms and treatment need owing to TMD, as well as association between different patterns of pain to palpation and pain in the jaw-face-head region were analyzed. Paper V assessed the association between widespread pain and TMD pain in 300 individuals of which 110 diagnosed as TMD pain according to DC/TMD (arthralgia, myalgia and myofascial pain with referral). Logistic regression analysis was applied in the papers II-V and the results were presented as odds ratios (OR) with 95% confidence interval (95% CI).

Results: The prevalence of symptoms indicative of TMD and frequent headaches was high in the adult population. The age and gender patterns were, for the most part, similar for the frequent symptoms in terms of prevalence. In general, lower prevalence of frequent headaches and symptoms indicative of TMD were observed among the elderly compared to the younger age groups. Clinical signs indicative of TMD were more commonly registered among women. In the analysis of putative factors related to presence of signs and symptoms, self- perceived impaired general health status was the most consistent finding in the different age groups. The estimated treatment need owing to TMD was 15% for the total sample. The presence of TMD signs, symptoms, smoking, living on the coast, and being a woman emerged as important factors in the clinical decision- making process of treatment need due to TMD. A significant dose-response like pattern was observed between frequent pain in the jaw-face-head region and the patterns of pain elicited to palpation. Individuals with widespread pain compared to those without widespread pain significantly more often had a TMD diagnosis of myofascial pain with referral and myalgia according to the DC/TMD.

Conclusions: The age and gender differences on signs and symptoms indicative of TMD among adults are likely related to factors included in the biopsychosocial model. The associations between comorbidities and TMD may influence demand for treatment among the affected. Thus, TMD treatment should be included in the medical health care payment systems. A significant proportion of the adult population has a need of treatment related to TMD. Generalized hyperalgesia and widespread pain conditions are related to pain in the jaw-face-head region and should be acknowledged in clinical evaluations, diagnostic decisions, treatment planning as well as in research settings.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå Universitet, 2021. s. 80
Serie
Umeå University odontological dissertations, ISSN 0345-7532 ; 145
Nyckelord
epidemiology, temporomandibular disorders, headache, gender, treatment need, clinical decision-making, widespread pain
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:umu:diva-183170 (URN)978-91-7855-555-0 (ISBN)978-91-7855-554-3 (ISBN)
Disputation
2021-06-15, Sal B, byggnad 1D, våning 9, Umeå, 09:00 (Engelska)
Opponent
Handledare
Anmärkning

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Tillgänglig från: 2021-05-25 Skapad: 2021-05-18 Senast uppdaterad: 2021-06-17Bibliografiskt granskad

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