Conditioned pain modulation in TMD patients with migraine and FMS
Research type
Research Study
Full title
Conditioned pain modulation in temporomandibular joint disorders patients with comorbid migraine and fibromyalgia; A preliminary study
IRAS ID
296528
Contact name
Tara Renton
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
2 years, 7 months, 24 days
Research summary
Summary of Research
In this research, we are utilized conditioned pain modulation (CPM) technique to compare descending pain modulation between temporomandibular joint disorders (TMD) patients without comorbidity, TMD pain patients with migraine, TMD pain patients with migraine and fibromyalgia, migraine patients and healthy controls.
Participants undergo mechanical temporal summation (MTS) and CMP protocols by using the
pinprick stimulator as the test stimulus and cold water at 10 °C as the conditioning stimulus (CS). We follow standardized protocols by the German Research Network on Neuropathic Pain (DFNS) (Rolke et al, 2006) and recommendation for CPM study (Yarnitsky et al,2015).
Both experiments are tested on patient’s arms for three cycle of single pinprick stimulus and three cycle of 10-successive stimuli.After each stimulation, patients will be asked to rate painful sensation on a numerical pain scale (0-100). An experiment will take 20-25 minutes including research instruction. The study will be performed in Dental institute, Kings College Hospital, Denmark Hill and Headache Centre Clinic at Gassiott House, St Thomas' Hospital.
Understanding physical and psychological status among these patients will support the awareness of underlying conditions in TMD sufferers and highlight the need of a multidisciplinary approach.
By using conditioned pain modulation paradigm (CPM) allows us to measure endogenous pain modulation (EPM). EPM is body's adaptation to nociceptive inputs. Impaired EPM reflects abnormality in central pain inhibitory systems and relates to development and maintenance of chronic pain. EPM assessment will contribute to classify pain modulation profile and predict pain onset and treatment outcome.Summary of Results
The study involved 139 people: 30 were healthy, 30 had TMD (temporomandibular disorder), 30 had TMD with migraines, and 19 had TMD with migraines and fibromyalgia. Out of the participants, 99 were women, and the average age was 42 years. People with pain had more unusual sensations, lower sensitivity to light touch, and lower tolerance to pressure pain than the healthy group. While certain pain response tests were different between the groups with migraines and TMD combinations, there wasn’t a significant difference within all the TMD groups.The results showed that higher pain levels were linked to a weaker pain-modulating response (CPM), and having more conditions at the same time also led to a weaker CPM response. The way pain was categorized in the study showed differences, but further analysis was tough.
Conclusion: Unlike previous studies suggesting that TMD patients could still control pain in non-painful areas, our findings show that when TMD patients also have other pain conditions, their ability to manage pain, even in unaffected areas, might be impaired because of heightened pain sensitivity.
REC name
West of Scotland REC 5
REC reference
21/WS/0050
Date of REC Opinion
28 Apr 2021
REC opinion
Favourable Opinion