Many chronic pain patients are refractory to treatment, which leads to the suspicion that somehow they are not fully effective and probably some mechanism of pain generation and/or maintenance is still unknown. The aim of this cross-sectional study was to provide evidence-based data on pain mechanisms in different types of chronic pain conditions. Eighty women, with 18-65 years old, were included, divided into four groups: myofascial pain of the masticatory muscles (n = 20), fibromyalgia (n = 20), chronic daily headache and healthy volunteers (n = 20). All patients were submitted to quantitative sensory tests: pressure pain threshold, mechanical detection threshold, mechanical pain threshold, ischaemic pain tolerance, cold pain sensitivity, aftersensation, wind-up ratio and conditioned pain modulation. Current perception threshold was also determined (Neurometer CPT/C - Neurotron). Three different zones were evaluated: trigeminal (masseter muscle), cervical and extratrigeminal (thenar eminence). Data were recorded and subjected to statistical analysis (anova, Tukey and Student's t-tests). Masticatory myofascial pain, fibromyalgia and chronic daily headache individuals presented lower pressure pain thresholds than healthy volunteers (P = 0.00). Chronic daily headache individuals had a significantly higher mechanical detection threshold than healthy volunteers (P = 0.01). Individuals of the symptomatic groups showed lower values for mechanical pain threshold and for ischaemic pain tolerance (P = 0.00) than healthy volunteers. The ability to activate the mechanism of endogenous modulation is impaired in women with fibromyalgia and myofascial pain (P = 0.00). These results reinforce evidence of central sensitisation and impaired endogenous modulation system in individuals with myofascial pain, fibromyalgia and chronic daily headache.

BACKGROUND AND OBJECTIVES: Temporomandibular disorder consists of a variety of conditions associated with pain and dysfunction of the temporomandibular joint, masticatory muscles and associated structures. Self-care clinical protocols are commonly used as initial therapy for temporomandibular disorder patients after diagnosis as a conservative and non-invasive approach. This review aimed to study the self-care techniques in the literature and its efficacy. CONTENTS: This was a systematic review of the literature, with a survey in the databases Science Direct and Pubmed, in addition to the gray literature, Google Scholar. The following descriptors were used: "self-care", "temporomandibular dysfunction" and "counseling". Articles in English and Portuguese published between 2010 and 2018 were included. Twenty-one articles were selected based on a series of inclusion and exclusion criteria. CONCLUSION: There are two main objectives in the treatment of temporomandibular disorder patients, the reduction of pain and improvement of function. It was concluded that self-care therapies are effective in achieving these goals, in addition to being low-tech and non-invasive. Patients who actively participate in their healing process present faster improvements, by altering their general perception of pain.

BACKGROUND AND OBJECTIVES: Different stimulations are needed to evaluate the integrity of afferent fibers and to better understand the mechanisms involved in different pain conditions which may affect the orofacial region. This study aimed primarily at reviewing the literature to provide guidelines to the clinical practice. CONTENTS: PubMed database was searched from 1990 to 2011 using MeSH terms. Mechanical stimulation could be done with Von-Frey monofilaments to test A-beta and A-delta fibers. Pinprick test is a simple way to evaluate A-delta and C fibers. Pressure pain threshold (PPT) tests A-delta and C fibers. Among thermal test modalities one may use ice cubes or a freezing spray to measure the level of central sensitization involved. Electric stimulations applied by the Neurometer/Neurotron ® device evaluated three major fibers (A-delta, A-beta and C), hyperesthesia and hypoesthesia. In addition, C fibers can also be evaluated by chemical stimulations with capsain and/or menthol. CONCLUSION: Quantitative sensory tests are a reliable way to evaluate nervous fibers sensory function. Sensory deficit may be quantified and data may be used as diagnostic aid or to compare the effectiveness of different treatment approaches. Guidelines for somatosensory evaluation of temporomandibular dysfunction and orofacial pain patients* Diretrizes para avaliação somatossensorial em pacientes portadores de disfunção temporomandibular e dor orofacial

Low pressure Pain Threshold (PPT) is considered a risk factor for Temporomandibular Disorders (TMD) and is influenced by psychological variables. Objectives To correlate deep pain sensitivity of masticatory muscles with prosthetic factors and Oral-Health-Related Quality of Life (OHRQoL) in completely edentulous subjects.Material and Methods A total of 29 complete denture wearers were recruited. The variables were: a) Pressure Pain Threshold (PPT) of the masseter and temporalis; b) retention, stability, and tooth wear of dentures; c) Vertical Dimension of Occlusion (VDO); d) Oral Health Impact Profile (OHIP) adapted to orofacial pain. The Kolmogorov-Smirnov test, the Pearson Product-Moment correlation coefficient, the Spearman Rank correlation coefficient, the Point-Biserial correlation coefficient, and the Bonferroni correction (α=1%) were applied to the data.Results The mean age (standard deviation) of the participants was of 70.1 years (9.5) and 82% of them were females. There were no significant correlations with prosthetic factors, but significant negative correlations were found between the OHIP and the PPT of the anterior temporalis (r=-0.50, 95% CI-0.73 to 0.17, p=0.005).Discussion The deep pain sensitivity of masticatory muscles in complete dentures wearers is associated with OHRQoL, but not with prosthetic factors.

CBCT could be a good image to evaluate DJD progression over time, but should not be used as a screening tool in healthy individuals.

BACKGROUND AND OBJECTIVES: This cross-sectional observational study was conducted due to the uncertainties that still exist about the role of playing wind instruments in musculoskeletal complaints. Therefore, the objective was to assess the prevalence of temporomandibular dysfunction and associated factors in wind instrument players. METHODS: Wind instrument players from the School of Music of Fine Arts of Paraná were evaluated for nine-months. Axes I and II of the Research Diagnostic Criteria for Temporomandibular Disorders was used to obtain the variables of interest. The statistical analyses were performed using the SPSS 2.0 software, using the Fishers Exact test, with a significance level of 5%. RESULTS: Thirty-five musicians were examined, 85.7% were male, and 14.3% were female. The temporomandibular dysfunction prevalence was 51.4% being more commonly found in the group II (disc displacements) 34.2%. This result was statistically meaningful when associated with females (p=0,052). Group I disorders (muscle disorders) were diagnosed in 5 patients (14.2%) and group III disorders (joint disorders) were diagnosed in 3 patients (8.5%). Gender also influenced the presence of chronic pain, being more frequent in females (p=0.019). CONCLUSION: In this research, we found a high prevalence of individuals affected by temporomandibular dysfunction. Therefore, studies with expanded samples are necessary, as well as educational and preventive measures. Temporomandibular dysfunction specialists should devote more attention to this group of people.

Introduction: Bruxism is defined as a repetitive activity of masticatory muscles, characterized by the clenching or grinding of the teeth, which can occur during wakefulness (awake bruxism) or during sleep (sleep bruxism). Objectives: The objectives of the present study were to determine the prevalence of awake bruxism and its associated factors. Methods: Sample was composed by 50 participants of both genders, aged between 18 and 60 years, submitted to a clinical examination - to observe the presence of tooth wear, marks on the mucosa, or masseter muscles hypertrophy - and self-applied questionnaires, which evaluated the presence of TMD signs and symptoms, oral behaviors, lifestyles, anxiety level and sleep quality. Results: The prevalence of awake bruxism was 48%. Its presence was statistically and significantly associated with the presence of signs and symptoms of TMD (p=0.002), poor sleep quality (p=0.032), buccal mucosa indentations (p<0.001) and tongue (p=0.011). Age, gender, social characteristics, habits (such as coffee ingestion, smoking, alcoholism and physical activity) and tooth wear were variables that had no significant association with awake bruxism. Conclusions: It was concluded that awake bruxism shows a high prevalence and a positive association with signs and symptoms of TMD and worst sleep quality. In addition, awake bruxism is more likely to occur in individuals who have buccal mucosa indentation and who present high rates of oral habits and oral behaviors.

This study evaluated the prevalence of temporomandibular disorders (TMDs) in ballet dancers and explored their association with levels of anxiety. Participants were 51 male and female ballet dancers with a mean age of 31.5 ± 12.6 years. The diagnosis of TMDs was made in accordance with Research Diagnostic Criteria for Temporomandibular Joint Disorders (RDC/TMD). All subjects completed the state part of an anxiety questionnaire (STAI). Data were gathered and analyzed using the R statistical software (version: 3.4.0.) with level of significance set at 5%. The prevalence of all TMDs in the sample was 78%; that is, of the 51 participants, 39 had at least one positive diagnosis. The two most prevalence diagnoses were disk displacement with reduction and arthralgia. Individuals with TMD had a mean anxiety score of 42.55 ± 9.92 on the STAI, whereas for those without TMD it was 44.27 ± 11.89, with no statistically significant difference (p = 0.53). It is concluded that the general prevalence of TMDs in ballet dancer is higher than in the population at large. Disk displacement with reduction and arthralgia are the most common TMDs, and the presence of TMDs does not seem to affect anxiety state levels in this population.