Temporomandibular disorders (TMD) represent a group of chronic painful conditions involving the muscles of mastication and the temporomandibular joint. We determined whether patients with painful TMD are more sensitive to noxious stimuli than age-matched control subjects. Fifty-two TMD patients (16 with muscle pain and 36 with combined muscle and joint pain) and 23 age-matched and gender-matched volunteers participated. Forearm thermal pain threshold and tolerance values were determined. A submaximal effort tourniquet procedure was used to evoke ischemic muscle pain. Relative to control subjects, TMD patients had significantly lower thermal pain threshold, ischemic pain threshold, and ischemic pain tolerance values; and thermal pain tolerance values also tended to be lower. Pain sensitivity did not differ between the two groups of TMD patients. Furthermore, the submaximal effort tourniquet procedure, which is capable of altering acute orofacial pain (Sigurdsson and Maixner, 1994) did not produce a consistent reduction in orofacial pain associated with TMD. We concluded that TMD patients are more sensitive to noxious stimuli than pain-free controls. These findings provide additional evidence that TMD is a psychophysiological disorder of the central nervous system which modulates emotional, physiological and neuroendocrine responses to emotional and physical stressors.

Objective: An impairment in endogenous opioid and/or serotonergic activity during the luteal phase may play a role in the etiology of premenstrual dysphoric disorder (PDD). This study tested the hypothesis that because of these alterations, PDD patients would exhibit greater pain sensitivity than non-PDD controls when tested during the luteal phase of their menstrual cycles. Participants: Seven subjects prospectively diagnosed with PDD and 11 healthy controls participated in the experiment. Design: After completing the Prospective Report of the Impact and Severity of Menstrual Symptoms (PRISM) calendar for 2 months for diagnostic purposes, all subjects underwent thermal and ischémie pain testing during the luteal phase of their menstrual cycles. Results: PDD subjects were significantly more sensitive to ischémie pain than were controls, with PDD subjects exhibiting lower ischémie pain onset and ischémie pain tolerance. PDD subjects also described their ischémie pain as more intense than did controls. No differences in thermal pain perception emerged. Conclusions: These results support the hypothesis that women suffering from PDD exhibit greater ischémie pain sensitivity compared with non-PDD controls. Several mechanisms may underlie this difference.

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