Anatomical changes within the medullary dorsal horn in chronic temporomandibular disorder pain

Wilcox, Sophie L.; Gustin, Sylvia M.; Macey, Paul M.; Peck, Chris; Murray, Greg M.; Henderson, Luke A.

doi:10.1016/j.neuroimage.2015.05.014

Cited by 34 publications

(46 citation statements)

References 51 publications

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“…Although the underlying mechanisms of microstructural changes in the brain gray matter of patients with chronic pain remain unclear, neuroimaging studies have demonstrated an apparent reduction in the density or volume of these patients’ gray matter (Obermann et al, 2013; Wilcox et al, 2015; Fritz et al, 2016; Krause et al, 2016). One report even showed that the degree of reduction is compatible with a natural decline occurring over 10–20 years under normal conditions (Apkarian et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Microstructural Abnormalities Were Found in Brain Gray Matter from Patients with Chronic Myofascial Pain

et al. 2016

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Myofascial pain, presented as myofascial trigger points (MTrPs)-related pain, is a common, chronic disease involving skeletal muscle, but its underlying mechanisms have been poorly understood. Previous studies have revealed that chronic pain can induce microstructural abnormalities in the cerebral gray matter. However, it remains unclear whether the brain gray matters of patients with chronic MTrPs-related pain undergo alteration. In this study, we employed the Diffusion Kurtosis Imaging (DKI) technique, which is particularly sensitive to brain microstructural perturbation, to monitor the MTrPs-related microstructural alterations in brain gray matter of patients with chronic pain. Our results revealed that, in comparison with the healthy controls, patients with chronic myofascial pain exhibited microstructural abnormalities in the cerebral gray matter and these lesions were mainly distributed in the limbic system and the brain areas involved in the pain matrix. In addition, we showed that microstructural abnormalities in the right anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) had a significant negative correlation with the course of disease and pain intensity. The results of this study demonstrated for the first time that there are microstructural abnormalities in the brain gray matter of patients with MTrPs-related chronic pain. Our findings may provide new insights into the future development of appropriate therapeutic strategies to this disease.

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Section: Discussionmentioning

confidence: 99%

Microstructural Abnormalities Were Found in Brain Gray Matter from Patients with Chronic Myofascial Pain

et al. 2016

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“…Taken as a whole, these data suggest that TMD patients suffer of a dysfunction in the endogenous pain inhibition systems [ 49 , 50 ] especially at the PAG level [ 51 ]. As with the CSSs, also for TMD it is difficult to find a specific physical and psychological marker that can give an account of all disorders, possibly because CS is not characteristic of a specific and unique nucleus or pathway, and it is possible that during the chronification process the involvement of different afferent and efferent systems entails the possibility of combining different outputs [ 38 ].…”

Section: Tmd and Cssmentioning

confidence: 99%

Central Sensitization-Based Classification for Temporomandibular Disorders: A Pathogenetic Hypothesis

Monaco

Cattaneo

Marci

et al. 2017

Pain Research and Management

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Dysregulation of Autonomic Nervous System (ANS) and central pain pathways in temporomandibular disorders (TMD) is a growing evidence. Authors include some forms of TMD among central sensitization syndromes (CSS), a group of pathologies characterized by central morphofunctional alterations. Central Sensitization Inventory (CSI) is useful for clinical diagnosis. Clinical examination and CSI cannot identify the central site(s) affected in these diseases. Ultralow frequency transcutaneous electrical nerve stimulation (ULFTENS) is extensively used in TMD and in dental clinical practice, because of its effects on descending pain modulation pathways. The Diagnostic Criteria for TMD (DC/TMD) are the most accurate tool for diagnosis and classification of TMD. However, it includes CSI to investigate central aspects of TMD. Preliminary data on sensory ULFTENS show it is a reliable tool for the study of central and autonomic pathways in TMD. An alternative classification based on the presence of Central Sensitization and on individual response to sensory ULFTENS is proposed. TMD may be classified into 4 groups: (a) TMD with Central Sensitization ULFTENS Responders; (b) TMD with Central Sensitization ULFTENS Nonresponders; (c) TMD without Central Sensitization ULFTENS Responders; (d) TMD without Central Sensitization ULFTENS Nonresponders. This pathogenic classification of TMD may help to differentiate therapy and aetiology.

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“…Few human neuroimaging studies addressed the specific functional/anatomical contributions of the TBSNC in acute and chronic orofacial pain by applying functional magnetic resonance imaging (fMRI) (DaSilva et al, 2002), diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) (Wilcox et al, 2015). However, none of the performed neuroimaging studies provided insights regarding neurochemical alterations in the human TBSNC thus corroborating some results provided by animal studies.…”

Section: Introductionmentioning

confidence: 97%

Neurochemical dynamics of acute orofacial pain in the human trigeminal brainstem nuclear complex

et al. 2017

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The trigeminal brainstem sensory nuclear complex is the first central relay structure mediating orofacial somatosensory and nociceptive perception. Animal studies suggest a substantial involvement of neurochemical alterations at such basal CNS levels in acute and chronic pain processing. Translating this animal based knowledge to humans is challenging. Human related examining of brainstem functions are challenged by MR related peculiarities as well as applicability aspects of experimentally standardized paradigms. Based on our experience with an MR compatible human orofacial pain model, the aims of the present study were twofold: 1) from a technical perspective, the evaluation of proton magnetic resonance spectroscopy at 3 T regarding measurement accuracy of neurochemical profiles in this small brainstem nuclear complex and 2) the examination of possible neurochemical alterations induced by an experimental orofacial pain model. Data from 13 healthy volunteers aged 19-46 years were analyzed and revealed high quality spectra with significant reductions in total N-acetylaspartate (N-acetylaspartate + N-acetylaspartylglutamate) (-3.7%, p = 0.009) and GABA (-10.88%, p = 0.041) during the pain condition. These results might reflect contributions of N-acetylaspartate and N-acetylaspartylglutamate in neuronal activity-dependent physiologic processes and/or excitatory neurotransmission, whereas changes in GABA might indicate towards a reduction in tonic GABAergic functioning during nociceptive signaling. Summarized, the present study indicates the applicability of H-MRS to obtain neurochemical dynamics within the human trigeminal brainstem sensory nuclear complex. Further developments are needed to pave the way towards bridging important animal based knowledge with human research to understand the neurochemistry of orofacial nociception and pain.

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Anatomical changes within the medullary dorsal horn in chronic temporomandibular disorder pain

Cited by 34 publications

References 51 publications

Microstructural Abnormalities Were Found in Brain Gray Matter from Patients with Chronic Myofascial Pain

Microstructural Abnormalities Were Found in Brain Gray Matter from Patients with Chronic Myofascial Pain

Central Sensitization-Based Classification for Temporomandibular Disorders: A Pathogenetic Hypothesis

Neurochemical dynamics of acute orofacial pain in the human trigeminal brainstem nuclear complex

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