Journal of Oral & Facial Pain and Headache 31
Can Experimentally Evoked Pain in the Jaw Muscles or
Temporomandibular Joint Affect Anterior
Bite Force in Humans?
Aims: To test the hypothesis that experimental pain in the masseter muscle or
temporomandibular joint (TMJ) will decrease the anterior maximum voluntary bite
force (MVBF) and jaw muscle activity in relation to the perceived effort. Methods:
Sixteen volunteers participated in two experimental sessions. Participants were
injected with 0.2 mL of monosodium glutamate (1.0 M) into either the masseter
muscle or TMJ. The MVBF and corresponding electromyographic (EMG) activity
of the masseter, anterior temporalis, and digastric muscles were recorded 10 times
at an interval of 2 minutes before and after injection. Pain was measured using a
visual analog scale and McGill Pain Questionnaire. In addition, participants were
asked how they perceived the interference of pain on their biting performance.
The data analysis included a two-way analysis of variance model and t test.
Results: There was no significant difference in peak pain intensity (P = .066)
and duration of pain (P = .608) between painful muscle and TMJ injections, but
TMJ injection produced a significantly larger area under the curve (P = .005) and
a significantly higher pain rating index (P = .030). Pain in the muscle (P = .421)
and TMJ (P = .057) did not significantly change the MVBF from baseline levels.
The EMG activity also did not differ significantly from baseline levels during
muscle pain. However, there was a significant increase (P = .028) in the EMG
activity of the anterior temporalis and a significant decrease (P = .010) in the
EMG activity of the anterior digastric muscle compared to baseline during TMJ
pain. Subject-based reports also revealed that in the majority of cases (62.5%),
pain did not interfere with the MVBF task. Conclusion: Experimental pain from
either masseter muscle or TMJ did not affect the MVBF, in accordance with
the subject-based reports. Jaw muscle activity, except for EMG activity of the
anterior temporalis and anterior digastric muscles during TMJ pain, also remained
unaffected by pain. The findings suggest that it is not pain in itself but rather how
pain is perceived that may lead to adaptation of motor function, supporting an
integrated pain adaptation model. J Oral Facial Pain Headache 2015;29:31–40.
doi: 10.11607/ofph.1268
Key words: electromyography, integrated pain adaptation model, monosodium
glutamate
T
he term temporomandibular disorders (TMD) encompasses a wide
variety of clinical conditions and pathologic states that involve the
masticatory muscles and/or the temporomandibular joints (TMJs)
along with the associated structures.
1–3
Pain in the masticatory muscles
and ⁄or TMJs, as well as disordered jaw function such as limitation in
mandibular movement and joint noises, are often considered to be the
cardinal signs of TMD.
1,2
Clinically, the majority of TMD patients can
be classifed into those with problems associated with the masticatory
musculature or with problems within the TMJ itself. Distinguishing these
two categories is often considered a clinical challenge.
4,5
It has been reported that pain in the musculoskeletal system (masti-
catory muscles and TMJ) causes signifcant changes in the masticato-
ry movement pattern, maximum occlusal force, and electromyographic
(EMG) activity as compared to individuals without such pain.
6,7
EMG
data from animal studies have also indicated that noxious stimulation
of the TMJ might have a different motor effect compared to noxious
Abhishek Kumar, BDS
PhD Scholar
Eduardo Castrillon, DDS, MSc, PhD
Associate Professor
Peter Svensson, DDS, PhD, Dr Odont
Professor
Section of Clinical Oral Physiology
Department of Dentistry
Aarhus University
Aarhus, Denmark
and
Scandinavian Center for Orofacial
Neurosciences
Correspondence to:
Dr Abhishek Kumar
Section of Clinical Oral Physiology
Department of Dentistry
Aarhus University
Aarhus 8000, Denmark
Fax: +45 8619 5665
Email: a.kumar@odontologi.au.dk
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