Difference between revisions of "Orofacial Pain"

The author points out that orofacial and neck pain comorbidities are often associated with TMD.<ref>Plesh O., Adams S.H., Gansky S.A. [https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21837286/ Temporomandibular joint and muscle disorder-type pain and comorbid pains in a national US sample]. J. Orofac. Pain. 2011;25:190–198.</ref> These coexisting conditions (particularly headaches, migraines, and neck pain) are not only highly associated with chronic pain-related TMDs, but also increase the risk of their development.<ref>Bender S.D. Orofacial pain and headache: A review and look at the commonalities. Curr Pain Headache Rep. 2014;18:400. doi: 10.1007/s11916-013-0400-5.</ref><ref name=":0">Botros J., Gornitsky M., Samim F., der Khatchadourian Z., Velly A.M. Back and neck pain: A comparison between acute and chronic pain-related Temporomandibular Disorders. Can. J. Pain. 2022;6:112–120. doi: 10.1080/24740527.2022.2067032. </ref><ref>Ohrbach R., Fillingim R.B., Mulkey F., Gonzalez Y., Gordon S., Gremillion H., Lim P.-F., Ribeiro-Dasilva M., Greenspan J.D., Knott C. [https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22074750/ Clinical findings and pain symptoms as potential risk factors for chronic tmd: Descriptive data and empirically identified domains from the opera case-control study.] J. Pain. 2011;12:T27–T45. doi: 10.1016/j.jpain.2011.09.001</ref> The International Classification of Headaches (ICHD)<ref>Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders; 3rd edition (beta version) Cephalalgia. 2013;33:629–808. doi: 10.1177/0333102413485658.</ref> and DC/TMD<ref name=":4">Schiffman E., Ohrbach R., Truelove E., Look J., Anderson G., Goulet J.P., List T., Svensson P., Gonzalez Y., Lobbezoo F., et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24482784/ Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†] J. Oral Facial Pain Headache. 2014;28:6–27. doi: 10.11607/jop.1151</ref> consider the main characteristics of pain in headache and TMD, respectively. There are several hypotheses that attempt to explain the association between TMD and headache, including neuronal convergence, central sensitization, and inhibition of descending pain downregulatory mechanisms.<ref name=":1">Matre D., Knardahl S. [https://www.degruyter.com/document/doi/10.1016/j.sjpain.2012.04.003/html ‘Central sensitization’ in chronic neck/shoulder pain]. Scand. J. Pain. 2012;3:230–235. doi: 10.1016/j.sjpain.2012.04.003. </ref><ref name=":2">Su M., Yu S. Chronic migraine: A process of dysmodulation and sensitization. Mol. Pain. 2018;14:1744806918767697. doi: 10.1177/1744806918767697.</ref> The close relationship between TMD, headache and neck pain has recently been evaluated, not only in terms of sharing common pathogenetic mechanisms and clinical features, but also considering that one condition might influence or promote the development of another.<ref>Chaves T.C., Dach F., Florencio L.L., Carvalho G.F., Gonçalves M.C., Bigal M.E., Speciali J.G., Bevilaqua-Grossi D. Concomitant Migraine and Temporomandibular Disorders are Associated With Higher Heat Pain Hyperalgesia and Cephalic Cutaneous Allodynia. Clin. J. Pain. 2016;32:882–888. doi: 10.1097/AJP.0000000000000369.</ref><ref name=":0" /><ref>Gonçalves D.A., Camparis C.M., Speciali J.G., Franco A.L., Castanharo S.M., Bigal M.E. Temporomandibular disorders are differentially associated with headache diagnoses: A controlled study. Clin. J. Pain. 2011;27:611–615. doi: 10.1097/AJP.0b013e31820e12f5.</ref> These conditions can cause facial pain and are frequently associated with the development of craniofacial allodynia during painful exacerbation.<ref name=":3">Greenspan J.D., Slade G.D., Bair E., Dubner R., Fillingim R.B., Ohrbach R., Knott C., Diatchenko L., Liu Q., Maixner W. [https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24275224/ Pain sensitivity and autonomic factors associated with development of TMD: The OPPERA prospective cohort study]. J. Pain. 2013;14:T63–T74.e746. doi: 10.1016/j.jpain.2013.06.007.</ref> Indeed, pain in both conditions has been attributed to common dysfunctions of central pain regulation mechanisms..<ref>Furquim B.D., Flamengui L.M., Conti P.C. TMD and chronic pain: A current view. Dental Press J. Orthod. 2015;20:127–133. doi: 10.1590/2176-9451.20.1.127-133.sar.</ref><ref>Bevilaqua-Grossi D., Lipton R.B., Napchan U., Grosberg B., Ashina S., Bigal M.E. Temporomandibular disorders and cutaneous allodynia are associated in individuals with migraine. Cephalalgia. 2010;30:425–432. doi: 10.1111/j.1468-2982.2009.01928.x.</ref> On the other hand, the concomitant TMD and migraine showed worse levels of cutaneous hyperalgesia and allodynia, probably due to central and peripheral nervous system sensitization and impairment of descending pain modulatory pathways.<ref>Conti P.C., Costa Y.M., Gonçalves D.A., Svensson P. Headaches and myofascial temporomandibular disorders: Overlapping entities, separate managements? J. Oral Rehabil. 2016;43:702–715. doi: 10.1111/joor.12410.</ref><ref>Furquim B.D., Flamengui L.M., Conti P.C. TMD and chronic pain: A current view. Dental Press J. Orthod. 2015;20:127–133. doi: 10.1590/2176-9451.20.1.127-133.sar.</ref>

A recent systematic review and meta-analysis, with a combined sample of 2518 subjects, suggested that the prevalence of TMD could range from 25.2% to 34.9%,<ref>Bueno C.H., Pereira D.D., Pattussi M.P., Grossi P.K., Grossi M.L. Gender differences in temporomandibular disorders in adult populational studies: A systematic review and meta-analysis. J. Oral Rehabil. 2018;45:720–729. doi: 10.1111/joor.12661</ref> with a predominance of the myofascial pain diagnosis (10.3- 15.4%) [2]. While a study by Javed Ashraf et al.<ref name=":6">Javed Ashraf,Matti Närhi, Anna Liisa Suominenand  Tuomas Saxlin. Association of temporomandibular disorder-related pain with severe headaches—a Bayesian view. Clin Oral Investig. 2022; 26(1): 729–738. Published online 2021 Jul 5. doi: 10.1007/s00784-021-04051-y. PMCID: PMC8791898. PMID: 34224000

</ref> using Bayesian methodology, aimed to examine the association of TMD-related pain with severe headaches (migraine and TTH) over an 11-year follow-up period compared with the frequency approach. Frequentist statistics suffer from some limitations, most notably the reliance on large sample sizes to accurately determine effect sizes.<ref name=":5">Buchinsky FJ, Chadha NK. To P or not to P: backing Bayesian statistics. Otolaryngol Head Neck Surg. 2017;157(6):915–918. doi: 10.1177/0194599817739260</ref> Furthermore, contrary to the Frequentist methodology, Bayesian statistics do not provide a (fixed) result value but rather an interval containing the regression coefficient.<ref>Depaoli S, van de Schoot R. Bayesian analyses: where to start and what to report. Eur Heal Psychol. 2014;16:75–84.</ref> These intervals, called credible intervals (CI), place a probability on the best estimate among all possible values of the parameter estimates.<ref name=":5" />

Therefore, in the closed probability (CP) the probability distribution <math>B</math> can be computed from probability <math>A</math> and conditional probabilities <math>P(B=\beta|A=\alpha)</math>. In quantum probability (QP), the classical Total Probability Formula (FTP) is perturbed by the interference term (Khrennikov, 2010);<ref>Khrennikov A. Ubiquitous Quantum Structure: From Psychology To Finances Springer, Berlin-Heidelberg-New York(2010)</ref> for the dichotomous quantum observables <math>A</math> and <math>B</math> of von Neumann type, i.e. given by the Hermitian operators <math>\hat{A}</math> and <math>\hat{B}</math>, the quantum version of FTP has the form:   

If the interference term is positive, then the QP computation would generate a higher probability than its CP counterpart given by the classical FTP. In particular, this probability amplification underlies the supremacy of quantum computing. There are numerous statistical data from cognitive psychology, decision making, molecular biology, genetics and epigenetics demonstrating that biosystems, from proteins and cells (Asano et al., 2015b)<ref>Asano M., Khrennikov A., Ohya M., Tanaka Y., Yamato I. Quantum Adaptivity in Biology: From Genetics To Cognition Springer, Heidelberg-Berlin-New York(2015)</ref> to humans (Khrennikov, 2010,<ref>Khrennikov A. Ubiquitous Quantum Structure: From Psychology To Finances Springer, Berlin-Heidelberg-New York(2010)</ref> Busemeyer and Bruza, 2012<ref>Busemeyer J., Bruza P. Quantum Models of Cognition and Decision Cambridge Univ. Press, Cambridge(2012)</ref>) use this amplification and operate with non-CP updates.