Dysmenorrhea and Pain Perception in Women with Temporomandibular Disorders (TMD)

Objectives: The majority of TMD patients presenting in tertiary care settings are women of reproductive age. Although most women have some pain with their menstrual periods, severe dysmenorrhea, i.e., severe menstrual pain not explicable by a medical diagnosis, is less common. The aim of this study was to compare clinical pain perception and laboratory pain response in female TMD patients with and without dysmenorrhea. Methods: All TMD subjects met RDC/TMD criteria for both myofascial pain and arthralgia; the criterion for dysmenorrhea was average menstrual pain ³ 6 on a 0-10 scale; those without dysmenorrhea had to have average menstrual pain £ 3. Twenty-six women with both TMD and dysmenorrhea (TMD/DYS+), 26 women with TMD, but no dysmenorrhea (TMD/DYS-) and 23 controls with dysmenorrhea but no TMD or other chronic pain completed baseline questionnaires and RDC/TMD examination, and underwent laboratory pain stimulation (palpation of TMD, placebo and fibromyalgia sites with standard algometer-delivered pressure and submaximal effort tourniquet test). Results: Age did not differ significantly across groups. At baseline, TMD/DYS+ women had higher characteristic TMD pain than TMD/DYS-: mean (s.d.) = 5.9(1.5) vs. 4.3(1.8), 0-10 scale; p = 0.001 (t-test). TMD/DYS+ showed the highest depression, anxiety and somatization scores, followed by TMD/DYS- and non-TMD dysmenorrheic controls (1-way ANOVA’s, p’s < 0.05). A similar pattern (TMD/DYS+>TMD/DYS->controls) occurred for number of TMD and placebo sites tender to standard pressure and ischemic pain sensitivity. Conclusions: Although dysmenorrhea per se does not appear to put women at risk for significant psychological distress or experimental pain sensitivity, women with both TMD pain and dysmenorrhea experience higher clinical pain, psychological distress and laboratory pain sensitivity than TMD cases without dysmenorrhea. The heightened pain sensitivity in the TMD/DYS+ group may reflect the effect of multiple pain conditions and/or a specific hormonal effect on pain. Supported by NIH DE12470.