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Master's Dissertation
Full name
Dyna Mara Araújo Oliveira Ferreira
Knowledge Area
Date of Defense
Bauru, 2017
Conti, Paulo Cesar Rodrigues (President)
Bonjardim, Leonardo Rigoldi
Fernandes, Giovana
Silva, Renato Oliveira Ferreira da
Title in English
Evaluation of the influence of experimental psychological stress on the quantitative sensory testing response in temporomandibular disorders patients
Keywords in English
Pain Threshold
Psychological Stress
Temporomandibular Joint Dysfunction Syndrome
Abstract in English
Background: Quantitative sensory testing (QST) is a promising method for assessing the mechanisms that contribute to the development and maintenance of painful Temporomandibular Disorders (TMD). All QST responses rely on the participant´s perception; therefore a number of cognitive and psychological factors are known to directly influence results, including psychological stress. Aims: To assess the effects of experimental psychological stress on QST response in TMD patients and healthy volunteers. Methods: 20 women with myofascial TMD and 20 healthy women underwent a standardized QST protocol, including cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), mechanical pain threshold (MPT), pressure pain threshold (PPT) and wind up ratio (WUR) at the masseter muscle. QST was conducted before and after to the Paced Auditory Serial Addition Task (PASAT), inducing acute psychological stress. ANOVA with repeated measures was performed to assess the effect of group and time on the reported stress and absolute values of QST. The significance level was set at 5% (p=0.050). Furthermore, Z-score profiles were generated. Results: The PASAT induced a significant stress reaction (p<0.001). After exposure to experimental stress, both healthy volunteers and TMD patients showed increase in thermal detection threshold (CDT: F=4.25, p=0.017 and WDT: F=4.10, p=0.020) and decrease in thermal pain threshold (CPT: F=11.2, p<0.001 and HPT: F=8.13, p<0.001) when compared to baseline. However, stress did not induce significant changes in MPT, PPT or WUR in both groups (p>0.050). Conclusion: The experimental psychological stress induces thermal hypoesthesia and thermal hyperalgesia on masticatory muscle, regardless of the presence of TMD painful. Overall, these findings emphasize the importance of considering the psychological stress when judging QST findings.
Title in Portuguese
Avaliação da influência de estresse psicológico experimental na resposta de testes sensoriais quantitativos em pacientes com disfunção temporomandibular
Keywords in Portuguese
Estresse Psicológico
Limiar de Dor
Síndrome da Disfunção da Articulação Temporomandibular
Abstract in Portuguese
Contextualização: Teste sensorial quantitativo (QST) é um método promissor para avaliar os mecanismos que contribuem para o desenvolvimento e manutenção das Disfunções Temporomandibulares (DTM) dolorosas. As respostas de QST dependem da percepção do participante; portanto, uma série de fatores cognitivos e psicológicos, como o estresse, podem influenciar os resultados. Objetivo: Avaliar a influência do estresse psicológico experimental na resposta de QST em pacientes com DTM e voluntários saudáveis. Métodos: 20 mulheres com DTM (Dor Miofascial) e 20 mulheres saudáveis foram submetidas a um protocolo padronizado de QST, incluindo limiar de detecção ao frio (CDT), limiar de detecção ao calor (WDT), limiar de dor ao frio (CPT), limiar de dor ao calor (HPT), limiar de dor mecânica (MPT), limiar de dor a pressão (PPT) e somação temporal de dor (WUR) na região de masseter. QST foi realizado antes e após teste de estresse psicológico laboratorial denominado Paced Auditory Serial Addition Task (PASAT). ANOVA foi realizada para avaliar o efeito de grupo e tempo sobre o estresse relatado e valores de QST a um nível de significância de 5% (p = 0,050). Ademais, perfis Z-score foram gerados. Resultados: PASAT induziu aumento significativo no relato de estresse (p <0,001). Após exposição ao estresse experimental, ambos os grupos apresentaram aumento nos limiares de detecção térmicos (CDT: F = 4,25, p = 0,017 e WDT: F = 4,10, p = 0,020) e redução dos limiares de dor térmicos (CPT: F= 11,2, p <0,001 e HPT: F = 8,13, p <0,001) quando comparados com valores iniciais. Entretanto, o estresse não induziu mudanças significativas em MPT, PPT ou WUR (p> 0,050). Conclusão: O estresse psicológico experimental induz hipoestesia térmica e hiperalgesia térmica na musculatura mastigatória independente da presença de DTM dolorosa. Esses achados enfatizam a importância de considerar o estresse psicológico do particpante ao interpretar os resultados de QST.
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