Patients with Concomitant Chronic Neck Pain and Myofascial Pain in Masticatory Muscles Have More Widespread Pain and Distal Hyperalgesia than Patients with Only Chronic Neck Pain

Pain Med. 2017 Mar 1;18(3):526-537. doi: 10.1093/pm/pnw274.


Objective: Insufficient evidence exists to compare widespread pain (WP), pain sensibility, and psychological factors that occur in patients presenting with chronic neck pain (CNP) or a combination of temporomandibular disorder (TMD) and other complaints. The present study compared the pain sensibility and psychological factors of subjects with CNP with those with TMD + CNP.

Design: Cross-sectional study.

Setting: Local community.

Subjects: A nonprobabilistic convenience sample of 86 persons with CNP or TMD was recruited into three groups: CNP, TMD with myofascial pain in masticatory muscles with cocomitant CNP (TMD + CNP), and asymptomatic control groups consisted of 27, 29, and 30 participants, respectively.

Methods: Participants underwent a clinical examination to evaluate WP with computerized assessment based on the pain drawing, pressure pain thresholds (PPT), and psychological factors, which were evaluated using the pain catastrophizing scale (PCS) and the state-trait anxiety inventory (STAI).

Results: Statistically significant differences were observed between participants with CNP and TMD + CNP for WP (t = -2.80, P < 0.01, d = -1.06). Post hoc analyses only revealed significant differences between TMD + CNP participants and asymptomatic controls for PPT at extratrigeminal areas. Pearson correlation analyses showed a moderate positive association between symptomatic groups within the WP and STAI ( P < 0.05) and a moderate negative association between PCS and PPT ( P < 0.05) at the right tibialis muscle.

Conclusion: TMD + CNP participants had more areas of pain and also showed widespread pain hyperalgesia. Both groups of participants had psychological factors positively associated with STAI and WP; further, PCS and the PPT at the extratrigeminal region were negatively associated with each other in both groups, except for the left tibialis in the TMD + CNP group.

Keywords: Anxiety; Neck Pain; Orofacial Pain; Pain Catastrophizing; Widespread Pain.

MeSH terms

  • Adult
  • Chronic Pain
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hyperalgesia / epidemiology*
  • Hyperalgesia / etiology
  • Hyperalgesia / psychology
  • Male
  • Masticatory Muscles
  • Neck Pain / complications*
  • Neck Pain / psychology
  • Pain Threshold
  • Temporomandibular Joint Dysfunction Syndrome / complications*
  • Temporomandibular Joint Dysfunction Syndrome / psychology