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Aims: To examine the jaw-stretch reflex after injection of local
anesthetic (LA) into painful temporomandibular joints (TMJs),
since the functional role of jaw-stretch reflexes in patients with
painful temporomandibular disorders is still not well understood.
Methods: Thirteen female patients with a clinical diagnosis of disc
displacement without reduction and TMJ pain participated in this
open study. Reflex responses were evoked by fast stretches at 15%
of the maximal voluntary contraction level before and after injection
of 1 mL carbocaine into the painful TMJ. Electromyographic
(EMG) activity was recorded from the left and right masseter and
temporalis muscles, and the mean level of prestimulus EMG activity
and peak-to-peak amplitude of the stretch reflex were measured.
Visual analog scale ratings of TMJ pain and TMJ pressure
pain thresholds (PPTs) were also obtained. Eleven healthy women
were examined with the same protocol (except for PPT determinations)
before and after injection of LA into the TMJ. Results: In
patients, injection of LA reduced the TMJ pain during jaw movements
and maximum clenching (P .021) and increased the PPTs
in the painful TMJ (P .01). The prestimulus EMG activity in the
masseter on the painful side (feedback muscle) was unaffected by
the injection of LA (P .262). There were no significant side-toside
asymmetries of latency or amplitude measures of the stretch
reflex in the patient group. Both the peak-to-peak amplitude and
the normalized peak-to-peak amplitude of the stretch reflex were
reduced in the masseter and temporalis muscles on the painful side
and in the masseter on the nonpainful side after LA injections (P
.048). There were no effects of LA injections into the TMJ in
the healthy group on any EMG or stretch parameters. Conclusion:
These results do not support the notion of asymmetries in the jawstretch
reflex in patients with TMJ pain, but they do suggest that
the reflex sensitivity can be influenced by nociceptive activity from
the TMJ area. J OROFAC PAIN 2004;18:33–40.
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