• Jarno Knuutila, Juhani Kivipuro, Ritva Näpänkangas, Juha Auvinen, Paula Pesonen, Jaro Karppinen, Markus Paananen, Pertti Pirttiniemi, Aune Raustia, and Kirsi Sipilä.
• Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.
• Eur J Pain. 2022 Jan 1; 26 (1): 143-153.

BackgroundPain related to temporomandibular disorders (TMD) can be linked with multiple site pain (MSP), and may associate with increased pain sensitivity, more frequently among women than men. The aim of the study was to examine the associations of pressure pain threshold (PPT) and tolerance (PPTo) with TMD and associated MSP in the Northern Finland Birth Cohort 1966 (NFBC1966) study.MethodsAltogether 1961 NFBC1966 subjects attended clinical medical and dental examination at the Institute of Dentistry, University of Oulu in 2012-2013. Clinical examinations were carried out using a modified Diagnostic Criteria for TMD protocol (DC/TMD). MSP was defined based on questions regarding body pain sites. Additionally, PPT and PPTo were assessed using algometer measurements. Mann-Whitney U-test and Tobit regression models were used to analyse associations between TMD sub-diagnoses, MSP, PPT and PPTo, stratified by sex. Further models were adjusted with anxiety and depressive symptoms, which were assessed using Hopkins Symptom Checklist-25 (HSCL-25) and two-way interaction terms.ResultsAmong females, lower PPT and PPTo were associated with myalgia and arthralgia. Among males, lower PPT and PPTo were associated with MSP-linked TMD. Tobit regression analysis showed significantly lower PPT and PPTo values in the myalgia and arthralgia subgroups among female TMD subjects. Among females, disc displacement with reduction had an inverse association with PPT and PPTo. Among males, lower PPTo was associated with degenerative joint disease and MSP-linked TMD.ConclusionsThe pain regulatory mechanisms behind TMD act differently between the genders as local TMD among females and MSP-linked TMD among males were associated with pain sensitivity.SignificanceThe study shows that there are differences in the associations of painful TMD with pressure pain tolerance, pressure pain sensitivity and MSP between male and female subjects.© 2021 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®.

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