• Davide Pietropaoli, Eleonora Ortu, Mario Giannoni, Ruggero Cattaneo, Alessandra Mummolo, and Annalisa Monaco.
• Department of Life Health and Environmental Science, Division of TMD and Orofacial Pain, University of L'Aquila, Building Delta 6, Floor -1, Room #22, San Salvatore Hospital, Zip Code 67100, V.le San Salvatore, L'Aquila, Italy.
• Pain Res Manag. 2019 Jan 1; 2019: 6256179.

BackgroundTenderness of masseters and temporalis can be considered a relevant tool for diagnosis of myo-type craniofacial pain disorders, but a limit of pain score systems is that they are based on subjective pain perception. Surface electromyography (sEMG) is a noninvasive and reliable tool for recording muscle activity. Therefore, we investigated whether a correlation exists between tenderness on masseters and temporalis, assessed by subjective pain scale, and muscles activity, evaluated by sEMG, in patients with painful temporomandibular disorder (TMD) and concurrent tension-type headache (TTH).MethodsA cross-sectional study on fifty adult volunteer patients with TMD and TTH, who underwent tenderness protocol according to Diagnostic Criteria for TMD (DC/TMD) guidelines, was conducted followed by sEMG recording of temporalis and masseters. Pearson's correlation was performed to investigate the correlation between muscular activity and subjective pain scores.ResultsAn overall moderate correlation between muscle tenderness and sEMG values (y = 1 + 1.2 · x; r2 = 0.62; p < 0.0001), particularly in the temporalis, was observed. Segregation of data occurred according to tenderness and sEMG values. At the highest pain score, the mean sEMG absolute value was higher at the temporalis than the masseters.ConclusionsOur study provides evidence that subjective pain perception can be objectively quantified at a magnitude proportional to pain severity. At greater tenderness scores, higher sEMG activity at the level of temporalis could help discriminate clinically prevalent TTH versus prevalent TMD. sEMG confirms to be an accurate tool to reliably objectify the subjective perception of pain. When combined with clinical evaluation and patients' symptoms, sEMG increases diagnostic sensitivity in the field of myo-type craniofacial pain disorders. This trial is registered with NCT02789085.Copyright © 2019 Davide Pietropaoli et al.

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