Better Palpation of Pain: Reliability and Validity of a New Pressure Pain Protocol in TMD

ABSTRACT

The purpose of this research was to employ a double-blind placebo control design of ion-tophoretically administered lidocaine to assess the test-retest reliability and validity of a magnitude matching procedure using a pressure algometer. In studies in the literature on assessment of pain in temporomandibular disorders (TMD), the pressure algometer has been found to be a reliable means of measuring pressure-pain threshold and a sensitive measure of treatment-response in the laboratory. However, previous research with this apparatus has not employed more sophisticated psychophysics. This study employs a magnitude matching psychophysical protocol to obtain a multidimensional pain report. Test-retest reliability over two occasions, 3–8 days apart, was found to be moderate for discrim-inability ($=.71, $ <.01) but poor for response bias (r =.44). The validity study used iontophoresis as an anesthetic in a double-blind placebo and no-treatment control design. Although it was hypothesized that subjects in the anesthesia group would demonstrate reduced discriminability as compared with the control groups, no differences were found among the three groups on this measure. However, differences in response bias were found, with both the placebo control and no-treatment control groups differing from the experimental group but not from each other. Possible explanations and the implications of these findings are discussed.

Additional information

Notes on contributors

Felicia F. Brown

Dr. Felicia F. Brown received her doctorate in clinical psychology from the University of Florida Department of Clinical and Health Psychology in 1998. She interned at The Harvard Medical School/McLean Hospital and then completed a post doctoral fellowship in behavioral medicine at The Harvard Medical Hospital/Cambridge Health Alliance (formerly Cambridge Hospital). Dr. Brown is currently on staff at McLean Hospital.

Michael E. Robinson

Dr. Michael E. Robinson received his Ph.D. in Clinical Psychology from Bowling Green State University in 1988. He did his internship at Duke University Medical Center in 1987. Since 1988 he has been on the faculty in the Department of Clinical and Health Psychology, where he is currently an Associate Professor. Dr. Robinson serves as the Research Director of the University of Florida SpineCare Center, the Center for Musculoskeletal Injury Research and the UF Pain Research Laboratory. He is also a consultant to the UF Facial Pain Center, the UF SpineCare Center and the Anesthesiology Pain Management Center. He has published numerous articles in the area of pain perception, management of pain conditions, psychological factors in chronic pain, and sex differences in pain.

Joseph L. Riley

Dr. Joseph L. Riley, III received the degree of Ph.D. in Clinical and Health Psychology from the University of Florida in 1996, with a training focus in the area of behavioral medicine/dentistry and is currently on the faculty of the University of Florida College of Dentistry. He has completed a one-year clinical internship at the Gainesville VMAC funded by Geriatric Research Education and Clinical Center followed by a two-year fellowship in Behavioral Dentistry funded by the National Institute of Dental Research through the Claude D. Pepper Center for Research on Oral Health in Aging. Dr. Riley's primary research interests involve the study of the behavioral factors in the experience of chronic pain and in the differences in pain. Topics of recent publications include the interrelationships between pain, negative mood, somatic focus, and outcome, sex differences in response to cutaneous anesthesia, sex differences in report of clinical and experimental pain, and painful orofacial symptoms in the elderly.

Henry A. Gremillion

Dr. Henry A. Gremillion is a 1977 graduate of Louisiana State University School of Dentistry. He maintained a private general dental practice in Cottonport, Louisiana from 1977 to 1989. He then completed a two-year fellowship in Craniofacial Pain and Dysfunction at the University of Florida College of Dentistry under the mentorship of Dr. Parker D. Mahan. Currently, Dr. Gremillion serves as an Associate Professor in the Department of Oral and Maxillofacial Surgery and holds an affiliate appointment in the Department of Prosthodontics at the UFCD. He is Director of the Parker E. Mahan Facial Pain Center, directs a fellowship program in orofacial pain and is on the active dental staff of Shands Teaching Hospital. He serves as a consultant in the fields of temporomandibular disorders and orofacial pain for the U.S. Army, U.S. Navy, Veteran's Administration Hospital in Gainesville, Florida, and the Comprehensive Dentistry Program at UFCD. Dr. Gremillion is an associate faculty member and on the Board of Directors of the LD. Pankey Institute for Advanced Dental Education. His research interests include temporomandibular disorders, bruxism and psychosocial aspects of orofacial pain. His major clinical interest is the diagnosis and management of orofacial pain.

James McSolay

James McSolay and Gary Meyers are students at the University of Florida School of Dentistry.

Gary Meyers

James McSolay and Gary Meyers are students at the University of Florida School of Dentistry.