Referred craniofacial pain patterns in patients with temporomandibular disorder

Background. Referred pain is prevalent in the craniofacial region, and it would be helpful for dental practitioners to have drawings delineating regions with a high probability for a patient's referred pain source. Methods. The author applied firm pressure for approximately five seconds to trigger points, nodules of spot tenderness, and selected masticatory structures within the head and neck region on 230 patients with temporomandibular disorder, or TMD. As firm pressure was being applied, subjects were asked whether pain was developing or intensifying in a location different than that being palpated. Results. One hundred ninety-six subjects (85 percent) reported that referred pain was being generated. The cheek area, ear and forehead were the most frequently reported sites of referred pain generation; palpation over the trapezius muscle, lateral pterygoid area and masseter muscle were the most common sources of referred pain to the craniofacial region. The author provides figures displaying common referred pain sites and their sources. Conclusions. Patients with TMD often report referred craniofacial pain arising from palpation of the head and neck region. The author found that the pattern between referred pain source and site was consistent and predictable. Practice Implications. Practitioners should consider craniofacial pain's propensity for referral when treating patients with TMD. Practitioners can use the figures presented to determine regions of high probability for a patient's referred pain source.