Manolis Jusakos

Background: Orofacial myofascial pain shows variable muscle sensitivity, referred pain, and complex spatiotemporal pressure processing profiles. Methods: This participant‐, examiner‐ and data analyst‐blinded case–control study compared masticatory muscle sensitivity and entropy patterns between 28 chronic myofascial TMD pain patients and 28 age‐ and sex‐matched controls, introducing a comprehensive approach for ‘topoalgesia’ assessment. Mechanical pain sensitivity (MPS) was assessed at nine sites on the masseter and temporalis muscles bilaterally using a palpometer with 0.5, 1.0 and 2.0 kgf for 2 s. Participants rated MPS on a 0–50–100 numeric rating scale after each palpation and reported referred sensations. Entropy and center of gravity (COG) were analysed. Results: Chronic myofascial TMD pain patients reported significantly greater MPS scores than controls across all force levels and muscles ( p < 0.05). Both groups showed increased MPS with higher applied forces. TMD patients exhibited significantly greater entropy in the masseter muscle at 0.5 and 1.0 kgf, and in the temporalis muscle at 2.0 kgf ( p < 0.001). TMD patients also reported more referred sensations than controls across all force levels ( p < 0.001). COG analysis showed myofascial TMD patients presented more centrally located COG within the masseter muscle than controls particularly at lower forces. Conclusions: Results suggest that chronic myofascial TMD patients present greater muscle sensitivity, differing entropy profiles across muscles and force levels, and distinct spatiotemporal patterns compared to controls, associated with more frequent referred sensations. These findings contribute to understanding chronic muscle pain manifestations, and topoalgesia may help better track disease progression or remission over time. Significance Statement: Quantification of spatial variation in pressure sensitivity (topoalgesia) showed that chronic myofascial TMD patients diverge from healthy controls at 0.5 kg and 2.0 kg palpation forces, but not at 1.0 kg, identifying force‐specific parameters that could sharpen diagnostic sensitivity for orofacial pain.

Temporomandibular disorders (TMDs) are complex multi-system disorders for which common traditional dental-centric approaches to research and care unfortunately continue to prevail. A committee appointed by the National Academies of Sciences, Engineering and Medicine (NAM) of the United States of America summarized important recommendations regarding the urgent need to transform, from the predominantly biomedical model, the research, professional education/training, and patient care for TMDs into the biopsychosocial model that is standard in the rest of pain medicine. The release of the Consensus Study Report identifies eleven short-term and long-term recommendations regarding gaps and opportunities oriented towards the situation in the US, which are equally applicable to the situation in Chile. The first four recommendations focus on basic and translational research, public health research and strengthening clinical research. The next three recommendations concern risk assessment, diagnostics, and dissemination of clinical practice guidelines and care metrics to improve patient care and expand its access. Recommendations eight to ten propose Centers of Excellence for Temporomandibular Disorders and Orofacial Pain Treatment, improving professional school education, and expanding specialized continuing education for healthcare providers. The eleventh recommendation focuses on patient education and stigma reduction. This article highlights the published recommendations and addresses what should be considered by Chilean professionals, as a first step of a major effort to shift TMD research, treatment, and education paradigms for the years to come.