TRIAZOLAM IMPROVES SLEEP BUT FAILS TO ALTER PAIN IN TMD PATIENTS

Patients with chronic ol orofacial pain often report disturbances in s leep, leading to the hypothesis that nocturnal motor hyperactivity of the muscles of mastication may contribute to the nociceptive process. This hypothesis was tested in a controlled study to evaluate the relat ionship between sleep stages, patient self-report of pain in the orofa cial region, and nocturnal masticatory muscle activity. Twenty subject s participating In a two-period, within subject, crossover study recei ved triazolam or placebo for 4 nights. Sleep, pain, and mandibular ran ge of motion were assessed at baseline, following the first period, an d again following the second period; a 3-day washout period separated the two treatments. Subjective report oi sleep quality was significant ly improved following triazolam in comparison to placebo as measured b y category scales for sleep qualify, restfulness, and sleep compared t o usual. The amount of time spent in stage-2 sleep was also significan tly increased by triazolam. No improvement teas seen in pain as measur ed by palpation with an algometer, in scales for sensory intensity and the affective component of pain, or in daily pain diaries. Mean facia l muscle electronmyographic activity for 30-second epochs averaged ove r the entire period of sleep did not reveal any differences in muscle activity across the three conditions. These data indicate that improve ments in sleep quality and alterations in sleep architecture do not af fect nocturnal facial muscle activity or subsequent pain report in tem poromandibular patients, thereby failing to support the hypothesized r elationship between sleep disturbances and chronic orofacial pain.