PAIN
Volume 137, Issue 2 , Pages 286-294, 15 July 2008

Effects of intra-articular ketamine on pain and somatosensory function in temporomandibular joint arthralgia patients

  • Emad E. Ayesh

      Affiliations

    • Department of Clinical Oral Physiology, School of Dentistry, University of Aarhus, Vennelyst Boulevard 9, DK-8000 Aarhus, Denmark
    • ,
  • Troels S. Jensen

      Affiliations

    • Department of Neurology, Aarhus University Hospital, Denmark
    • ,
  • Peter Svensson

      Affiliations

    • Department of Clinical Oral Physiology, School of Dentistry, University of Aarhus, Vennelyst Boulevard 9, DK-8000 Aarhus, Denmark
    • Department of Oral Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
    • Center for Sensory Motor Interaction, Aalborg University, Denmark
    • Corresponding Author InformationCorresponding author. Tel.: +45 8942 4191; fax: + 45 8619 5665.

Received 26 March 2007; received in revised form 23 August 2007; accepted 5 September 2007. published online 08 October 2007.

Abstract 

Recent studies have hypothesized that peripheral glutamate receptors could be implicated in deep craniofacial pain conditions. In this study 18 temporomandibular joint (TMJ) arthralgia patients received intra-articular injections of the N-methyl-d-aspartate (NMDA) receptor antagonist, ketamine, or normal saline to study in a cross-over, double-blinded, placebo-controlled manner the effect on TMJ pain and somatosensory function. Spontaneous pain and pain on jaw function was scored by patients on 0–10cm visual analogue scale (VAS) for up to 24h. Quantitative sensory tests (QST): tactile, pin-prick, pressure pain threshold and pressure pain tolerance were used for assessment of somatosensory function at baseline and up to 15min after injections. There were no significant effects of intra-articular ketamine over time on spontaneous VAS pain measures (ANOVA: P=0.532), pain on jaw opening (ANOVA: P=0.384), or any of the somatosensory measures (ANOVA: P>0.188). The poor effect of ketamine could be due to involvement of non-NMDA receptors in the pain mechanism and/or ongoing pain and central sensitization independent of peripheral nociceptive input. In conclusion, there appears to be no rationale to use intra-articular ketamine injections in TMJ arthralgia patients, and peripheral NMDA receptors may play a minor role in the pathophysiology of this disorder.

Keywords: TMJ pain, Arthralgia, NMDA, Ketamine, Quantitative sensory tests, Trigeminal physiology

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PII: S0304-3959(07)00513-1

doi:10.1016/j.pain.2007.09.004

PAIN
Volume 137, Issue 2 , Pages 286-294, 15 July 2008

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