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Association of decrease in insula fMRI activation with changes in trait anxiety in patients with craniomandibular

J Dammann¹, K Klepzig¹, E Schenkenberger²

¹Functional Imaging Unit, Center for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Germany.

Behavioural Brain Research

|November 8, 2019

Summary

Craniomandibular disorder (CMD) patients experience high trait anxiety. Splint therapy reduced anxiety and anterior insula fMRI activation, suggesting this brain region processes anxiety-related pain anticipation in CMD.

Keywords:

Chronic pain Craniomandibular disease Insula Temporomandibular disease Trait anxiety fMRI

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Area of Science:

Neuroscience
Psychology
Dentistry

Background:

Patients with chronic pain, particularly craniomandibular disorder (CMD), exhibit specific psychopathology related to trait anxiety.
Previous research indicated anterior insula modulation during successful therapy and pain relief in CMD patients.

Purpose of the Study:

To investigate associations between anterior insula functional magnetic resonance imaging (fMRI) activation during occlusal movements and trait anxiety in CMD patients undergoing splint therapy.
To explore the role of the anterior insula in processing anxiety and pain in the context of CMD treatment.

Main Methods:

Three fMRI scans during an occlusal task were conducted on 9 CMD patients before, during, and after 3 months of DIR-mandibular splint therapy.
Pain scores and trait anxiety (State-Trait Anxiety Inventory; STAI) were assessed concurrently.
The Depression and Anxiety Scale (DASS) was also used for anxiety assessment.

Main Results:

CMD patients presented with elevated anxiety levels (STAI, DASS) before therapy.
Splint therapy led to significant pain reduction and a decrease in STAI scores over time.
Reduced STAI scores correlated with decreased fMRI activation in the anterior insula of both brain hemispheres.

Conclusions:

The anterior insula appears to process anxiety-driven anticipation of pain triggered by occlusal stimuli in CMD patients.
This processing within the anterior insula may be a key factor targeted by splint therapy for CMD treatment.