Chronic joint pain is a widespread problem that frequently occurs with aging and trauma. Pain occurs most often in synovial joints, the body's load bearing joints. The mechanical and molecular mechanisms contributing to synovial joint pain are reviewed using two examples, the cervical spinal facet joints and the temporomandibular joint (TMJ). Although much work has focused on the macroscale mechanics of joints in health and disease, the combined influence of tissue mechanics, molecular processes, and nociception in joint pain has only recently become a focus. Trauma and repeated loading can induce structural and biochemical changes in joints, altering their microenvironment and modifying the biomechanics of their constitutive tissues, which themselves are innervated. Peripheral pain sensors can become activated in response to changes in the joint microenvironment and relay pain signals to the spinal cord and brain where pain is processed and perceived. In some cases, pain circuitry is permanently changed, which may be a potential mechanism for sustained joint pain. However, it is most likely that alterations in both the joint microenvironment and the central nervous system (CNS) contribute to chronic pain. As such, the challenge of treating joint pain and degeneration is temporally and spatially complicated. This review summarizes anatomy, physiology, and pathophysiology of these joints and the sensory pain relays. Pain pathways are postulated to be sensitized by many factors, including degeneration and biochemical priming, with effects on thresholds for mechanical injury and/or dysfunction. Initiators of joint pain are discussed in the context of clinical challenges including the diagnosis and treatment of pain.
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February 2017
Research-Article
The Interface of Mechanics and Nociception in Joint Pathophysiology: Insights From the Facet and Temporomandibular Joints
Megan M. Sperry,
Megan M. Sperry
Department of Bioengineering,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: sperrym@seas.upenn.edu
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: sperrym@seas.upenn.edu
Search for other works by this author on:
Meagan E. Ita,
Meagan E. Ita
Department of Bioengineering,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: meita@seas.upenn.edu
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: meita@seas.upenn.edu
Search for other works by this author on:
Sonia Kartha,
Sonia Kartha
Department of Bioengineering,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: skartha@seas.upenn.edu
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: skartha@seas.upenn.edu
Search for other works by this author on:
Sijia Zhang,
Sijia Zhang
Department of Bioengineering,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: sijiaz@seas.upenn.edu
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: sijiaz@seas.upenn.edu
Search for other works by this author on:
Ya-Hsin Yu,
Ya-Hsin Yu
Department of Endodontics,
School of Dental Medicine,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: yayu@upenn.edu
School of Dental Medicine,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: yayu@upenn.edu
Search for other works by this author on:
Beth Winkelstein
Beth Winkelstein
Departments of Bioengineering
and Neurosurgery,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: winkelst@seas.upenn.edu
and Neurosurgery,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: winkelst@seas.upenn.edu
Search for other works by this author on:
Megan M. Sperry
Department of Bioengineering,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: sperrym@seas.upenn.edu
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: sperrym@seas.upenn.edu
Meagan E. Ita
Department of Bioengineering,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: meita@seas.upenn.edu
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: meita@seas.upenn.edu
Sonia Kartha
Department of Bioengineering,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: skartha@seas.upenn.edu
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: skartha@seas.upenn.edu
Sijia Zhang
Department of Bioengineering,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: sijiaz@seas.upenn.edu
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: sijiaz@seas.upenn.edu
Ya-Hsin Yu
Department of Endodontics,
School of Dental Medicine,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: yayu@upenn.edu
School of Dental Medicine,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: yayu@upenn.edu
Beth Winkelstein
Departments of Bioengineering
and Neurosurgery,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: winkelst@seas.upenn.edu
and Neurosurgery,
University of Pennsylvania,
240 Skirkanich Hall,
210 S. 33rd Street,
Philadelphia, PA 19104-6321
e-mail: winkelst@seas.upenn.edu
Manuscript received December 10, 2016; final manuscript received December 23, 2016; published online January 19, 2017. Assoc. Editor: Victor H. Barocas.
J Biomech Eng. Feb 2017, 139(2): 021003 (13 pages)
Published Online: January 19, 2017
Article history
Received:
December 10, 2016
Revised:
December 23, 2016
Citation
Sperry, M. M., Ita, M. E., Kartha, S., Zhang, S., Yu, Y., and Winkelstein, B. (January 19, 2017). "The Interface of Mechanics and Nociception in Joint Pathophysiology: Insights From the Facet and Temporomandibular Joints." ASME. J Biomech Eng. February 2017; 139(2): 021003. https://doi.org/10.1115/1.4035647
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