r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2025-30-3-4-12r-n-j-706Research ArticleОБЗОРLITERATURE REVIEWГенетические факторы риска развития хронической орофациальной боли и дисфункции жевательной мускулатуры при синдроме болевой дисфункции височно-нижнечелюстного суставаGenetic risk factors for the development of chronic orofacial pain and masticatory muscle dysfunction in temporomandibular joint pain-dysfunction syndromehttps://orcid.org/0000-0001-9881-5942КоцюбинскаяЮ. В.KotsiubinskayaYu. V.

Санкт-Петербург

St. Petersburg

platonk-juliak@yandex.ruhttps://orcid.org/0009-0009-7606-7168ЕфимовЕ. В.EfimovE. V.

Санкт-Петербург

St. Petersburg

efimov72rus@mail.ruНациональный медицинский исследовательский центр психиатрии и неврологии им. В.М. БехтереваРоссияThe Federal State Institution «V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology» of the Russian Federation Ministry of HealthRussian Federation202508092025303412Copyright © Коцюбинская Ю.В., Ефимов Е.В., 20252025Коцюбинская Ю.В., Ефимов Е.В.Kotsiubinskaya Y.V., Efimov E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/706

Синдром болевой дисфункции височно-нижнечелюстного сустава (СБД ВНЧС) представляет собой мультифакторное заболевание опорно-двигательного аппарата, занимающее второе место по частоте встречаемости после хронической боли в пояснице. Современные исследования подтверждают биопсихосоциальную природу заболевания, которое определяется генетической предрасположенности, приводящей к центральной сенсибилизации, и широкого спектра как психосоциальных, так и физиологических факторов, взаимодействие которых формирует хронический болевой синдром в орофациальной области. В статье анализируется роль генетических факторов в развитии и хронизации СБД ВНЧС. Ключевыми генетическими маркерами признаны вариации гена COMT (Val158Met, rs4680), влияющие на активность катехол-О-метилтрансферазы и регулирующие дофаминергическую/адренергическую передачу. Низкоактивные аллели COMT (Met/Met) коррелируют с повышенной болевой чувствительностью, риском хронизации болевого синдрома и повышенной тревожностью. Полиморфизмы генов ADRB2 (rs1042713) и HTR1A (rs6295) связаны с миофасциальной болью, аллодинией. Изменения в гене ADRB2 влияют на болевую чувствительность людей, связанную с симптомами соматизации, депрессии и тревоги, то есть с фенотипическими характеристиками, обычно встречающимися у людей с генерализованной хронической болью и СБД ВНЧС.

 Исследования, включая масштабный проект OPPERA, демонстрируют, что генетические вариации определяют не только восприимчивость к боли, но и ответ на терапию. В частности, носители минорных аллелей COMT и OPRM1 хуже реагируют на лечение, что указывает на необходимость персонализированного подхода в диагностике и терапии. Полученные данные подчеркивают сложность генетической архитектуры синдрома болевой дисфункции височно-нижнечелюстного сустава, требующую дальнейших исследований, а также наращивания международного сотрудничества для расширения выборки пациентов. Интеграция генетических данных в клиническую практику может улучшить прогнозирование хронизации боли, оптимизировать терапию и разработать превентивные стратегии, снижая социально-экономическое бремя заболевания.

Temporomandibular disorder (TMD) pain represents a multifactorial musculoskeletal condition, ranking as the second most common chronic pain condition after chronic low back pain. Contemporary research confirms its biopsychosocial nature, determined by genetic predisposition leading to central sensitization, and a wide spectrum of interacting psychosocial and physiological factors that shape the chronic orofacial pain syndrome. This article analyzes the role of genetic factors in the development and chronification of TMD pain. Key genetic markers identified include variations in the COMT gene (val158met, rs4680), which influence catechol-O-methyltransferase activity and regulate dopaminergic/adrenergic neurotransmission. Low-activity COMT alleles (met/met) correlate with heightened pain sensitivity, increased risk of pain chronification, and elevated anxiety. Polymorphisms in the ADRB2 (rs1042713) and HTR1A (rs6295) genes are associated with myofascial pain and allodynia. Variations in ADRB2 influence pain sensitivity linked to symptoms of somatization, depression, and anxiety — phenotypic characteristics commonly observed in individuals with generalized chronic pain and TMD. Studies, including the large-scale OPPERA project, demonstrate that genetic variations determine not only pain susceptibility but also treatment response. Specifically, carriers of minor alleles in COMT and OPRM1 exhibit poorer treatment outcomes, highlighting the need for a personalized approach in diagnosis and therapy. These findings underscore the complexity of the genetic architecture underlying Temporomandibular Disorder pain syndrome, necessitating further research and enhanced international collaboration to expand patient cohorts. Integrating genetic data into clinical practice could improve prediction of pain chronification, optimize treatment strategies, and develop preventive measures, thereby reducing the socioeconomic burden of the disease.

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The authors declare that there are no conflicts of interest present.