van Grootel Robert J, van der Glas Hilbert W, Buchner Rob, de Leeuw Johannes R J, Passchier Jan
Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Clin J Pain. 2005 Mar-Apr;21(2):154-65. doi: 10.1097/00002508-200503000-00007.
Myogenous temporomandibular disorders are characterized by jaw muscle pain. The aims were: 1) to characterize this pain generally in terms of intensity, frequency, duration, and behavior across a period of 2 weeks; 2) to identify main intraday pain patterns and to examine whether subgroups of patients in this respect differed in clinical, demographic, pain and sleep variables, psychosocial factors, and use of medication; and 3) to investigate some possible interday trends of pain intensity at a group level.
One hundred thirty-three patients with myogenous temporomandibular disorders completed a 2-week diary, rating pain intensity (100 mm Visual Analog Scale [VAS]), duration, behavior (verbal 6-point scale), and medication use on 4 times of the day. Furthermore, questionnaires were completed to score pain period before seeking treatment, spread of pain, and demographic, psychosocial, and sleep variables.
In the diary, pain intensity, frequency, daily pain duration, and the score of pain behavior were on average 29.1 mm, 69% of the scoring times, 5.5 hours, and 1.8 points (approaching "pain present, but I can ignore it at times"), respectively. Pain intensity was, on average, maximal late in the day (before dinner or bedtime) for the majority of patients (79%) and early in the day (before breakfast or lunchtime) for the minority (21%). The larger subgroup had a significantly higher daily pain intensity, more frequently a widespread pain and problems with falling asleep at bedtime, agreed more about the role of a physician as an external health locus of control, and had a more distancing coping style. Both subgroups were similar for other variables, most notably in the level of state anxiety and depressive mood, and in a sparse use (7.8% of all possible times) of over-the-counter medication. Daily mean VAS scores, averaged across patients, were approximately constant for the various diary days. Both the daily mean and maximal VAS score were not related to a specific day of the week.
Two main daily pain patterns occur in patients with myogenous temporomandibular disorders (79%: maximal pain late in the day; 21%: early in the day), which might be related to differences in processes that influence pain sensitivity and patterns of jaw muscle activation. The interday similarities in pain level suggest that a sustained influence of counseling after the intake or an influence of a common behavioral pattern with a cycle duration of a week are not involved.
肌源性颞下颌关节紊乱症的特征是颌面部肌肉疼痛。本研究旨在：1）在为期2周的时间内，从强度、频率、持续时间和行为方面对这种疼痛进行总体描述；2）识别主要的日内疼痛模式，并检查在这方面患者亚组在临床、人口统计学、疼痛和睡眠变量、心理社会因素以及药物使用方面是否存在差异；3）在组水平上研究疼痛强度的一些可能的日间趋势。
133例肌源性颞下颌关节紊乱症患者完成了一份为期2周的日记，记录疼痛强度（100毫米视觉模拟量表[VAS]）、持续时间、行为（言语6级量表）以及一天中4个时间点的药物使用情况。此外，还完成了问卷调查，以评估治疗前的疼痛期、疼痛扩散情况以及人口统计学、心理社会和睡眠变量。
在日记中，疼痛强度、频率、每日疼痛持续时间和疼痛行为评分平均分别为29.1毫米、69%的评分时间、5.5小时和1.8分（接近“疼痛存在，但我有时可以忽略它”）。大多数患者（79%）的疼痛强度平均在一天晚些时候（晚餐前或就寝时间）达到最大值，少数患者（21%）在一天早些时候（早餐前或午餐时间）达到最大值。较大的亚组每日疼痛强度明显更高，更频繁地出现广泛疼痛以及就寝时入睡困难，更多地认同医生作为外部健康控制点的作用，并且具有更疏离的应对方式。两个亚组在其他变量方面相似，最显著的是在状态焦虑和抑郁情绪水平，以及非处方药物的使用较少（占所有可能时间的7.8%）。患者的每日平均VAS评分在不同日记日大致保持不变。每日平均VAS评分和最大VAS评分均与一周中的特定日期无关。
肌源性颞下颌关节紊乱症患者出现两种主要的日内疼痛模式（79%：一天晚些时候疼痛最大；21%：一天早些时候疼痛最大），这可能与影响疼痛敏感性的过程差异以及颌面部肌肉激活模式有关。疼痛水平的日间相似性表明，摄入后咨询的持续影响或一周周期的常见行为模式的影响并不存在。
