Mongini Franco, Ciccone Giovannino, Ceccarelli Manuela, Baldi Ileana, Ferrero Luca
Section Headache-Facial Pain, Department of Clinical Pathophysiology, University of Turin, 14 Corso Dogliotti, I-10126 Torino, Italy.
Pain. 2007 Sep;131(1-2):106-11. doi: 10.1016/j.pain.2006.12.017. Epub 2007 Jan 26.
To evaluate in patients with different types of facial pain the association between muscle tenderness and a set of characteristics, 649 consecutive outpatients with facial myogenous pain (MP), TMJ disorder, neuropathic pain (NP) and facial pain disorder (FPD) (DSM-IV) were enrolled. For each patient a psychological assessment on the Axis 1 of the DSM-IV and standardized palpation of pericranial and cervical muscles were carried out. A pericranial muscle tenderness score (PTS), a cervical muscle tenderness score (CTS) and a cumulative tenderness score (CUM, range 0-6) were calculated. Univariate analyses (one-way analysis of variance or chi(2) test) indicated that both age- and sex-distribution, tenderness scores and prevalence of psychiatric disorders markedly differed between groups. The prevalence of depression was highest in FPD patients (44.9%). Both muscle tenderness scores (either PTS or CTS) and prevalence of anxiety were higher in patients with MP than in those with TMJ or NP. To assess associations between CUM score and patients' demographic and clinical characteristics an ordered logit model was fit and interactions between psychiatric disorders and diagnostic groups were tested. The analysis showed that, regardless of the diagnostic group, anxiety and depression independently increase the likelihood of having one point higher muscle tenderness score (OR=1.55, 95% CI: 1.13-2.12 and OR=1.56, 95% CI: 1.10-2.21, respectively). A careful screening for the presence of an underlying psychiatric disorder, either anxiety or depression, should be part of the clinical evaluation in patients suffering from facial pain.
为了评估不同类型面部疼痛患者中肌肉压痛与一组特征之间的关联，我们招募了649例连续性门诊患者，他们分别患有面部肌源性疼痛（MP）、颞下颌关节紊乱症、神经性疼痛（NP）和面部疼痛障碍（FPD，DSM-IV标准）。对每位患者进行了DSM-IV轴I的心理评估以及颅周和颈部肌肉的标准化触诊。计算了颅周肌肉压痛评分（PTS）、颈部肌肉压痛评分（CTS）和累积压痛评分（CUM，范围0 - 6）。单因素分析（方差分析或卡方检验）表明，年龄和性别分布、压痛评分以及精神障碍患病率在各组之间存在显著差异。FPD患者中抑郁症的患病率最高（44.9%）。MP患者的肌肉压痛评分（PTS或CTS）和焦虑患病率均高于颞下颌关节紊乱症或NP患者。为了评估CUM评分与患者人口统计学和临床特征之间的关联，我们拟合了一个有序logit模型，并测试了精神障碍与诊断组之间的相互作用。分析表明，无论诊断组如何，焦虑和抑郁独立增加肌肉压痛评分高一分的可能性（OR = 1.55，95% CI：1.13 - 2.12；OR = 1.56，95% CI：1.10 - 2.21）。对于患有面部疼痛的患者，临床评估应包括仔细筛查是否存在潜在的精神障碍，无论是焦虑还是抑郁。
