Canada Research Chair in Neuropharmacology, Faculty of Pharmaceutical Sciences, University of British Columbia, 2146 East Mall, Vancouver, Canada.
J Oral Rehabil. 2010 May;37(6):391-410. doi: 10.1111/j.1365-2842.2010.02074.x. Epub 2010 Mar 10.
This article discusses the pathophysiology of temporomandibular disorders (TMD)-related pain and its treatment with analgesic drugs. Temporomandibular disorders are comprised of a group of conditions that result in temporomandibular joint pain (arthralgia, arthritis) and/or masticatory muscle pain (myofascial TMD). In at least some patients with TMD, a peripheral mechanism contributes to this pain. However, there is often a poor correlation between the severity of TMD-related pain complaints and evidence of definitive tissue pathology. This has led to the concept that pain in some patients with TMD may result from altered central nervous system pain processing and further that this altered pain processing may be attributable to specific genes that are heritable. Psychosocial stressors are also thought to contribute to the development of TMD-related pain, particularly masticatory muscle pain. Finally, substantially more women suffer from TMD than men. Although there are arguably multiple reasons for sex-related differences in the prevalence of TMD, one candidate for the increased occurrence of this disorder in women has been suggested to be the female sex hormone oestrogen. Analgesic drugs are an integral part of the primary treatment for TMD-related pain and dysfunction with more that 90% of treatment recommendations involving use of medications. The most commonly used agents include non-steroidal anti-inflammatory drugs, corticosteroids, muscle relaxants, anxiolytics, opiates and tricyclic antidepressants, however, evidence in support of the effectiveness of these drugs is lacking. Continued research into the pathophysiology of TMD-related pain and the effectiveness of analgesic treatments for this pain is required.
本文讨论了颞下颌关节紊乱相关疼痛的病理生理学及其与镇痛药的治疗。颞下颌关节紊乱症是一组导致颞下颌关节疼痛（关节痛、关节炎）和/或咀嚼肌疼痛（肌筋膜 TMD）的病症。在至少一些 TMD 患者中，外周机制促成了这种疼痛。然而，TMD 相关疼痛的严重程度与明确的组织病理学证据之间往往相关性较差。这导致了这样一种概念，即一些 TMD 患者的疼痛可能是由于中枢神经系统疼痛处理的改变引起的，而这种改变的疼痛处理可能归因于可遗传的特定基因。心理社会应激源也被认为是导致 TMD 相关疼痛发展的原因，特别是咀嚼肌疼痛。最后，女性患 TMD 的比例明显高于男性。尽管有多个理由可以解释 TMD 发病率的性别差异，但女性中这种疾病发生率增加的一个候选因素被认为是女性性激素雌激素。镇痛药是 TMD 相关疼痛和功能障碍的主要治疗方法的重要组成部分，超过 90%的治疗建议涉及药物使用。最常用的药物包括非甾体抗炎药、皮质类固醇、肌肉松弛剂、抗焦虑药、阿片类药物和三环类抗抑郁药，但缺乏这些药物有效性的证据。需要进一步研究 TMD 相关疼痛的病理生理学以及这些疼痛的镇痛药治疗效果。
