Jasim H, Louca S, Christidis N, Ernberg M
Section of Orofacial Pain and Jaw Function, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
J Oral Rehabil. 2014 Feb;41(2):122-32. doi: 10.1111/joor.12118. Epub 2013 Dec 7.
The aim of this study was to compare the salivary cortisol level, pain intensity and psychological factors between patients with chronic and acute oro-facial pain (OP) and pain-free subjects. Twenty-seven females with chronic OP (a diagnosis of myofascial pain according to the Research Diagnostic Criteria for Temporomandibular Disorders with at least 6 months duration), 24 females with acute OP (<10 days duration) and 27 pain-free females participated. Morning saliva was collected from all participants for analyses of the cortisol level. The pain intensity was assessed on a 0-10 numeric rating scale. The participants were evaluated by the Symptom Checklist 90-revised for levels of depression and somatisation, and the Perceived Stress Scale. The cortisol levels among the three patient groups were similar with no significant group differences. The median (interquartile range) current pain level did not differ between chronic and acute OP and was, respectively, 5 (4) and 5 (3). Patients with chronic OP showed significantly higher scores for depression, somatisation and perceived stress compared with patients with acute OP (Ps < 0.001), but there were no significant differences between acute OP and controls. To conclude, there were no differences in cortisol level between groups, despite significant higher levels of depression, somatisation and perceived stress in patients with chronic OP. This shows that psychological distress has a more important role in chronic than in acute OP. However, the relation between pain, adreno-cortical activity and psychological distress is complex and warrants further investigation.
本研究旨在比较慢性和急性口面部疼痛（OP）患者与无疼痛受试者之间的唾液皮质醇水平、疼痛强度和心理因素。27名患有慢性OP的女性（根据颞下颌关节紊乱研究诊断标准诊断为肌筋膜疼痛，病程至少6个月）、24名患有急性OP的女性（病程<10天）和27名无疼痛的女性参与了研究。收集所有参与者的晨唾液以分析皮质醇水平。疼痛强度采用0至10的数字评分量表进行评估。通过症状自评量表90修订版评估参与者的抑郁和躯体化水平，并采用感知压力量表进行评估。三组患者的皮质醇水平相似，无显著组间差异。慢性和急性OP患者当前的疼痛水平中位数（四分位间距）无差异，分别为5（4）和5（3）。与急性OP患者相比，慢性OP患者的抑郁、躯体化和感知压力得分显著更高（P<0.001），但急性OP患者与对照组之间无显著差异。总之，尽管慢性OP患者的抑郁、躯体化和感知压力水平显著更高，但各组之间的皮质醇水平无差异。这表明心理困扰在慢性OP中比在急性OP中起更重要的作用。然而，疼痛、肾上腺皮质活动和心理困扰之间的关系很复杂，值得进一步研究。
