Maísa Soares Gui, Rizzatti-Barbosa Célia Marisa
Department of Anatomy, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil.
Department of Prosthesis and Periodontology, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil.
Braz Oral Res. 2015;29. doi: 10.1590/1807-3107BOR-2015.vol29.0018. Epub 2015 Jan 13.
Facial pain often persists long after any identifiable organic pathology has healed. Moreover, in a subgroup of patients with temporomandibular disorder (TMD), no treatment is effective. Knowledge of factors associated with persistent pain in TMD could help identify personalized treatment approaches. Therefore, we conducted a critical review of the literature for the period from January 2000 to December 2013 to identify factors related to TMD development and persistence. The literature findings showed that chronic TMD is marked by psychological distress (somatization and depression, affective distress, fear of pain, fear of movement, and catastrophizing) and characteristics of pain amplification (hyperalgesia and allodynia). Furthermore, these factors seem to interact in TMD development. In addition, our review demonstrates that upregulation of the serotonergic pathway, sleep problems, and gene polymorphisms influence the chronicity of TMD. We conclude that psychological distress and pain amplification contribute to chronic TMD development, and that interactions among these factors complicate pain management. These findings emphasize the importance of multidisciplinary assistance in TMD treatment.
面部疼痛往往在任何可识别的器质性病变愈合后仍会持续很长时间。此外，在颞下颌关节紊乱症（TMD）患者的一个亚组中，任何治疗都无效。了解与TMD持续性疼痛相关的因素有助于确定个性化的治疗方法。因此，我们对2000年1月至2013年12月期间的文献进行了批判性综述，以确定与TMD发生和持续相关的因素。文献研究结果表明，慢性TMD的特征是心理困扰（躯体化和抑郁、情感困扰、疼痛恐惧、运动恐惧和灾难化）以及疼痛放大的特征（痛觉过敏和感觉异常）。此外，这些因素在TMD的发生过程中似乎相互作用。此外，我们的综述表明，血清素能通路的上调、睡眠问题和基因多态性会影响TMD的慢性病程。我们得出结论，心理困扰和疼痛放大促成了慢性TMD的发生，并且这些因素之间的相互作用使疼痛管理变得复杂。这些发现强调了多学科辅助在TMD治疗中的重要性。
