Bair Eric, Gaynor Sheila, Slade Gary D, Ohrbach Richard, Fillingim Roger B, Greenspan Joel D, Dubner Ronald, Smith Shad B, Diatchenko Luda, Maixner William
Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Departments of Biostatistics and Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Biostatistics, Harvard University, Boston, MA, USA Departments of Dental Ecology and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, NY, USA Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA Department of Neural and Pain Sciences and Brotman Facial Pain Clinic, University of Maryland School of Dentistry, Baltimore, MD, USA The Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada.
Pain. 2016 Jun;157(6):1266-1278. doi: 10.1097/j.pain.0000000000000518.
The classification of most chronic pain disorders gives emphasis to anatomical location of the pain to distinguish one disorder from the other (eg, back pain vs temporomandibular disorder [TMD]) or to define subtypes (eg, TMD myalgia vs arthralgia). However, anatomical criteria overlook etiology, potentially hampering treatment decisions. This study identified clusters of individuals using a comprehensive array of biopsychosocial measures. Data were collected from a case-control study of 1031 chronic TMD cases and 3247 TMD-free controls. Three subgroups were identified using supervised cluster analysis (referred to as the adaptive, pain-sensitive, and global symptoms clusters). Compared with the adaptive cluster, participants in the pain-sensitive cluster showed heightened sensitivity to experimental pain, and participants in the global symptoms cluster showed both greater pain sensitivity and greater psychological distress. Cluster membership was strongly associated with chronic TMD: 91.5% of TMD cases belonged to the pain-sensitive and global symptoms clusters, whereas 41.2% of controls belonged to the adaptive cluster. Temporomandibular disorder cases in the pain-sensitive and global symptoms clusters also showed greater pain intensity, jaw functional limitation, and more comorbid pain conditions. Similar results were obtained when the same methodology was applied to a smaller case-control study consisting of 199 chronic TMD cases and 201 TMD-free controls. During a median 3-year follow-up period of TMD-free individuals, participants in the global symptoms cluster had greater risk of developing first-onset TMD (hazard ratio = 2.8) compared with participants in the other 2 clusters. Cross-cohort predictive modeling was used to demonstrate the reliability of the clusters.
大多数慢性疼痛疾病的分类着重于疼痛的解剖位置，以区分一种疾病与另一种疾病（例如，背痛与颞下颌关节紊乱症 [TMD]）或定义亚型（例如，TMD 肌痛与关节痛）。然而，解剖学标准忽略了病因，可能会妨碍治疗决策。本研究使用一系列全面的生物心理社会测量方法确定了个体集群。数据来自一项病例对照研究，该研究纳入了1031例慢性TMD病例和3247例无TMD的对照。使用监督聚类分析确定了三个亚组（称为适应性、疼痛敏感和全身症状集群）。与适应性集群相比，疼痛敏感集群的参与者对实验性疼痛表现出更高的敏感性，而全身症状集群的参与者则表现出更高的疼痛敏感性和更大的心理困扰。集群归属与慢性TMD密切相关：91.5%的TMD病例属于疼痛敏感和全身症状集群，而41.2%的对照属于适应性集群。疼痛敏感和全身症状集群中的颞下颌关节紊乱症病例也表现出更高的疼痛强度、下颌功能受限和更多的合并疼痛情况。当将相同方法应用于一项较小的病例对照研究（包括199例慢性TMD病例和201例无TMD的对照）时，也获得了类似结果。在无TMD个体的中位3年随访期内，全身症状集群的参与者与其他两个集群的参与者相比，发生首发TMD的风险更高（风险比 = 2.8）。使用跨队列预测模型来证明集群的可靠性。
