头痛会加剧颞下颌关节紊乱症的疼痛特征。

Headache Exacerbates Pain Characteristics in Temporomandibular Disorders.

作者信息

Costa Yuri Martins, Alves da Costa Dayse Regina, de Lima Ferreira Ana Paula, Porporatti André Luís, Svensson Peter, Rodrigues Conti Paulo César, Bonjardim Leonardo Rigoldi

出版信息

J Oral Facial Pain Headache. 2017 Fall;31(4):339–345. doi: 10.11607/ofph.1746. Epub 2017 Oct 3.

DOI:10.11607/ofph.1746

PMID:28973049

Abstract

AIMS

To evaluate the impact of headache in adults with masticatory myofascial pain (MMP) on the outcome variables clinical pain (ie, self-reported pain intensity and pressure pain sensitivity), sleep quality, and pain catastrophizing.

METHODS

A total of 97 patients with MMP were diagnosed with co-existing headache (MMPH group, n = 50) or without headache (MMP group, n = 47) according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The outcome parameters were the Pittsburgh Sleep Quality Index (PSQI); the Catastrophizing Thoughts subscale of the Pain-Related Self-Statement Scale (PRSS-C); pressure pain thresholds (PPTs) of the masseter and anterior temporalis muscles; and self-reported facial pain intensity measured on a 0- to 10-cm visual analog scale (VAS). Student t test for independent samples (α = 1.2%) and factorial analysis of variance (ANOVA) (α = 5%) were used to analyze the data.

RESULTS

The MMPH group showed significantly impaired sleep quality (mean ± standard deviation [SD] PSQI score 9.1 ± 3.5) compared with the MMP group (7.2 ± 3.4; P = .008). Subscale scores on the PRSS-C were significantly higher in the MMPH (2.1 ± 1.2) than in the MMP group (1.6 ± 1.4, uncorrected P = .048). Also, the PPTs (kgf/cm²) of the masseter and anterior temporalis muscles were significantly lower in the MMPH group (1.52 ± 0.53; 1.29 ± 0.43, respectively) than in the MMP group (2.09 ± 0.73; 1.70 ± 0.68, respectively; P < .001), with no differences in self-reported facial pain intensity. Factorial analyses further indicated that chronic migraine was associated with poorer sleep quality (P = .003) and that tension-type headache patients had lower PPTs in the anterior temporalis muscle (P = .041) in comparison with non-headache patients.

CONCLUSION

Co-existence of headache further exacerbates clinical characteristics in patients with painful TMD, which implies involvement of common mechanisms and pathways of vulnerability in these patients.

摘要

目的

评估咀嚼肌筋膜疼痛（MMP）成年患者的头痛对临床疼痛（即自我报告的疼痛强度和压痛敏感性）、睡眠质量和疼痛灾难化等结果变量的影响。

方法

根据颞下颌关节紊乱病研究诊断标准（RDC/TMD），共97例MMP患者被诊断为并存头痛（MMPH组，n = 50）或无头痛（MMP组，n = 47）。结果参数包括匹兹堡睡眠质量指数（PSQI）；疼痛相关自我陈述量表（PRSS-C）的灾难化思维子量表；咬肌和颞肌前束的压痛阈值（PPTs）；以及在0至10厘米视觉模拟量表（VAS）上测量的自我报告的面部疼痛强度。采用独立样本t检验（α = 1.2%）和方差分析（ANOVA）（α = 5%）对数据进行分析。

结果

与MMP组（7.2±3.4）相比，MMPH组的睡眠质量明显受损（平均±标准差[SD]PSQI评分9.1±3.5；P = .008）。MMPH组PRSS-C的子量表得分（2.1±1.2）显著高于MMP组（1.6±1.4，未校正P = .048）。此外，MMPH组咬肌和颞肌前束的PPTs（kgf/cm²）（分别为1.52±0.53；1.29±0.43）显著低于MMP组（分别为2.09±0.73；1.70±0.68；P < .001），自我报告的面部疼痛强度无差异。析因分析进一步表明，与无头痛患者相比，慢性偏头痛与较差的睡眠质量相关（P = .003），紧张型头痛患者颞肌前束的PPTs较低（P = .041）。