Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.
Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Arch Oral Biol. 2018 Jun;90:125-129. doi: 10.1016/j.archoralbio.2018.03.011. Epub 2018 Mar 23.
Temporomandibular disorders (TMD) are the most common source of non-dental pain. The pathogenesis of TMD is multifactorial, involving biological, psychological and behavioral factors. Those factors are involved with alterations of the autonomic nervous system (ANS) and stressful conditions. Heart rate variability (HRV) has been used as a marker of ANS function. Increased cortisol level (a stress indicator), has been found in chronic pain. Therefore, the present study aimed to compare pain intensity, HRV, psychological factors, and salivary cortisol level between TMD patients and a control group. Twenty-one TMD patients and twenty-three healthy control subjects participated in the study. All participants underwent 24-h-Holter monitoring to record HRV. Morning unstimulated saliva samples were collected from each participant for cortisol analysis. The pain intensity was assessed using a visual analog scale. The participants were evaluated for anxiety and depression via the Hospital Anxiety and Depression Scales. We found that pain intensity and psychological distress in the TMD group were significantly greater than those of the control (p < 0.01). Pain intensity showed a positive correlation with psychological distress (p < 0.01). HRV parameters in the TMD group were significantly lower than those in the control, suggesting reduced HRV in TMD patients. Pain intensity was negatively associated with HRV. Salivary cortisol level of the TMD group was greater than that of control. Our findings indicate that reduced HRV with higher psychological distress and increased salivary cortisol levels were observed in the TMD group. Therefore, TMD patients may benefit from interventions that can restore ANS function and stress balance.
颞下颌关节紊乱病（TMD）是最常见的非牙科疼痛来源。TMD 的发病机制是多因素的，涉及生物、心理和行为因素。这些因素与自主神经系统（ANS）的改变和应激条件有关。心率变异性（HRV）已被用作 ANS 功能的标志物。在慢性疼痛中发现皮质醇水平（应激指标）升高。因此，本研究旨在比较 TMD 患者和对照组之间的疼痛强度、HRV、心理因素和唾液皮质醇水平。21 名 TMD 患者和 23 名健康对照组参加了研究。所有参与者都接受了 24 小时 Holter 监测以记录 HRV。从每位参与者采集早晨非刺激唾液样本用于皮质醇分析。使用视觉模拟量表评估疼痛强度。使用医院焦虑和抑郁量表评估参与者的焦虑和抑郁情况。我们发现 TMD 组的疼痛强度和心理困扰明显大于对照组（p<0.01）。疼痛强度与心理困扰呈正相关（p<0.01）。TMD 组的 HRV 参数明显低于对照组，表明 TMD 患者的 HRV 降低。疼痛强度与 HRV 呈负相关。TMD 组的唾液皮质醇水平高于对照组。我们的研究结果表明，TMD 组观察到 HRV 降低、心理困扰增加和唾液皮质醇水平升高。因此，TMD 患者可能受益于可以恢复 ANS 功能和平衡应激的干预措施。
