颞下颌关节紊乱病相关头痛与共患躯体疼痛有关：一项病例对照研究。

Headache attributed to TMD Is Associated With the Presence of Comorbid Bodily Pain: A Case-Control Study.

机构信息

Department of Endodontics and Department of Dental Ecology, School of Dentistry, UNC-CH, Chapel Hill, NC, USA.

Department of Endodontics, School of Dentistry, UNC-CH, Chapel Hill, NC, USA.

出版信息

Headache. 2018 Nov;58(10):1593-1600. doi: 10.1111/head.13404. Epub 2018 Sep 4.

DOI:10.1111/head.13404

PMID:30178880

Abstract

UNLABELLED

Headache attributed to temporomandibular disorders (TMDH) is defined as a secondary headache by the International Classification of Headache Disorders 3rd edition (ICHD-3).

OBJECTIVE

The objective of this case-control study is to investigate the phenotypic characteristics of chronic TMD with and without TMDH. We hypothesize that chronic TMD with TMDH is associated with increased number of bodily pain conditions, more painful sites in the head and neck region, and greater TMD pain intensity.

METHODS

This is a retrospective cross-sectional review of the medical records of consecutive patients who sought treatment at the University of North Carolina Orofacial Pain Clinic between 2013 and 2014. The inclusion criterion was a diagnosis of myalgia or arthralgia according to the Research Diagnostic Criteria for Temporomandibular Disorders. In addition, cases had a diagnosis of TMDH according to the ICHD-3 criteria. Data on the presence and the number of self-reported bodily pain conditions (such as fibromyalgia and low back pain), pain intensity, number of painful sites in the head and neck upon palpation, and TMD pain onset were analyzed.

RESULTS

A total of 295 records were reviewed. Thirty-four (29.3%) patients fulfilled inclusion criteria for cases (TMD+TMDH) and 82 (70.7%) for controls (TMD-TMDH). Cases reported greater number of bodily pain conditions than controls, with a mean of 1.97 ± 1.50 and 1.26 ± 1.28 of bodily pain conditions, respectively (P = .012, OR = 1.43 [95% CI 1.07-1.92]). In fact, 55.9% of cases reported at least 2 comorbid pain conditions compared to 37.8% controls (P = .044). Compared to controls (8.65 ± 5.32), cases (13.05 ± 4.46) exhibited greater number of painful sites upon palpation in the head and neck region (P < .0001, OR = 1.18 [95% CI 1.09-1.30]), and greater TMD pain intensity, with a mean of 6.00 ± 2.17 for cases and 5.09 ± 2.14 for controls (P = .041, OR = 1.22 [95% CI 1.01-1.47]).

CONCLUSION

In a population of patients with chronic TMD seeking pain management, TMDH was significantly associated with an increased number of self-reported bodily pain conditions, a greater number of painful sites in the head and neck regions, and higher TMD pain intensity.

摘要

背景

国际头痛疾病分类第 3 版（ICHD-3）将颞下颌关节紊乱相关头痛定义为继发性头痛。

目的

本病例对照研究旨在调查伴和不伴 TMDH 的慢性 TMD 的表型特征。我们假设伴 TMDH 的慢性 TMD 与身体疼痛状况的数量增加、头颈部更疼痛的部位和更大的 TMD 疼痛强度有关。

方法

这是对 2013 年至 2014 年间在北卡罗来纳大学口腔颌面疼痛诊所就诊的连续患者的病历进行的回顾性横断面研究。纳入标准为根据颞下颌关节紊乱研究诊断标准诊断为肌痛或关节炎。此外，根据 ICHD-3 标准，病例被诊断为 TMDH。分析了存在和报告的身体疼痛状况（如纤维肌痛和腰痛）的数量、疼痛强度、触诊时头颈部疼痛部位的数量以及 TMD 疼痛发作的情况。

结果

共回顾了 295 份记录。34 名（29.3%）患者符合病例（TMD+TMDH）的纳入标准，82 名（70.7%）患者符合对照（TMD-TMDH）的纳入标准。病例比对照组报告了更多的身体疼痛状况，分别为 1.97±1.50 和 1.26±1.28 个身体疼痛状况（P=0.012，OR=1.43[95%CI 1.07-1.92]）。事实上，55.9%的病例报告了至少 2 种合并疼痛状况，而对照组为 37.8%（P=0.044）。与对照组（8.65±5.32）相比，病例（13.05±4.46）在头颈部触诊时表现出更多的疼痛部位（P<0.0001，OR=1.18[95%CI 1.09-1.30]），且 TMD 疼痛强度更大，病例平均为 6.00±2.17，对照组为 5.09±2.14（P=0.041，OR=1.22[95%CI 1.01-1.47]）。