Division of TMD and Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Department of Endodontics, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Minnesota Head and Neck Pain Clinic, Plymouth, Minnesota.
Division of TMD and Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota; HealthPartners Institute for Education and Research, Bloomington, Minnesota.
J Endod. 2020 May;46(5):619-626.e2. doi: 10.1016/j.joen.2020.01.018. Epub 2020 Mar 11.
We measured the long-term outcomes of patients reporting persistent pain 6 months after root canal treatment (RCT) and assessed the characteristics differing patients with pain chronification from those with pain resolution.
Forty-five patients previously found to have persistent pain 6 months post-RCT from the National Dental Practice-Based Research Network were approached for a 3-year follow-up, and 27 participated in the survey. The frequency of self-reported pain, its impact on the ability to perform daily activities, and health care use were measured. The differences between patients whose persistent pain continued and those whose pain resolved were assessed.
Five patients met criteria for pain at 3.4 years (range, 3.1-3.9 years) post-RCT, which was moderate in intensity, occurred for about 3 days in the preceding month, and kept 1 patient from usual activities. Additional health care was received by 4 of 5 patients whose pain continued compared with 7 of 22 patients whose pain resolved. A longer duration of preoperative pain and higher pain intensity and interference at 6 months were found among patients with pain chronification. Of 13 patients with specific diagnoses for the persistent pain derived at 65 ± 41 days (∼8 months) post-RCT, 10 improved regardless of the diagnosis or treatment, and 11 had a temporomandibular disorder and/or headache as comorbid diagnoses (6) or causes (6) of the persistent "tooth" pain.
Progression of persistent post-RCT pain occurred in 19% of patients. The majority (56%) of patients improved without additional interventions. Both the group that improved and the group that continued to experience pain had a mixture of odontogenic and nonodontogenic etiologies.
我们测量了根管治疗（RCT）后 6 个月报告持续性疼痛的患者的长期结果，并评估了疼痛慢性化患者与疼痛缓解患者的特征差异。
从国家牙科实践为基础的研究网络中，我们找到了 45 名先前在 RCT 后 6 个月有持续性疼痛的患者，并对他们进行了为期 3 年的随访，其中 27 名患者参与了调查。测量了自我报告疼痛的频率、对执行日常活动能力的影响以及卫生保健的使用情况。评估了持续性疼痛持续和疼痛缓解患者之间的差异。
5 名患者在 RCT 后 3.4 年（范围，3.1-3.9 年）符合疼痛标准，疼痛强度中等，在前一个月持续了约 3 天，使 1 名患者无法进行正常活动。与疼痛缓解的 22 名患者中的 7 名相比，持续性疼痛的 4 名患者接受了额外的医疗保健。在疼痛慢性化患者中，术前疼痛持续时间较长，6 个月时疼痛强度和干扰较高。在 RCT 后 65 ± 41 天（约 8 个月）得出的 13 名持续性疼痛的特定诊断患者中，10 名患者无论诊断或治疗如何都有所改善，11 名患者有颞下颌关节紊乱症和/或头痛作为共病诊断（6 名）或持续性“牙齿”疼痛的原因（6 名）。
持续性 RCT 后疼痛的进展发生在 19%的患者中。大多数（56%）患者无需额外干预即可改善。无论是改善的组还是继续经历疼痛的组，都有牙源性和非牙源性病因的混合。
