Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Pain. 2020 Dec;161(12):2710-2719. doi: 10.1097/j.pain.0000000000001976.
Pain-related disability is a multifaceted construct that refers to the impact of pain on an individual's capacity to fulfill their self-defined and social roles. This research examined the relationship between clinical, psychological, and pain sensitivity factors and pain-related disability among adults with chronic temporomandibular disorder (TMD). We analyzed data from a cross-sectional community-based sample of 1088 men and women with chronic TMD. We first constructed and tested a measure of pain-related disability (ie, pain impact), including a variable assessing presenteeism, created measurement models of jaw limitation, psychological unease (negative affect, somatic symptoms, and catastrophizing), and experimental pain sensitivity (eg, pressure pain threshold, thermal tolerance, and mechanical pressure pain threshold). Subsequently, latent variables were combined in a structural equation model. Participants (n = 1088) were 18 to 44 years old (mean 29.2, SD ± 7.8) whose chronic TMD had persisted, on average, for 6.9 years (SD ± 6.4). A model of pain-related disability, jaw limitation, and psychological unease was created and refined with exploratory model revisions to account for correlation among variables. Estimation of the final model indicated excellent fit with the data (root-mean-square error of approximation = 0.048, root-mean-square error of approximation 90% confidence interval [CI] 0.043-0.053, comparative fit index = 0.956, standardized root-mean-square residual = 0.040). Jaw functional limitation and psychological unease was strongly related to pain-related disability. Experimental pain sensitivity was removed from our model because of weak direct effect and the burden of performing experimental pain sensitivity testing in a clinical setting. The final model explained 78% of the variance in pain-related disability.
疼痛相关残疾是一个多方面的概念，指的是疼痛对个体履行自我定义和社会角色能力的影响。本研究考察了临床、心理和疼痛敏感性因素与慢性颞下颌关节紊乱（TMD）成人疼痛相关残疾之间的关系。我们分析了来自一个横断面社区为基础的 1088 名患有慢性 TMD 的男性和女性样本的数据。我们首先构建并测试了一个疼痛相关残疾（即疼痛影响）的测量工具，包括一个评估出勤情况的变量，创建了颌限制、心理不安（负性情绪、躯体症状和灾难化）和实验性疼痛敏感性（如压力疼痛阈值、热耐受和机械压力疼痛阈值）的测量模型。随后，将潜在变量合并在结构方程模型中。参与者（n = 1088）年龄在 18 至 44 岁之间（平均 29.2，标准差 ± 7.8），慢性 TMD 平均持续 6.9 年（标准差 ± 6.4）。创建并改进了疼痛相关残疾、颌限制和心理不安的模型，通过探索性模型修订来解释变量之间的相关性。对最终模型的估计表明，数据拟合度非常好（近似均方根误差 = 0.048，近似均方根误差 90%置信区间[CI] 0.043-0.053，比较拟合指数= 0.956，标准化均方根残差= 0.040）。颌功能限制和心理不安与疼痛相关残疾密切相关。由于实验性疼痛敏感性测试在临床环境中的执行负担和微弱的直接效应，我们从模型中删除了实验性疼痛敏感性。最终模型解释了疼痛相关残疾 78%的方差。
