Department of Orofacial Pain and Oral Medicine, College of Dentistry, Dankook University, Cheonan, South Korea.
J Oral Rehabil. 2021 Sep;48(9):1013-1024. doi: 10.1111/joor.13217. Epub 2021 Jul 10.
Pain related to temporomandibular disorder (TMD) usually affects jaw function. In patients with TMD, little is known about the biopsychosocial relevance to jaw functional limitations.
This study explored the impact of biopsychosocial risk factors on jaw functional limitation in patients with painful TMD.
A comprehensive set of patient-reported outcomes (PROs), consisting of pain severity (Brief Pain Inventory), psychological stress (Symptom Checklist-90-Revised), catastrophising thought (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia-TMD), sleep quality (Pittsburgh Sleep Quality Index) and jaw functional limitation (Jaw Functional Limitation Scale-20), were administered, and clinical examinations were performed in patients with TMD.
This study included the data obtained from 131 patients with painful TMD. In the logistic regression analysis, biomedical factors (age, sex, pain duration and TMD phenotype) were not associated with jaw functional limitation. Correlations were higher in the order of sleep quality (ρ = 0.946), pain severity (ρ = 0.582), pain catastrophising (ρ = 0.535), kinesiophobia (ρ = 0.486) and emotional distress (ρ = 0.268). Multiple regression analysis demonstrated three predictors, including pain severity (p = .001), kinesiophobia (p = .023) and sleep quality (p < .001) for jaw functional limitation. In the mediation analysis, the indirect effect of pain severity on the association between sleep and limitation was significant (p < .0001).
Jaw functional limitation is associated with biopsychosocial factors. In particular, sleep may be a core risk factor for functional limitation in patients with painful TMD.
与颞下颌关节紊乱（TMD）相关的疼痛通常会影响下颌功能。在 TMD 患者中，关于下颌功能受限与生物心理社会因素的相关性知之甚少。
本研究探讨了生物心理社会危险因素对 TMD 患者下颌功能受限的影响。
对 TMD 患者进行了一套全面的患者报告结局（PROs）评估，包括疼痛严重程度（简明疼痛量表）、心理压力（症状清单 90 修订版）、灾难化思维（疼痛灾难化量表）、运动恐惧（运动恐惧量表-TMD）、睡眠质量（匹兹堡睡眠质量指数）和下颌功能受限（下颌功能受限量表-20）。同时进行了临床检查。
本研究纳入了 131 例 TMD 疼痛患者的数据。在逻辑回归分析中，生物医学因素（年龄、性别、疼痛持续时间和 TMD 表型）与下颌功能受限无关。按相关性高低排序依次为睡眠质量（ρ=0.946）、疼痛严重程度（ρ=0.582）、疼痛灾难化（ρ=0.535）、运动恐惧（ρ=0.486）和情绪困扰（ρ=0.268）。多元回归分析显示，有三个预测因子可预测下颌功能受限，包括疼痛严重程度（p=0.001）、运动恐惧（p=0.023）和睡眠质量（p<0.001）。中介分析显示，疼痛严重程度对睡眠与限制之间关联的间接效应具有统计学意义（p<0.0001）。
下颌功能受限与生物心理社会因素有关。特别是，睡眠可能是 TMD 疼痛患者功能受限的核心危险因素。
