Staniszewski Kordian, Willassen Lisa, Berge Trond, Johansson Anders, Schjødt Borrik, Rosen Annika
Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway.
J Pain Res. 2022 May 2;15:1283-1296. doi: 10.2147/JPR.S341861. eCollection 2022.
To investigate the outcome of patients with long-term refractory temporomandibular disorders (TMD) three years after a Norwegian interdisciplinary evaluation program with attention to patient satisfaction, function, pain, and psychosocial variables.
The study population consisted of 60 long-term refractory TMD patients who were investigated by a Norwegian interdisciplinary team. A questionnaire that covered medical history, function, pain, lifestyle factors, TMD-status and follow-up from their general medical practitioner (GMP) was sent to the patients three years after the evaluation. Questionnaires that assessed function (Mandibular Functional Index Questionnaire [MFIQ] and Roland Morrison Scale [RMS]), pain intensity (General Pain Intensity questionnaire [GPI]) and psychosocial factors (Hospital Anxiety and Depression scale [HADS]); a 2-item version of the Coping Strategies Questionnaire [CSQ]) were included in the package.
Thirty-nine out of 60 TMD patients completed the questionnaires. Improvements in TMD symptoms were reported in 10 patients (26%), were unchanged in 16 patients (41%) and worsened in 13 patients (33%). Only 8 patients (21%) were satisfied with the follow-up of the suggested treatments from their GMP. Significant improvements of symptoms were noted in MFIQ (jaw function), GPI (including pain intensity at maximum and suffering from pain), and CSQ (pain related catastrophizing), in all 39 TMD patients as one group. However, a subgroup analysis showed that the significant improvements were mostly within patients who reported improvement of TMD symptoms. A high pain intensity at baseline was a significant risk factor .79, 95% CI: 1.34, 24.96) for patients who reported worsening of TMD symptoms at follow-up.
High pain intensity at baseline was a significant risk factor for poorer recovery three years after an interdisciplinary evaluation. Our data support the notion that improved coping with TMD pain includes both decreased pain intensity, CSQ and MFIQ scores.
在一项挪威多学科评估项目开展三年后，调查长期难治性颞下颌关节紊乱病（TMD）患者的预后情况，重点关注患者满意度、功能、疼痛及社会心理变量。
研究人群包括60例长期难治性TMD患者，由挪威多学科团队进行调查。在评估三年后，向患者发送一份涵盖病史、功能、疼痛、生活方式因素、TMD状况及来自其全科医生（GMP）随访情况的问卷。问卷包中包含评估功能的问卷（下颌功能指数问卷[MFIQ]和罗兰·莫里森量表[RMS]）、疼痛强度问卷（一般疼痛强度问卷[GPI]）以及社会心理因素问卷（医院焦虑抑郁量表[HADS]）；还有应对策略问卷的2项版本[CSQ]）。
60例TMD患者中有39例完成了问卷。报告TMD症状改善的患者有10例（26%），症状未改变的有16例（41%），症状恶化的有13例（33%）。只有8例患者（21%）对其GMP建议治疗的随访情况感到满意。作为一个整体的39例TMD患者在MFIQ（下颌功能）、GPI（包括最大疼痛强度和疼痛困扰）及CSQ（与疼痛相关的灾难化思维）方面症状有显著改善。然而，亚组分析显示，显著改善主要出现在报告TMD症状改善的患者中。基线时疼痛强度高是随访时报告TMD症状恶化患者的一个显著危险因素（.79，95%置信区间：1.34，24.96）。
基线时疼痛强度高是多学科评估三年后恢复较差的一个显著危险因素。我们的数据支持这样一种观点，即更好地应对TMD疼痛包括降低疼痛强度、CSQ和MFIQ评分。
