Aguiar Aroldo D S, Moseley G Lorimer, Bataglion Cesar, Azevedo Beatriz, Chaves Thaís C
Ph.D. in Musculoskeletal Rehabilitation, Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
DSc Ph.D, Bradley Distinguished Professor, IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia.
J Pain. 2023 Feb;24(2):251-263. doi: 10.1016/j.jpain.2022.09.012. Epub 2022 Oct 8.
The objective of this study was to determine the effect of enhancing conventional care for people with chronic painful temporomandibular disorders (TMD) with an individualised contemporary pain science education (PSE) intervention. In this randomized controlled trial, a consecutive sample of 148 participants (18-55 years of age) was randomized into 2 groups: PSE-enhanced conventional care or Conventional care alone. Conventional care involved a 6-week, 12-session manual therapy and exercise program. The PSE enhancement involved 2 sessions of modern PSE, undertaken in the first 2 treatment sessions. Primary outcomes were pain intensity, assessed with a numeric pain rating scale, and disability, assessed with the craniofacial pain and disability inventory, post-treatment. Linear mixed model analyses were used to investigate between-group differences over time. There was a statistically and clinically meaningful effect of PSE enhancement on disability (Mean Difference = 6.1, 95% CI: 3.3-8.8), but not on pain intensity, post-treatment. Secondary analyses suggested clinically meaningful benefit of PSE enhancement on pain and disability ratings at 10-week and 18-week follow-ups, raising the possibility that preceding conventional care with a PSE intervention may result in long-term benefits. PERSPECTIVE: The addition of modern Pain Science Education (PSE) intervention improved disability for people with chronic TMD receiving manual therapy and exercise, but not pain. A mean difference in pain and disability favoring the PSE group at the 10- and 18-week follow-ups, respectively, suggests that PSE addition resulted in longer-lasting effects. Trial registration: NCT03926767. Registered on April 29, 2019. https://clinicaltrials.gov/ct2/show/NCT03926767.
本研究的目的是确定通过个体化的当代疼痛科学教育（PSE）干预来加强对慢性疼痛性颞下颌关节紊乱症（TMD）患者的常规护理的效果。在这项随机对照试验中，148名参与者（年龄在18至55岁之间）的连续样本被随机分为两组：PSE强化常规护理组或单纯常规护理组。常规护理包括一个为期6周、共12节的手法治疗和运动计划。PSE强化包括在前两个治疗疗程中进行2节现代PSE课程。主要结局指标为治疗后用数字疼痛评分量表评估的疼痛强度，以及用颅面部疼痛和残疾量表评估的残疾程度。采用线性混合模型分析来研究组间随时间的差异。PSE强化对治疗后的残疾程度有统计学和临床意义上显著的效果（平均差异=6.1，95%置信区间：3.3 - 8.8），但对疼痛强度没有影响。二次分析表明，PSE强化在10周和18周随访时对疼痛和残疾评分有临床意义上的益处，这增加了先前进行PSE干预的常规护理可能产生长期益处的可能性。观点：添加现代疼痛科学教育（PSE）干预改善了接受手法治疗和运动的慢性TMD患者的残疾程度，但未改善疼痛。在10周和18周随访时，疼痛和残疾方面的平均差异分别有利于PSE组，这表明添加PSE产生了更持久的效果。试验注册：NCT03926767。于2019年4月29日注册。https://clinicaltrials.gov/ct2/show/NCT03926767 。
