Gadd Madeleine, Attard Alan, Green Jason, Elledge Ross O C
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Consultant Oral and Maxillofacial Surgeon, University Hospitals Birmingham NHS Foundation Trust, UK.
Br J Oral Maxillofac Surg. 2024 Apr;62(3):318-323. doi: 10.1016/j.bjoms.2023.12.020. Epub 2024 Jan 11.
Patients with chronic pain have a higher prevalence of mood disorders with depression and anxiety contributing to higher pain intensity, emotional allodynia, and neuro-anatomical changes. We sought to quantify the prevalence of psychiatric comorbidities (PCs) in a tertiary referral clinic for temporomandibular disorders (TMDs). Medical records of all patients attending clinics run by three tertiary temporomandibular joint (TMJ) surgeons for the period January to April 2022 inclusive were audited for the prevalence of concomitant psychiatric conditions. A total of 166 patients were identified with a female to male ratio of 5:1 and mean (SD) age of 45.1 (15.2) years. A total of 124 (89.9%) patients were tertiary referrals and 72 (43.4%) patients had concomitant psychiatric diagnoses, with 58 (34.9%) being on some form of psychotropic medication (PM) (patients on anticonvulsants for neuropathic pain were not included). A majority of 136 (81.9%) patients had some form of intervention (including Dysport® and minimally invasive surgery) which appeared more common in patients with co-existing psychiatric issues (p < 0.05). A higher proportion of mental health issues exist among TMD patients in a tertiary referral clinic than would be expected in the general population. We suggest a holistic approach to patients with multidisciplinary care taking into account this prevalence to ensure decision-making that contextualises the patient and not simply the pathology.
慢性疼痛患者中情绪障碍的患病率较高，抑郁和焦虑会导致疼痛强度增加、情绪性痛觉过敏和神经解剖学变化。我们试图量化颞下颌关节紊乱病（TMD）三级转诊诊所中精神疾病共病（PCs）的患病率。对2022年1月至4月期间由三位颞下颌关节（TMJ）外科医生开设的诊所中所有患者的病历进行审核，以确定伴发精神疾病的患病率。共识别出166例患者，男女比例为5:1，平均（标准差）年龄为45.1（15.2）岁。共有124例（89.9%）患者为三级转诊患者，72例（43.4%）患者伴有精神疾病诊断，其中58例（34.9%）正在服用某种形式的精神药物（PM）（服用抗惊厥药治疗神经性疼痛的患者未包括在内）。大多数136例（81.9%）患者接受了某种形式的干预（包括肉毒杆菌素和微创手术），这在伴有精神疾病的患者中似乎更为常见（p<0.05）。在三级转诊诊所中TMD患者的心理健康问题比例高于一般人群的预期。我们建议对患者采取多学科综合护理的整体方法，考虑到这一患病率，以确保决策能够结合患者实际情况，而不仅仅是病理情况。
