探讨东亚颞下颌关节紊乱病患者躯体化、面部疼痛与心理困扰之间的关系。
Exploring the Relationship Between Somatisation, Facial Pain and Psychological Distress in East Asian Temporomandibular Disorder Patients.
机构信息
Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore, Singapore.
National Dental Centre Singapore and Duke-NUS Medical School, Singapore Health Services, National Dental Research Institute Singapore, Singapore, Singapore.
出版信息
J Oral Rehabil. 2024 Dec;51(12):2566-2576. doi: 10.1111/joor.13857. Epub 2024 Sep 17.
OBJECTIVES
The relationship of somatisation with facial pain duration/intensity, pain-related interference/disability and psychological distress was investigated in East Asian temporomandibular disorder (TMD) patients. Correlations between somatisation, facial pain and psychological characteristics were also explored alongside the demographic/physical factors associated with moderate-to-severe depression and anxiety.
METHODS
Anonymised data were acquired from records of consecutive 'first-time' patients seeking TMD care at a tertiary oral medicine clinic. Axis I physical TMD diagnoses were established utilising the diagnostic criteria for TMDs (DC/TMD) protocol and patients with TMD pain were stratified into those with pain-related (PT) and combined (CT) conditions. Axis II measures administered encompassed the Patient Health Questionnaire-15 (PHQ-15), Graded Chronic Pain Scale (GCPS), Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder Scale-7 (GAD-7). Individuals with PT and CT were further categorised into those without (Pain - Som/Comb - Som) and with somatisation (Pain + Som/Comb + Som). Statistical evaluations were performed with nonparametric and logistic regression analyses (α = 0.05).
RESULTS
The final sample comprised 473 patients (mean age 36.2 ± 14.8 years; 68.9% women), of which 52.0% had concomitant somatisation. Significant differences in pain duration (Comb + Som > Pain - Som), pain-related interference/disability (Comb + Som > Comb - Som) and depression/anxiety (Pain + Som, Comb + Som > Pain - Som, Comb - Som) were discerned. Depression/anxiety was moderately correlated with somatisation (r = 0.64/0.52) but not facial pain characteristics. Multivariate modelling revealed that somatisation was significantly associated with the prospects of moderate-to-severe depression (OR 1.35) and anxiety (OR 1.24).
CONCLUSION
Somatisation exhibited a strong association with psychological distress when contrasted with facial pain in East Asian TMD patients.
目的
本研究旨在探讨躯体化与东亚颞下颌关节紊乱病（TMD）患者面部疼痛持续时间/强度、疼痛相关干扰/残疾和心理困扰之间的关系。同时，还探讨了躯体化与面部疼痛以及心理特征之间的相关性，以及与中重度抑郁和焦虑相关的人口统计学/身体因素。
方法
从一家三级口腔医学诊所接受 TMD 治疗的“首次”连续就诊患者的记录中获取匿名数据。利用 TMD 诊断标准（DC/TMD 方案）确定 I 轴躯体 TMD 诊断，将 TMD 疼痛患者分为与疼痛相关（PT）和混合（CT）两种情况。实施的 II 轴测量包括患者健康问卷-15 项（PHQ-15）、慢性疼痛分级量表（GCPS）、患者健康问卷-9 项（PHQ-9）和广泛性焦虑障碍量表-7 项（GAD-7）。将 PT 和 CT 患者进一步分为无躯体化（疼痛-躯体/混合-躯体）和躯体化（疼痛+躯体/混合+躯体）患者。使用非参数和逻辑回归分析进行统计评估（α=0.05）。
结果
最终样本包括 473 名患者（平均年龄 36.2±14.8 岁；68.9%为女性），其中 52.0%伴有躯体化。在疼痛持续时间（混合+躯体>疼痛-躯体）、疼痛相关干扰/残疾（混合+躯体>混合-躯体）和抑郁/焦虑（疼痛+躯体，混合+躯体>疼痛-躯体，混合-躯体）方面存在显著差异。抑郁/焦虑与躯体化中度相关（r=0.64/0.52），但与面部疼痛特征无关。多变量建模显示，躯体化与中重度抑郁（OR 1.35）和焦虑（OR 1.24）的发生显著相关。
结论
与东亚 TMD 患者的面部疼痛相比，躯体化与心理困扰具有更强的相关性。
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