Jones D A, Rollman G B, Brooke R I
Department of Psychology, University of Western Ontario, London, Canada.
Pain. 1997 Aug;72(1-2):171-82. doi: 10.1016/s0304-3959(97)00035-3.
The salivary cortisol response to psychological stress and its relationship to psychological variables was examined in 36 female temporomandibular dysfunction (TMD) sufferers and 39 female control participants. Saliva samples were taken at baseline, after completion of a modified version of the Trier Social Stress Test, and after rest. Participants also completed a battery of measures, including Visual Analog Scales for measuring pain intensity and disability and a number of established psychological scales. The TMD group showed a significantly higher cortisol response to experimental stress than the control group. Closer examination of the data revealed that the TMD group was heterogeneous and composed of a group that hypersecreted cortisol in response to stress (Hi-SC TMD group) and another group whose cortisol response was not significantly different from the control group (Lo-SC TMD group). The Lo-SC TMD group showed significant negative relationships between cortisol response and self-reported symptoms of both anxiety and depression, plus significantly more use of the Praying or Hoping coping strategy on the Coping Strategies Questionnaire. A dual relationship between TMD symptoms and the stress response is proposed. First, a biological predisposition to TMD is suggested by the stress response in the Hi-SC TMD group. Second, both psychological and biological variables appear to be important factors in those TMD patients who respond to stress with low cortisol secretion.
对36名患有颞下颌关节紊乱症（TMD）的女性患者和39名女性对照参与者进行了研究，以检测唾液皮质醇对心理压力的反应及其与心理变量的关系。在基线、完成改良版的特里尔社会压力测试后以及休息后采集唾液样本。参与者还完成了一系列测量，包括用于测量疼痛强度和功能障碍的视觉模拟量表以及一些既定的心理量表。TMD组对实验性压力的皮质醇反应明显高于对照组。对数据的进一步检查发现，TMD组是异质性的，由一组对应激反应皮质醇分泌过多的组（高分泌皮质醇TMD组）和另一组皮质醇反应与对照组无显著差异的组（低分泌皮质醇TMD组）组成。低分泌皮质醇TMD组在皮质醇反应与自我报告的焦虑和抑郁症状之间显示出显著的负相关，并且在应对策略问卷上更多地使用祈祷或希望应对策略。提出了TMD症状与应激反应之间的双重关系。首先，高分泌皮质醇TMD组的应激反应表明TMD存在生物学易感性。其次，心理和生物学变量似乎都是那些对应激反应皮质醇分泌低的TMD患者的重要因素。
