Dahlström L, Widmark G, Carlsson S G
Department of Orofacial Pain, Public Dental Service, Mölndal Hospital, Sweden.
Eur J Oral Sci. 1997 Oct;105(5 Pt 1):377-83. doi: 10.1111/j.1600-0722.1997.tb02133.x.
Psychological homogeneity in temporomandibular disorders (TMD) is not conclusive. The multidimensional pain inventory (MPI) has previously identified 3 cognitive-behavioral profiles in TMD and chronic pain patients. Our aims were to replicate these findings in another cultural setting and relate the profiles to the diagnosis and to the treatment demand and outcome. The MPI was administered to 112 referrals comprising 6 categories of patients diagnosed with TMD or intractable orofacial pain. Dysfunctional profiles (high in pain and distress) were most common in patients with orofacial pain of obscure origin and more common in myofascial pain patients than in patients with other TMD diagnoses. Interpersonally-distressed profiles were found in all categories. Among patients with disk displacement, the 3rd profile (adaptive copers with low pain and distress and high control and activity) was most common in earlier successfully diskectomized patients and least common in those about to undergo invasive interventions. A dysfunctional profile was associated with treatment failure, conservative or surgical, and with the demand for radical therapy. Some support for a cyclical causality between pain and psychological factors was found. It is concluded that the robustness of the MPI as a relevant assessment instrument was further strengthened.
颞下颌关节紊乱病（TMD）中的心理同质性尚无定论。多维疼痛量表（MPI）先前已在TMD和慢性疼痛患者中识别出3种认知行为模式。我们的目的是在另一种文化背景下重复这些发现，并将这些模式与诊断、治疗需求及结果联系起来。对112名转诊患者进行了MPI测试，这些患者包括6类被诊断为TMD或顽固性口面部疼痛的患者。功能失调模式（疼痛和痛苦程度高）在病因不明的口面部疼痛患者中最为常见，在肌筋膜疼痛患者中比在其他TMD诊断患者中更常见。人际困扰模式在所有类别中均有发现。在盘移位患者中，第三种模式（疼痛和痛苦程度低、控制感和活动度高的适应性应对者）在早期成功进行椎间盘切除术的患者中最为常见，而在即将接受侵入性干预的患者中最不常见。功能失调模式与保守或手术治疗失败以及激进治疗需求相关。发现了一些疼痛与心理因素之间循环因果关系的证据。结论是，MPI作为一种相关评估工具的稳健性得到了进一步加强。
