Korszun A, Papadopoulos E, Demitrack M, Engleberg C, Crofford L
Department of Psychiatry and School of Dentistry, University of Michigan, Ann Arbor 48109-0840, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Oct;86(4):416-20. doi: 10.1016/s1079-2104(98)90366-3.
The purpose of this study was to determine the comorbidity of temporomandibular disorders and other stress-associated conditions in patients with chronic fatigue syndrome and fibromyalgia.
Of 92 patients who fulfilled the criteria for chronic fatigue syndrome or fibromyalgia (or both), 39 (42%) reported a prior diagnosis of temporomandibular disorder. Further questionnaires were sent to the members of this group, and 30 patients responded.
Of the original 92 patients, of whom 42% reported temporomandibular disorders, 46% had histories of irritable bowel syndrome, 42% of premenstrual syndrome, and 19% of interstitial cystitis. Of the patients with temporomandibular disorders, the great majority reported an onset of generalized symptoms before the onset of facial pain. Despite this, 75% had been treated exclusively for temporomandibular disorders, usually with bite splints.
Patients appearing for treatment with chronic facial pain show a high comorbidity with other stress-associated syndromes. The clinical overlap between these conditions may reflect a shared underlying pathophysiologic basis involving dysregulation of the hypothalamic-pituitary-adrenal stress hormone axis in predisposed individuals. A multidisciplinary clinical approach to temporomandibular disorders would improve diagnosis and treatment outcomes for this group of patients.
本研究旨在确定慢性疲劳综合征和纤维肌痛患者颞下颌关节紊乱症及其他应激相关病症的共病情况。
在92名符合慢性疲劳综合征或纤维肌痛（或两者）标准的患者中，39名（42%）报告曾被诊断为颞下颌关节紊乱症。向该组患者进一步发放问卷，30名患者做出回应。
在最初的92名患者中，42%报告患有颞下颌关节紊乱症，46%有肠易激综合征病史，42%有经前综合征病史，19%有间质性膀胱炎病史。在患有颞下颌关节紊乱症的患者中，绝大多数报告在面部疼痛发作之前出现全身性症状。尽管如此，75%的患者仅接受过颞下颌关节紊乱症的治疗，通常使用咬合夹板。
因慢性面部疼痛前来治疗的患者与其他应激相关综合征的共病率较高。这些病症之间的临床重叠可能反映了一个共同的潜在病理生理基础，即易感个体下丘脑 - 垂体 - 肾上腺应激激素轴调节异常。对颞下颌关节紊乱症采用多学科临床方法将改善这类患者的诊断和治疗效果。
