Association of decrease in insula fMRI activation with changes in trait anxiety in patients with craniomandibular disorder (CMD)
Association of decrease in insula fMRI activation with changes in trait anxiety in patients with craniomandibular disorder (CMD)
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DOI：
10.1016/j.bbr.2019.112327
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发表时间：
2020-02-03
影响因子：
2.7
通讯作者：
Lotze, M.
中科院分区：
文献类型：
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作者：
Dammann, J.;Klepzig, K.;Lotze, M.
慢性疼痛患者，尤其是颅下颌关节紊乱病（CMD）患者在特质焦虑方面表现出特殊的精神病理学特征。在先前的CMD纵向功能成像研究中，我们发现前额叶受到成功的治疗干预和疼痛缓解的调节。在此，我们旨在调查CMD患者咬合运动过程中前牙MRI激活与夹板治疗方法的特质焦虑之间的可能关联。在一小组（n = 9）CMD患者中，在DIR-下颌夹板治疗前、治疗后两周和治疗后三个月，进行了三次颅下颌咬合任务的fMRI调查，并进行了疼痛评分评价和特质焦虑评分（状态-特质焦虑量表; STAI）。患者在治疗前表现出焦虑水平增加，用STAI和抑郁和焦虑量表（DASS）进行评估。除了疼痛的相关减轻外，STAI随时间推移而降低。STAI降低与两个半球的前岛叶fMRI激活降低相关。我们的结论是，焦虑驱动的预期相关的咬合触发疼痛的处理在前牙，因此可能是一个主要的驱动程序的治疗干预夹板治疗CMD。
Patients with chronic pain and especially with craniomandibular disorder (CMD) show specific psychopathology in trait anxiety. In a previous longitudinal functional imaging study on CMD we found that the anterior insula was modulated by successful therapy intervention and pain relief. We here intended to investigate possible associations between anterior insula fMRI-activation during occlusal movements and trait anxiety over a splint therapy approach in patients with CMD. Three fMRI-investigations of a craniomandibular occlusion task were performed together with pain score evaluations and scoring of trait anxiety (State-Trait Anxiety Inventory; STAI) before, after two weeks and after three months of a DIR-mandibular splint therapy in a small group (n = 9) of CMD patients. Patients showed increased anxiety levels before therapy assessed with the STAI and the depression and anxiety scale (DASS). Besides of relevant reduction in pain the STAI decreased over time. Reduction in STAI was associated with anterior insular fMRI-activation reduction on both hemispheres. We conclude that the anxiety driven anticipation of pain related to occlusal trigger is processed in the anterior insula and might therefore be a main driver of therapeutic intervention by the splint therapy in CMD.