How negative and positive constructs and comorbid conditions contribute to disability in chronic orofacial pain.
How negative and positive constructs and comorbid conditions contribute to disability in chronic orofacial pain.
复制标题
消极和积极的结构以及合并症如何导致慢性口面部疼痛的残疾。
DOI：
10.1002/ejp.2042
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Colloca,Luana
中科院分区：
文献类型：
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作者：
Thomas,Sharon;Wang,Yang;Cundiff-O'Sullivan,Rachel;Massalee,Rachel;Colloca,Luana
背景颞颌关节紊乱病(TMD)的症状发展为慢性疼痛，但其原因尚不清楚。心理社会因素和慢性重叠疼痛状况被认为是导致疼痛相关残疾的原因。在控制人口统计学变量的同时，我们考察了颌骨功能、消极和积极的心理因素以及慢性重叠疼痛状况(COPC)在疼痛相关残疾中的作用。方法收集了400名慢性TMD参与者的人口学数据、医学和心理社会病史以及衡量疼痛强度和疼痛干预的分级慢性疼痛量表。在控制人口学变量的同时，使用结构方程模型对COPC模型和心理不安的潜在变量(疼痛灾难、躯体症状和消极情绪)、正价因素(乐观和积极情绪)、下颌功能(咀嚼、张开和表达受限)和疼痛相关残疾(疼痛强度和疼痛干扰)进行评估。结果简约模型(近似均方根误差=0.063[90%CI][0.051-0.075])、比较拟合度指数F=0.942，标准均方根残差=0.067。颌骨功能是最强的潜在变量预测因子，其次是心理不安和COPC，提示集中于改善关节功能、心理社会支持和COPC管理的资源将改善TMD疼痛相关残疾。结论这些发现不仅增加了与TMD临床表型相关的知识体系，而且对进一步支持靶向物理治疗(如颌骨锻炼)和心理干预作为多学科非药物治疗方案的潜在价值具有翻译作用。
BackgroundTemporomandibular disorders (TMD) symptoms develop into chronic pain for some patients, but the reasons for this are unclear. Psychosocial factors and chronic overlapping pain conditions are believed to contribute to the development of pain‐related disability. We examined the role of jaw function, negative and positive psychological factors and chronic overlapping pain conditions (COPCs) on pain‐related disability whilst controlling for demographic variables.MethodsWe collected demographics, medical and psychosocial history and the Graded Chronic Pain Scale, a measure of pain intensity and pain interference from 400 participants with chronic TMD. Structural equation modelling was used to assess a model of COPCs and the latent variables of psychological unease (pain catastrophizing, somatic symptoms and negative affect), positive valence factors (optimism and positive affect), jaw function (chewing, opening and expression limitation) and pain‐related disability (pain intensity and pain interference) whilst controlling for demographic variables.ResultsWe achieved good fit of a parsimonious model (root‐mean‐square error of approximation = 0.063 [90% CI] [0.051–0.075]), comparative fit index = 0.942, standard root‐mean‐square residual = 0.067. Jaw function was the strongest latent variable predictor, followed by psychological unease and COPCs suggesting resources focused on improving joint function, psychosocial support and management of COPCs will improve pain‐related disability in TMDs.ConclusionsThese findings not only increase the body of knowledge related to TMD clinical phenotypes but also, have a translational impact in further supporting the potential value of targeting physical therapy such as jaw exercise along with psychological interventions as multidisciplinary nonpharmacological therapeutic solutions.