Long-term changes in biopsychosocial characteristics related to temporomandibular disorder: findings from the OPPERA study
Long-term changes in biopsychosocial characteristics related to temporomandibular disorder: findings from the OPPERA study
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DOI：
10.1097/j.pain.0000000000001348
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发表时间：
2018-11-01
期刊：
影响因子：
7.4
通讯作者：
Ohrbach, Richard
中科院分区：
文献类型：
--
作者：
Fillingim, Roger B.;Slade, Gary D.;Ohrbach, Richard
疼痛性颞下颌关节紊乱病（TMDs）是多种临床、心理社会和生物学因素共同作用的结果和原因。虽然纵向研究已经确定了增加TMD发病和持续风险的先行生物心理社会因素，但对TMD发展或缓解后这些因素的长期变化知之甚少。在7.6年的中位随访期内，我们测量了189名基线慢性TMD状态持续或缓解的参与者和505名最初无TMD的参与者（其中83人发展为TMD）的心理社会特征、疼痛敏感性、自主神经功能的心血管指标和临床颌功能的变化。在最初没有TMD的参与者中，发展TMD的症状和疼痛敏感性增加，而心理功能恶化。相比之下，慢性TMD参与者在基线时往往表现出改善的TMD症状，改善下颌功能，减少躯体症状，并增加积极的影响。在一般情况下，临床和心理社会变量更频繁地改变与TMD状态相比，疼痛敏感性和自主神经的措施。这些研究结果表明，一个复杂的模式，相当大的变化，在生物心理社会功能与TMD状态的变化。特别是，尽管疼痛持续多年，但慢性TMD参与者的几个生物心理社会参数得到改善，这表明持续应对和适应持续疼痛的潜力相当大。
Painful temporomandibular disorders (TMDs) are both consequence and cause of change in multiple clinical, psychosocial, and biological factors. Although longitudinal studies have identified antecedent biopsychosocial factors that increase risk of the TMD onset and persistence, little is known about long-term change in those factors after TMD develops or remits. During a 7.6-year median follow-up period, we measured change in psychosocial characteristics, pain sensitivity, cardiovascular indicators of autonomic function, and clinical jaw function among 189 participants whose baseline chronic TMD status either persisted or remitted and 505 initially TMD-free participants, 83 of whom developed TMD. Among initially TMD-free participants who developed TMD, symptoms and pain sensitivity increased, whereas psychological function worsened. By contrast, participants with chronic TMD at baseline tended to show improved TMD symptoms, improved jaw function, reduced somatic symptoms, and increased positive affect. In general, clinical and psychosocial variables more frequently changed in parallel with TMD status compared with pain sensitivity and autonomic measures. These findings demonstrate a complex pattern of considerable changes in biopsychosocial function associated with changes in TMD status. In particular, several biopsychosocial parameters improved among participants with chronic TMD despite pain persisting for years, suggesting considerable potential for ongoing coping and adaptation in response to persistent pain.