Impact of Fibromyalgia Phenotype in Temporomandibular Disorders.
Impact of Fibromyalgia Phenotype in Temporomandibular Disorders.
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纤维肌痛表型对颞下颌疾病的影响。
DOI：
10.1093/pm/pnab077
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Aronovich,Sharon
中科院分区：
文献类型：
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作者：
Harper,DanielE;Sayre,Kelly;Schrepf,Andrew;Clauw,DanielJ;Aronovich,Sharon
BackgroundMounting证据表明，中枢神经系统放大，类似于纤维肌痛（FM），有助于疼痛的经验，在一个子集的患者与颞下颌关节紊乱病（TMD）MethodsIn this prospective observational study，patients with TMD completed the 2011 FM survey questionnaire，a surrogate measure of“centralized”pain.集中疼痛对TMD疼痛，功能障碍和残疾的影响进行了评估二分法确定FM阳性病例的发生率在样本中，并通过使用FM调查分数作为一个连续的措施“纤维肌痛性”（“FM-ness”）。FM-ness与休息时疼痛、消极情绪、触诊压痛、感知下颌功能受限和疼痛相关残疾呈正相关，与舒适无痛的下颌张开呈负相关。FM-ness对下颌功能限制和残疾的影响是由口面区域的自发性持续疼痛水平介导的。重要的是，这种模式的研究结果仍然存在，即使在那些不符合FM diagnosis.ConclusionTogether的标准，这些结果意味着，更高的FM-ness增加TMD患者的负担，放大自发性疼痛和进一步阻碍无痛颌功能，即使在患者谁不符合FM诊断标准。这些结果与TMD的临床管理高度相关，因为它们意味着在治疗有疼痛集中证据的TMD患者时靶向中枢神经系统可能有助于改善疼痛和下颌功能障碍。
BackgroundMounting evidence suggests that central nervous system amplification, similar to that seen in fibromyalgia (FM), contributes to the pain experience in a subset of patients with temporomandibular disorders (TMD).MethodsIn this prospective observational study, patients with TMD completed the 2011 FM survey questionnaire, a surrogate measure of “centralized” pain. The influence of centralized pain on TMD pain, dysfunction, and disability was assessed dichotomously by determining the incidence of FM-positive cases in the sample and by using FM survey scores as a continuous measure of “fibromyalgia-ness” (“FM-ness”).ResultsThe patients meeting criteria for FM diagnosis (17 of 89) had significantly more disease burden on numerous measures. FM-ness was positively associated with pain at rest, negative mood, tenderness to palpation, perceived jaw functional limitation, and pain-related disability, and it was negatively associated with comfortable pain-free jaw opening. The impact of FM-ness on perceived jaw functional limitation and disability was mediated by levels of spontaneous, ongoing pain in the orofacial region. Importantly, this pattern of findings was still present even in those not meeting the criteria for FM diagnosis.ConclusionTogether, these results imply that higher FM-ness increases TMD patient burden by amplifying spontaneous pain and further hampering painless jaw function, even in patients who do not meet criteria for FM diagnosis. These results are highly relevant for the clinical management of TMD, as they imply that targeting the central nervous system in the treatment of patients with TMD with evidence of pain centralization may help ameliorate both pain and jaw dysfunction.