Identification of clusters of individuals relevant to temporomandibular disorders and other chronic pain conditions: the OPPERA study
Identification of clusters of individuals relevant to temporomandibular disorders and other chronic pain conditions: the OPPERA study
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DOI：
10.1097/j.pain.0000000000000518
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发表时间：
2016-06-01
期刊：
影响因子：
7.4
通讯作者：
Maixner, William
中科院分区：
文献类型：
--
作者：
Bair, Eric;Gaynor, Sheila;Maixner, William
大多数慢性疼痛疾病的分类强调疼痛的解剖位置，以区分一种疾病与另一种疾病（例如，背痛与颞下颌关节紊乱病[TMD]）或定义亚型（例如，TMD肌痛与关节痛）。然而，解剖学标准忽略了病因，可能妨碍治疗决策。这项研究确定了集群的个人使用一系列全面的生物心理社会措施。资料收集自1031例慢性TMD病例和3247例无TMD对照的病例对照研究。使用监督聚类分析确定了三个亚组（称为自适应、疼痛敏感和全局症状聚类）。与适应性集群相比，疼痛敏感集群的参与者对实验性疼痛表现出更高的敏感性，而全球症状集群的参与者表现出更高的疼痛敏感性和更大的心理困扰。集群成员与慢性TMD密切相关：91.5%的TMD病例属于疼痛敏感和全球症状集群，而41.2%的对照组属于适应性集群。疼痛敏感性和整体症状群中的颞下颌关节紊乱病例也显示出更大的疼痛强度、下颌功能受限和更多的共病疼痛状况。当同样的方法被应用到一个较小的病例对照研究，包括199慢性TMD病例和201无TMD对照组，获得了类似的结果。在无TMD个体的中位3年随访期间，与其他2个集群的参与者相比，全球症状集群的参与者发生首发TMD的风险更大（风险比=2.8）。跨队列预测建模用于证明聚类的可靠性。
The classification of most chronic pain disorders gives emphasis to anatomical location of the pain to distinguish one disorder from the other (eg, back pain vs temporomandibular disorder [TMD]) or to define subtypes (eg, TMD myalgia vs arthralgia). However, anatomical criteria overlook etiology, potentially hampering treatment decisions. This study identified clusters of individuals using a comprehensive array of biopsychosocial measures. Data were collected from a case-control study of 1031 chronic TMD cases and 3247 TMD-free controls. Three subgroups were identified using supervised cluster analysis (referred to as the adaptive, pain-sensitive, and global symptoms clusters). Compared with the adaptive cluster, participants in the pain-sensitive cluster showed heightened sensitivity to experimental pain, and participants in the global symptoms cluster showed both greater pain sensitivity and greater psychological distress. Cluster membership was strongly associated with chronic TMD: 91.5% of TMD cases belonged to the pain-sensitive and global symptoms clusters, whereas 41.2% of controls belonged to the adaptive cluster. Temporomandibular disorder cases in the pain-sensitive and global symptoms clusters also showed greater pain intensity, jaw functional limitation, and more comorbid pain conditions. Similar results were obtained when the same methodology was applied to a smaller case-control study consisting of 199 chronic TMD cases and 201 TMD-free controls. During a median 3-year follow-up period of TMD-free individuals, participants in the global symptoms cluster had greater risk of developing first-onset TMD (hazard ratio=2.8) compared with participants in the other 2 clusters. Cross-cohort predictive modeling was used to demonstrate the reliability of the clusters.