Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
권호 표지

Impacts of Depression, Somatization, and Jaw Disability on Graded Chronic Pain in TMD Patients

우울, 신체화, 턱기능장애가 측두하악장애 환자의 만성통증척도에 미치는 영향

  • Kim, Cheul (Department of Oral Medicine and Diagnosis, College of Dentistry, Kangnung National University) ;
  • Shin, Eun-Seop (Department of Oral Medicine and Oral Diagnosis, College of Dentistry, Seoul National University) ;
  • Chung, Jin-Woo (Department of Oral Medicine and Oral Diagnosis, College of Dentistry, Seoul National University)
  • 김철 (강릉대학교 치과대학 구강내과진단학교실) ;
  • 신은섭 (서울대학교 치과대학 구강내과진단학교실) ;
  • 정진우 (서울대학교 치과대학 구강내과진단학교실)
  • Published : 2005.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

The aim of this study was to investigate the impact of depression, somatization, and jaw disability on graded chronic pain of TMD using Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Ninety-three patients (17 men and 76 women, mean$\pm$SD age of 30.1$\pm$12.5 years) diagnosed with TMD based on RDC/TMD axis I criteria were administered RDC/TMD axis II history questionnaire. The relationships between depression, somatization, jaw disability, and each parameters of graded chronic pain (e.g. pain intensity, pain days, disability score, disability days, graded chronic pain scale) were analyzed by multiple regression analysis. The obtained results were as follows: 1. Among 93 TMD patients, the prevalence of low disability group of graded chronic pain scale was 42.0% and high disability group of graded chronic pain scale was 51.5%. 2. Depression did not show any significant influences on pain intensity, pain days, disability score, disability days, and graded chronic pain scale. 3. Somatization showed a significant effect on pain intensity (p<0.01), disability days (p<0.01), and graded chronic pain scale (p<0.01) except for both pain days and disability score. 4. Jaw disability also showed a significant effect on pain intensity (P<0.001), disability days (p<0.01), and graded chronic pain scale (P<0.001) except for both pain days and disability score. Somatization and jaw disability may closely relate to the pain intensity and degree of disability that TMD patients perceive. Therefore, comprehensive understanding of psychological profile and improvement of functional limitation of jaw movements in the patient should be considered to obtain an excellent outcome of chronic TMD management.

측두하악장애 연구진단기준 (Research Diagnostic Criteria for Temporomandibular Disorders; RDC/TMD)을 이용하여 측두하악장애 환자들에서 심리학적 상태 및 턱기능장애의 정도가 통증의 정도 및 지속기간, 통증과 관련된 일상생활 장애의 정도 및 기간, 만성통증척도에 미치는 영향 등을 알아보기 위하여 RDC/TMD axis I criteria에 따라 측두하악장애로 진단받은 평균연령 30.1$\pm$12.5 세인 93 명의 환자들(남성 17명, 여성 76명)을 대상으로 RDC/TMD axis II 병력 설문지를 작성하게 한 뒤, 우울증점수, 신체화장애점수, 턱기능장애점수와 만성통증척도의 통증 강도, 통증 지속기간, 통증과 연관된 장애 점수, 통증과 연관된 장애의 기간 및 만성통증척도 사이의 연관성을 분석하여 다음과 같은 결론을 얻었다. 1. 93명의 측두하악장애 환자들에서 만성통증척도의 경도의 장애를 보이는 군 (low disability group, grade I and II)은 42.0% 이었으며, 심도의 장애를 보이는 군 (high disability group, grade III and IV)은 51.5% 이었다. 2. 우울증점수는 통증 강도, 통증 지속기간, 통증과 연관된 장애 점수, 통증과 연관된 장애의 기간, 만성통증척도 모두에 통계적으로 유의한 영향을 미치지 않았다. 3. 신체화장애점수는 통증 강도 (p<0.01), 통증과 연관된 장애의 기간 (p<0.01), 만성통증척도 (p<0.01)에 유의한 영향을 미쳤으나, 통증 지속기간이나 통증과 연관된 장애 점수에는 통계적으로 유의한 영향을 미치지 않았다. 4. 턱기능장애점수는 통증 강도 (p<0.001), 통증과 연관된 장애의 기간 (p<0.01), 만성통증척도 (p<0.001)에 유의한 영향을 미쳤으나, 통증 지속기간이나 통증과 연관된 장애 점수에는 통계적으로 유의한 영향을 미치지 않았다. 측두하악장애환자에서 신체화장애와 턱기능장애는 환자가 느끼는 통증의 강도 및 장애의 정도와 밀접하게 관련되어 나타날 수 있으며, 환자가 호소하는 정서적 스트레스에 대한 포괄적인 이해와 기능장애에 대한 적절한 관리가 측두하악장애 환자의 성공적인 치료에 매우 중요하리라 생각된다.

Keywords

References

  1. McNeill C. Temporomandibular disorders, Guidelines for Classification, Assessment, and Management. The American Academy of Orofacial Pain, Chicago, Quintessence Publishing Co. 1994
  2. Fricton JR, Kroening RJ, Hathaway KM. TMJ and craniofacial pain: Diagnosis and Management. 1st ed., St. Louis, Tokyo 1988, Ishiyaku EuroAmerica, Inc., pp. 27-37
  3. Lee YO, Lee SW. A study of the emotional characteristics of temporomandibular disorder patients using SCL-90-R. J Craniomandib Disord Facial Oral Pain 1989;3:25-34
  4. Schulte JK, Anderson GC, Hathaway MK, Will TE. Psychometric profiles and related pain characteristics of temporomandibular disorder patients. J Orofac Pain 1993;7:247-253
  5. Butterworth JC, Deardorff WW. Psychometric profiles of craniomandibular pain patients: Identifying specific subgroups. J Craniomand Pract 1987;5:225-232
  6. Dahlstrom L. Psychometrics in temporomandibular disorders: An overview. Acta Odontol Scand 1993;51:339-352 https://doi.org/10.3109/00016359309040585
  7. Yap AU, Chua EK, Hoe JK. Clinical TMD, painrelated disability and psychological status of TMD patients. J Oral Rehabil 2002;29:374-380 https://doi.org/10.1046/j.1365-2842.2002.00822.x
  8. Gale EN, Dixon DC. A simplified psychologic questionnaire as a treatment planning aid for patients with temporomandibular joint disorders. J Prosthet Dent 1989;61:235-238 https://doi.org/10.1016/0022-3913(89)90381-8
  9. Suvinen TI, Reade PC. Temporomandibular disorders: A critical review of the nature of pain and its assessment. J Orofac Pain 1995;9:317-339
  10. Cimino R, Michelotti A, Stradi R, Farinaro C. Comparison of clinical and psychologic features of fibromyalgia and masticatory myofascial pain. J Orofac Pain 1998;12:35-41
  11. Rollman GB, Gillespie JM. The role of psychosocial factors in temporomandibular disorders. Curr Rev Pain 2000;4(1):71-81 https://doi.org/10.1007/s11916-000-0012-8
  12. Lindroth JE, Schmidt JE, Carlson CR. A comparison between masticatory uscle pain patients and intracapsular pain patients on behavioral and psychosocial domains. J Orofac Pain 2002;16:277-283
  13. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord Facial Oral Pain 1992;6:301-355
  14. Macfarlane TV, Blinkhorn AS, Davies RM, Kincey J, Worthington HV. Oro-facial pain in the community: prevalence and associated impact. Community Dent Oral Epidemiol. 2002;30:52-60 https://doi.org/10.1034/j.1600-0528.2002.300108.x
  15. Seok H, Son BK, Ha YR, Ryu HH, Moon JH. Clinical influence of emotional depression on chronic low back pain. J Korean Acad Rehabil Med 2003;27:568-574
  16. Dworkin SF, Sherman J, Mancl L, Ohrbach R, LeResche L, Truelove E. Reliability, validity, and clinical utility of the Research Diagnostic Criteria for Temporomandibular Disorders Axis II scales: Depression, Non-specific physical symptoms, and Graded chronic pain. J Orofac Pain 2002; 16(3):207-220
  17. Manfredini D, Segu M, Bertacci A, Binotti G, Bosco M. Diagnosis of temporomandibular disorders according to RDC/TMD axis I findings, A multicenter Italian study. Minerva Stomatol. 2004;53:429-438
  18. List T, Dworkin SF. Comparing TMD diagnoses and clinical findings at Swedish and US TMD centers using research diagnostic criteria for temporomandibular disorders. J Orofac Pain 1996;10:240-253
  19. Wahlund K, List T, Dworkin SF. Temporomandibular disorders in children and adolescents: Reliability of a questionnaire, clinical examination, and diagnosis. J Orofac Pain 1998;12:42-51
  20. Rantala MA, Ahlberg J, Suvinen TI, Savolainen A, Kononen M. Symptoms, signs, and clinical diagnoses according to the research diagnostic criteria temporomandibular disorders among Finnish multiprofessional media personnel. J Orofac Pain 2003;17(4):311-316
  21. Dworkin SF, Huggins KH, Wilson L, Mancl L, Turner J, Massoth D, LeResche L, and Truelove E. A randomized clinical trial using Research Diagnostic Criteria for Temporomandibular Disorders-Axis II to target clinic cases for tailored self-care TMD treatment program. J Orofac Pain 2002;16(1):48-63
  22. Yap AU, Chua EK, Hoe JK. Clinical TMD, painrelated disability and psychological status of TMD patients. J Oral Rehabil. 2002;29(4):374-380 https://doi.org/10.1046/j.1365-2842.2002.00822.x
  23. Wilson L, Dworkin SF, Whitney C, LeResche L. Somatization and pain dispersion in chronic temporomandibular disorder pain. Pain 1994:57:55-61 https://doi.org/10.1016/0304-3959(94)90107-4
  24. Mccreary CP, Clark GT, Oakley ME, Flack V. Predicting response to treatment for temporoman dibular disorders. J Craniomandib Disord Facial Oral Pain. 1992;6:161-170
  25. Schmitter M, Kress B, Rammelsberg P. Temporomandibular joint pathosis in patients with myofascial pain: a comparative analysis of magnetic resonance imaging and a clinical examination based on a specific set of criteria. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:318-324 https://doi.org/10.1016/j.tripleo.2003.10.009