Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Psychosocial Impact of Chronic Orofacial Pain

만성 구강안면통증의 사회심리적 영향

  • Yang, Dong-Hyo (Department of Oral Medicine, School of Dentistry, Dankook University) ;
  • Kim, Mee-Eun (Department of Oral Medicine, School of Dentistry, Dankook University)
  • 양동효 (단국대학교 치과대학 구강내과학 교실) ;
  • 김미은 (단국대학교 치과대학 구강내과학 교실)
  • Published : 2009.12.30
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Abstract

The aim of the study was to evaluate psychosocial impact of non-dental chronic orofacial pain (OFP) on daily living using the graded chronic pain (GCP) scale. It is also investigated the clinical profile such as demographics, event related to initiation of OFP and prior treatments for patients. During previous 6 months since September 2008, 572 patients (M:F=1:1.5, mean age=34.7 years) with non-dental OFP attended university-based specialist orofacial pain clinic (Dankook University Dental Hospital, Cheonan) to seek care although 63% of them already experienced related treatment for their OFP problem. They visited the most frequently general dental practitioner and orthopedic doctors due to their pain problem and medication was the most commonly employed modality. Most of the patients (89.2%) had TMD and the most common related event to initiation of their pain was trauma, followed by dental treatment. Almost half of the patients (46%) suffered from chronic pain(${\geq}6\;M$) and 40% of them exhibited relatively high disability due to chronic OFP. GCP pain intensity and disability days were significantly different for age and diagnosis (p<0.05) but not for gender and duration. GCP grades were affected by all the factors including gender, age, pain duration and diagnosis.(p=0.000) Female gender, elders, and long lasting pain were closely related to high disability. The patients with neuropathic Pain and mixed OFP rather than TMD were graded as being highly disabled. Conclusively, a considerable percentage of chronic OFP patients reports high pain-related disability in their daily, social and work activity, which suggest a need for psychosocial support and importance of earlier referral for appropriate diagnosis and tailored management.

본 연구는 6개월 이상의 만성 비치성 구강안면통증(orofacial pain, OFP) 환자들을 대상으로 통증으로 인한 사회심리적 영향을 평가하고, 대학병원의 구강안면통증 전문클리닉에 내원한 OFP 환자들의 임상적 특성(유발사건, 이전 치료병력 등)을 조사하고자 하였다. 연구를 위하여 2008년 9월부터 6개월간 단국대학교 치과대학 부속 치과병원 구강내과 구강안면통증클리닉에 내원한 초진환자 중 OFP 환자들의 초진시 진료기록과 면담 전 대기실에서 작성한 만성통증척도(Graded Chronic Pain Scale, GCPS) 설문지를 조사분석하였다. 본원에 지난 6개월간 내원한 다양한 비치성 구강안면통증 572 명의 환자들 중 63%는 이전 치료 경험이 있었고 약물치료, 상담, 물리치료의 순으로 빈도가 높았고, 전문과목은 일반치과와 정형외과의 순서였다. 환자들의 89.2%는 턱관절장애였고 6.4%는 삼차신경통을 포함한 신경병성동통, 4.5%는 2가지 이상의 OFP가 공존하는 복합성 안면통증(mixed OFP)이었다. 통증의 발생과 관련한 유발요인에 대해서는 환자들의 약 35%가 인지하고 있었으며, 외상, 치과치료의 순으로 빈도가 높았다. OFP 환자의 약 반 정도(46%)는 만성 통증을 가진 환자였으며, 이 중 40%에 이르는 많은 환자들이 구강안면통증으로 인하여 일상적인 활동과 사회적 활동 및 업무능력에 상당히 제한(high disability)을 받는다고 보고하였다. 여성일수록, 나이가 많을수록, 통증병력이 길수록(>5년) 그리고 턱관절장애보다는 신경병성 통증과 복합성 구강안면통증 환자들이 더 심한 사회심리적 활동제한을 보였다.(p=0.000) 이러한 연구결과는 환자가 자신의 만성통증에 수반되는 사회적, 심리적 장애(disability)를 잘 이해할 수 있도록 사회심리적 지원이 필요하며, 가능한 한 조기에 전문가에게 내원하여 정확한 진단을 받을 필요가 있음을 보여준다.

Keywords

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