Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Pain Disability of Orofacial Pain Patients

구강안면통증 환자의 통증활동제한

  • Choi, Se-Heon (Department of Oral Medicine, School of Dentistry, Dankook University) ;
  • Kim, Ki-Suk (Department of Oral Medicine, School of Dentistry, Dankook University) ;
  • Kim, Mee-Eun (Department of Oral Medicine, School of Dentistry, Dankook University)
  • 최세헌 (단국대학교 치과대학 구강내과학교실) ;
  • 김기석 (단국대학교 치과대학 구강내과학교실) ;
  • 김미은 (단국대학교 치과대학 구강내과학교실)
  • Published : 2009.06.30
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Abstract

As Pain is a comprehensive, biopsy chosocial phenomenon, improved understanding and successful management of pain need assessment of health-related quality of life and psychological states. The purpose of this study was to evaluate pain severity and pain-related interference to daily lives for patients with non-dental, orofacial pain(OFP) and a possible relation of OFP with psychological morbidity. Relation with such factors as gender, age, pain duration and diagnosis was also assessed. Inclusion criteria was all new patients with non-dental OFP attending the oral medicine.orofacial pain clinic of Dankook University Dental Hospital over 3 months' period, who completed the questionnaires of the Brief Pain Inventory (BPI) and Hospital Anxiety and Depression Scale (HADS). Prior to the first consultation, the patients were asked to fill out the questionnaire in the waiting room and were diagnosed through consultation and clinical examination. Total subjects were 163 with M:F ratio of 1:1.5 and mean age of 34.6${\pm}$17.7 years. Mean duration of pain was 13.3${\pm}$26.2 months and all patients were divided into; Trigeminal Neuralgia group (TN, N=8), Neuropathic Pain group (NeP, N=9), Persistent Idiopathic Facial Pain group (PIFP, N=8), and Temporomandibular Disorders group (TMD, N=138), subdivided into muscle problem (TMD-m, N=73), joint problem (TMD-j, N=24) and muscle-joint combined problem (TMD-c, N=41). OFP patients showed moderate pain severity and moderate pain-related interference. There was no gender difference in overall pain severity and interference and levels of anxiety and depression. Elderly patients aged ${\geq}$ 60 years showed higher pain severity (p<0.05). Patients with chronic pain ${\geq}$ 3 months reported more increased level of anxiety and depression than those with acute pain (p<0.05). Compared to TMD patients, patients with TN, NeP and PIFP suffered from higher level of pain and pain-related interference and reported higher level of anxiety and depression (p<0.05). Pain interference was closely correlated with their pain severity and with psychometric properties such as anxiety and depression. Pain severity was weakly correlated with levels of anxiety and depression. The results suggest a need for psychosocial assessment and support for successful management of OFP in addition to control of pain itself.

통증은 포괄적이고 생리적, 심리적, 사회적 복합현상이기 때문에 통증을 보다 잘 이해하고 더 나은 치료를 위해서는 환자의 삶의 질과 심리적 상태에 대한 평가가 필요하다. 본 연구는 비치성 구강안면통증 환자들이 느끼는 통증의 정도와 통증으로 인한 일상생활의 제한(pain interference)을 평가하고 심리적 요인과의 관련성을 평가하고자 하였다. 또한 성별 및 연령, 통증의 지속기간과 진단에 따른 차이를 함께 평가하고자 하였다. 연구대상은 3개월간 단국대학교 부속 치과병원 구강내과구강안면통증클리닉에 내원한 초진환자들 중에서 간이동통목록(Brief Pain Inventory, BPI)과 병원불안우울척도(Hospital Anxiety and Depression Scale, HADS)의 두 가지 설문지에 답하고, 비치성 구강안면통증으로 진단받은 환자들을 대상으로 하였다. 환자들은 의사와의 첫 면담 전 대기실에서 설문지를 작성하도록 하였고, 작성 후에는 진료실에서 임상검사와 면담을 통해 진단을 내렸다. 총 163명의 환자들이 연구에 포함되었는데, 남녀비 1:1.5, 평균 연령 34.6세, 평균 통증지속기간 13.3개월이었다. 진단에 따라 삼차신경통군(Trigeminal Neuralgia group; TN), 신경병성동통군(Neuropathic Pain group; NeP), 만성안면통증군(Persistent Idiopathic Facial Pain; PIFP), 턱관절장애군(TMD)으로 나누고 TMD는 저작근장애군(TMD-m), 관절장애군(TMD-j) 및 근육-관절 복합군(TMD-c)으로 세분하였다. 비치성 구강안면통증 환자들은 중등도의 통증과 중등도의 일상생활 제한을 보였다. 3개월 이상의 만성통증을 가진 환자들은 급성군에 비해 높은 수준의 불안과 우울척도를 보였다(p<0.05). TMD 환자들보다 삼차신경통, 만성안면통증 및 신경병성통증 환자들의 통증이 심하고 pain interference가 컸으며 불안과 우울척도도 높았다 (p<0.05). Pain interference는 통증의 강도과 강한 상관관계를 보였고 우울 및 불안척도와 중등도의 상관관계를 보였다 (p=0.000). 우울 및 불안척도는 통증의 강도와 약한 상관관계를 보였다 (p<0.05). 결론적으로 구강안면통증의 성공적인 치료를 위해서는 통증 자체의 조절뿐 아니라 통증으로 인한 심리적, 사회적 영향에 대한 평가와 심리사회적 측면에서의 지원(psychosocial support)가 필요함을 알 수 있다.

Keywords

References

  1. Okeson JP. Bell's orofacial pains: The clinical management of orofacial pain. 6th ed., Chicago, 2005, Quintessence, pp. 3
  2. Simpson KH. Chronic non-cancer pain In: Chronic pain. Dickman A & Simpson KH eds. Oxford, 2008, Oxford University Press
  3. Breivik H, Collett B, Ventafridda V et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006;10:287-333 https://doi.org/10.1016/j.ejpain.2005.06.009
  4. Main CJ, Waddell G. Behavioural responses to examination. A reappraisal of the interpretation of non-organic signs. Spine 1998:23:2367-2371 https://doi.org/10.1097/00007632-199811010-00025
  5. Aggarwal VR, McBeth J, Zakrzewska JM, Lunt M, Macfarlane GJ. Are reports of mechanical dysfunction in chronic oro-facial pain related to somatisation? A population based study. Eur J Pain 2008;12:501-507 https://doi.org/10.1016/j.ejpain.2007.08.002
  6. Murray H, Locker D, Mock D, Tenenbaum HC. Pain and the quality of life in patients referred to a craniofacial pain unit. J Orofac Pain 1996;10:316-323
  7. 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
  8. Siccoli MM, Bassetti CI, Sndor PS. Facial Pain:clinical differential diagnosis. Lancet Neurol 2006;5:257-267 https://doi.org/10.1016/S1474-4422(06)70375-1
  9. Zakrzewska JM. Diangosis and management of non-dental orofacial pain. Dent Update 2007;34:134-139 https://doi.org/10.12968/denu.2007.34.3.134
  10. Chung JW, Kim JH, Kim HD et al. Chronic orofacial pain among Korean elders: prevalence, and impact using the graded chronic pain scale. Pain 2004;112:164-170 https://doi.org/10.1016/j.pain.2004.08.014
  11. Jaafar N, Razak IA, Zain RB. The social impact of oral and facial pain in an industrial population. Ann Acad med Singapore 1989;18:553-555
  12. Radbruch L, Loick G, Kiencke P et al. Validation of the German version of the Brief Pain Inventory. J Pain Symptom Managel 1999;18:180-187 https://doi.org/10.1016/S0885-3924(99)00064-0
  13. Zigmond AS and Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983;67:361-370 https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
  14. Headache Classification Subcommittee of the International headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalagia 2004;24(suppl 1)
  15. Stohler CS. Chronic orofacial pain: Is the puzzle unraveling? Journal of Dental Education 2001;65:1383-1392
  16. Keogh E, McCracken LM, Eccleston C. Do men and women differ in their response to interdisciplinary chronic pain management? Pain 2005;114:37-46 https://doi.org/10.1016/j.pain.2004.12.009
  17. Spinhoven P, Ormel J, Sloekers PP et al. A validation study of the Hospital Anxiety and Depression Scale(HADS) in different groups of Dutch subjects. Psycho Med 1997;27:363-370 https://doi.org/10.1017/S0033291796004382
  18. Loeser JD, Melzack R. Pain: an overview. Lancet 1999;353:1607-1609 https://doi.org/10.1016/S0140-6736(99)01311-2
  19. Auerbach SM, Laskin DM, Frantsve LM, Orr T. Depression, pain, exposure to stressful life events, and long-term outcomes in temporomandibular disorders patients. J Oral Maxillofac Surg 2001;59:628-633 https://doi.org/10.1053/joms.2001.23371
  20. Wikson KG, Eriksson MY, D'Eon JL, Mikail SF,Emery PC. Major depression and insomnia in chronic pain. Clin J Pain 2002;18:77-83 https://doi.org/10.1097/00002508-200203000-00002
  21. Jung JS, Hur YK, Choi JK. Evaluation of quality of life in patients with temporomandibular disorders. Korean J Oral Med 2006;31:127-139
  22. 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;10:240-252
  23. Forssell H, Santalahti P, Puukka P, Talo S. Searching for an assessment instrument to determine temporomandibular disorders pain profiles for the purposes of primary health care. Int J of Rehabil Res 2005;28:203-209 https://doi.org/10.1097/00004356-200509000-00002
  24. Kafas P, Leeson R. Assessment of pain in temporomandibular disorders: the bio-psychosocial complexity. Int J Oral Maxillofac Surg 2006;35:145-149 https://doi.org/10.1016/j.ijom.2005.04.023