颞下颌关节紊乱病的临床疼痛特征调查

Investigation on clinical pain features in temporomandibular disorders

目的定性和定量分析颞下颌关节紊乱病（TMD）患者的疼痛多维感受，探讨TMD的临床疼痛特征。方法使用短式McGiU疼痛调查表（short-form McGill pain questionnaire，SF-MPQ）和视觉模拟量表（visual analogscale，VAS）评价250例TMD疼痛患者的疼痛感觉、感受和强度。250例TMD疼痛患者分3组：关节痛组（A组）：139例；肌肉痛组（B组）：47例；混合痛组（C组）：64例。采用SAS统计软件分析。结果B组SF-MPQ疼痛描述词多于其他两组。3组患者疼痛性质相近，隐痛、触痛、沉重样痛是最常见的感觉类描述词；感觉疲劳-精疲力竭和令人厌恶为3组疼痛的感受类高频选词，其中B组感受类描述词的选择频率更高。静止状态下，B组VAS均分高于A、c组，得分与A组比较，差异有统计学意义（P〈0．05）；功能状态下，B组VAS均分低于A、C组，得分与A组比较，差异有统计学意义（P〈0．05）。静止状态下，3组患者多无疼痛；功能状态下，3组患者疼痛强度多以轻、中度痛为主。结论TMD疼痛特点：①疼痛强度多为轻度、中度；②疼痛性质多为隐痛、触痛、沉重样痛，并有感觉疲劳-精疲力竭和令人厌恶的情感不愉快；③下颌静止时不痛，功能运动时疼痛加重；④肌肉痛有不同于关节痛的自身特征。

Objective To investigate the pain features of temporomandibular disorders （TMD） by qualitatively and quantitatively analyzing patient multi-dimension sensations. Methods Two hundred and fifty patients with painful TMD from January to December 2005 were included, short-form mcgiU pain questionnaire （SF-MPQ） and visual analog scale （VAS） were administered to assess patients＇ sensation, affection and intensity of pain. The data were analyzed by SAS 8.0 software. Results All patients were assigned to three groups including 139 joint pain, 47 muscle pain and 64 both joint and muscle pain group. In joint pain group, the total number of descriptors was 250, 1.80 in average; in muscle pain group, the total number was 99, 2. 11 in average; in both joint and muscle pain group, the total number was 107, 1.64 in average. The sensitive descriptors most frequently chosen in all three groups were ＂aching＂, ＂heavy＂, and ＂tender＂. ＂ Tiring-exhausting＂ and ＂ sickening＂ were high frequency descriptors in affective items. There were higher affective scores in the muscle pain group than in others. Muscle pain group had a higher VAS score at rest than the other two （ P 〈 0. 05 ）, but had a lower VAS score during function than the other two （P〈0.001）. All three groups usually had no pain at rest, and complained a slight to moderate pain during function. Conclusions TMD pain was generally slight to moderate;＂ a ching＂ ,＂ heavy＂, and ＂tender＂ were the most frequently sensitive descriptors, while unpleasant feelings were described as ＂tiringexhausting＂ and ＂sickening＂ ; pain generally occurred or exacerbated during mandibular function; compared to joint pain, muscle pain had its own features.