关于《颞下颌关节紊乱病相关慢性疼痛的临床实践指南》解读

Interpretation of a clinical practice guideline on the management of chronic pain associated with temporomandibular joint disorders

颞下颌关节紊乱病(TMD)是一组影响颞下颌关节、咀嚼肌系统、牙齿咬合甚至全身多种结构的病症,具有显著的生物-心理-社会模式特点。TMD相关慢性疼痛作为其最主要的临床症状,会带给患者负面情绪,严重影响生活质量和身心健康。既往国内外报道的TMD治疗方法多种多样,一直缺乏公认有效的治疗方案。由加拿大麦克马斯特大学迈克尔·G·德格鲁特医学院国家疼痛中心Jason W Busse教授牵头,联合多所国际知名高校/医院制订的《颞下颌关节紊乱病相关慢性疼痛的临床实践指南》,2023年12月15日发布于临床研究国际知名期刊《英国医学杂志》。该临床实践指南分析比较了TMD相关慢性疼痛现行疗法的有效性,条件性建议了不同方案治疗/缓解疼痛的具体干预措施,提出了较为全面、规范、标准化的临床实践指南。本文详述该指南的制订流程及关键内容,以帮助国内学者理解并使用指南,为现阶段TMD相关慢性疼痛的临床诊疗提供参考和依据。

Temporomandibular disorders(TMD)are a heterogeneous group of diseases that affect the temporomandibular joint,chewing muscle system,dental occlusion,and even various structures throughout the body,with significant characteristics of biological-psychological-social pattern.TMD related chronic pain,as the most important clinical symptom,can result in negative emotions seriously affecting patients′quality of life and physical and mental health.Although a variety of therapies have been previously reported to treat TMD related chronic pain,there is a lack of widely recognized therapies.Professor Jason W Busse(from Michael G DeGroote National Pain Centre,McMaster University,Hamilton ON,Canada)took the lead and collaborated with multiple internationally renowned schools/hospitals of stomatology to develop an international consensus on the management of chronic pain associated with TMD,a clinical practice guideline,which took two years and was published in December 15th,2023 in a global top journal of clinical research The British Medical Journal.This clinical practice guideline explored the comparative effectiveness of available therapies for chronic pain associated with TMD,conditionally recommended the specific intervention for different treatment or pain relief,proposed a comprehensive,agreed,and standardized clinical practice guideline.This present article describes the methodology and key elements of the clinical practice guideline to help clinicians fully understand and appropriately apply this guidance,which could provide the references for clinical practice of TMD associated chronic pain in China.