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Título: Impact of painful comorbidities associated persistent and recurrent temporomandibular disorder-related pain
Autores: Ahmed, Ahad
Fecha: 2014
Publicador: McGill University - MCGILL
Fuente:
Tipo: Electronic Thesis or Dissertation
Tema: Health Sciences - Dentistry
Descripción: Objectives: The primary aims of this study were to determine if: i) TMD-related pain was associated with migraine and musculoskeletal comorbidities; and ii) persistent or recurrent TMD-related pain were related to these comorbidities. Methods: Data from 750 TMD-related pain cases – of which 477 were classified as persistent and 261 as recurrent TMD-related pain, and 146 controls – were obtained from the National Institute of Dental and Craniofacial Research’s Temporomandibular Joint Implant Registry and Repository (NIDCR’s TIRR). The diagnosis of TMD-related pain was determined by clinical examination using a modified Craniomandibular Index wherein the exam items were redesigned to conform to those specified for the Research Diagnostic Criteria. Controls were participants without TMD. Patterns of pain (i.e., persistent or recurrent) and comorbidities were assessed using questionnaires from the TIRR. Painful comorbidities include migraine and musculoskeletal conditions. Univariate and multivariable logistic regression analyses were used to investigate the associations between TMD-related pain and painful comorbidities. Results: There was a significant difference in the mean age of TMD-related pain cases (mean = 41.9, SD = 14.7) and of controls (mean = 34.2, SD = 13.8, P < .0001). Females were significantly more prevalent among cases (89%) than among controls (66%, P < .0001). The mean pain intensity (0 - 10 NRS) in the last 6 months was significantly higher for persistent (mean = 7.8, SD = 2.6) as compared to recurrent (mean = 6.3, SD = 2.7, P < 0.001) TMD-related pain. In multivariable logistic analyses adjusted by age, gender, and psychological comorbidities, migraine (OR = 2.19, P = 0.004), neck pain (OR = 7.44, P < .0001), back pain (OR = 4.45, P < .0001) and fibromyalgia (OR = 4.80, P = 0.03) were associated with TMD-related pain. Furthermore, neck and back pains remained related to TMD-related pain, persistent or recurrent, when the model included the painful comorbidities, with the exception of migraine. Finally, persistent TMD-related pain cases were more likely to have fibromyalgia (OR = 1.92, P = 0.01) than the recurrent cases. Conclusion: These results demonstrated that participants with musculoskeletal painful conditions were more likely to have TMD-related pain, regardless of TMD characteristics such as recurrent and persistent TMD-related pain. A significant difference was nonetheless noted on the odds of fibromyalgia between persistent and recurrent TMD-related pain. Finally, the association with migraine seems to be modified by the manifestation of other comorbid conditions and type of TMD-related pain as compared to other painful comorbidities. To our knowledge, this study is the first to assess the association between painful comorbid conditions and TMD-related pain (persistent or recurrent) regardless of occurrence of other painful comorbid conditions. Understanding the relationship between TMD-related pain with painful comorbid conditions will lead to better patient management using a multidisciplinary approach.
Objectif: Les principaux objectifs de cette étude étaient de déterminer si: i) la douleur liée au troubles de l’articulation temporomandibulaire (TMD) était associée à la migraine et les comorbidités musculo-squelettiques, et ii) la douleur persistante ou récurrente liée aux TAT était associée à ces comorbiditésMéthode: Les données de 750 cas de douleur liée aux TMD – dont 477 furent classés comme ayant de la douleur persistante et 261 comme ayant de la douleur récurrente liée aux TMD, ainsi que 146 contrôles – ont été obtenus à partir du Temporomandibular Joint Implant Registry and Repository de la National Institute of Dental and Craniofacial Research (la TIRR de la NIDCR). Le diagnostic de douleur liée au TMD a été déterminé par un examen clinique en utilisant un indice craniomandibulaire modifiée, où les questions de l`examen furent modifiées afin d`être conformes à celles spécifiées par le Research Diagnostic Criteria. Les contrôles étaient des participants sans TMD. Les modèles de la douleur (i.e. persistante ou récurrente) et les comorbidités ont été évalués au moyen de questionnaires de la TIRR. Les comorbidités douloureuses comprennent la migraine et les troubles musculo-squelettiques. Des analyses de régression logistique univariée et multivariée ont été utilisés pour étudier les associations entre la douleur liée aux TMD et les comorbidités douloureuses.Résultats: Il y avait une différence significative dans l'âge moyen des cas de douleur liée aux TMD (moyenne = 41,9 , SD = 14,7) et des contrôles (moyenne = 34,2 , SD = 13,8 , P < 0,0001) . Les femmes étaient significativement plus fréquentes parmis les cas (89 %) que parmis les contrôles (66 % , p < 0,0001) . L`intensité de douleur (0 - 10 NRS) dans les 6 derniers mois était significativement plus élevée pour la douleur persistante (moyenne = 7,8 , SD = 2,6) que pour la douleur récurrente (moyenne = 6.3 , SD = 2,7 , p
Idioma: en