[논문]구강안면통증 환자의 통증활동제한

최세헌; 김기석; 김미은

[국내논문] 구강안면통증 환자의 통증활동제한
Pain Disability of Orofacial Pain Patients 원문보기

대한구강내과학회지 = Korean journal of oral medicine, v.34 no.2 = no.75, 2009년, pp.217 - 225

최세헌 (단국대학교 치과대학 구강내과학교실) , 김기석 (단국대학교 치과대학 구강내과학교실) , 김미은 (단국대학교 치과대학 구강내과학교실)

초록
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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.

Abstract ▼ AI-Helper

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.

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문제 정의

The purpose of this study was to evaluate pain severity and pain-related interference to daily lives for patients with non-dental, OFP and a possible relation of OFP with psychological morbidity. Relation with factors such as gender, age, pain duration and diagnosis was also assessed.

제안 방법

of Korea over 3 months' period in 2008, who completed questionnaires. Prior to the first consultation, all new patients in the waiting room were asked to fill in the Brief Pain Inventory (BPI) and Hospital Anxiety and Depression Scale (HADS). All of them were examined clinically and diagnosed.
Information collected retrospectively from clinical records of the eligible patients included scores of pain severity and interference from BPI and anxiety and depression subscales from HADS, duration of pain and diagnosis.
This study evaluated pain disability and psychological morbidity over various OFP pain disorders including TN, NeP and PIFP. Previous researches regarding pain disability have been performed over TMD patients.

데이터처리

Pearson's Correlation Coefficients were calculated to investigate any possible relation of pain severity to interference, and to psychometric properties such as anxiety and depression.

이론/모형

Each item scores on a 4-point Likert scale, giving maximum subscale scores of 21 for depression and anxiety, respectively. Korean version of HADS was used in this study.

성능/효과

According to diagnostic criteria for OFP proposed by both the International Association for the Study of Pain (IASP) and the International Headache Society (HIS) and the Research Criteria for TMD (RDC/TMD), we divided diagnosis groups into; Trigeminal Neuralgia group (TN, N=8), Neuropathic Pain group (NeP, N=9), Persistent Idiopathic Facial Pain (PIFP, N=8), and Temporomandibular Disorders group (TMD, N=138). As 84.7% of total was TMD patients and TMD is considered a heterogeneous disorder, based on the structures affected, TMD were subdivided into TMD with muscle problem (TMD-m, N=73), TMD with joint problem (TMD-j, N=24) and TMD with muscle-joint combined problem (TMD-c, N=41). NeP comprised postoperative trigeminal neuropathic pain (N=4), atypical odontalgia (N=1) and burning mouth syndrome (BMS, N=4).
Overall patients with OFP in this study showed moderate pain severity and pain-related interference and various OFP disorder groups were significantly different in pain severity and interference (Table 5, p<0.005).
Heterogeneous TMD group showed relatively lower pain severity and interference and psychometric properties than other OFP groups such as TN, NeP and PIFP groups and TMD having both muscle and joint problems reported the highest pain severity and interference among TMD subgroups while TMD with joint problem had the lowest scores. This finding was partly supported by a study by Jung et al about quality of life over 61 TMD patients, which presented with patients with masticatory muscle pain were negatively affected on quality of life and interfered compared to those with intracapsular complaint of TMJ.

후속연구

However, weakness of this study is proportion of various OFP disorders. As more than 80% of the participants in this study were TMD patients, relatively small numbers of other OFP conditions needs a future research with large population sample in each pain groups. A further study is also needed to evaluate whether reduced pain with proper treatment improves physical and psychological disability or vise versa.
As more than 80% of the participants in this study were TMD patients, relatively small numbers of other OFP conditions needs a future research with large population sample in each pain groups. A further study is also needed to evaluate whether reduced pain with proper treatment improves physical and psychological disability or vise versa.

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