[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.

주제어

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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

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.
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.
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).
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.
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).

후속연구

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.
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.

참고문헌 (24)

Okeson JP. Bell's orofacial pains: The clinical management of orofacial pain. 6th ed., Chicago, 2005, Quintessence, pp. 3
Simpson KH. Chronic non-cancer pain In: Chronic pain. Dickman A & Simpson KH eds. Oxford, 2008, Oxford University Press
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

상세보기
Main CJ, Waddell G. Behavioural responses to examination. A reappraisal of the interpretation of non-organic signs. Spine 1998:23:2367-2371

상세보기
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

상세보기
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

상세보기
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

상세보기
Siccoli MM, Bassetti CI, Sndor PS. Facial Pain:clinical differential diagnosis. Lancet Neurol 2006;5:257-267

상세보기
Zakrzewska JM. Diangosis and management of non-dental orofacial pain. Dent Update 2007;34:134-139

상세보기
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

상세보기
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

상세보기
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

상세보기
Zigmond AS and Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983;67:361-370

상세보기
Headache Classification Subcommittee of the International headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalagia 2004;24(suppl 1)
Stohler CS. Chronic orofacial pain: Is the puzzle unraveling? Journal of Dental Education 2001;65:1383-1392

상세보기
Keogh E, McCracken LM, Eccleston C. Do men and women differ in their response to interdisciplinary chronic pain management? Pain 2005;114:37-46

상세보기
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

상세보기
Loeser JD, Melzack R. Pain: an overview. Lancet 1999;353:1607-1609

상세보기
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

상세보기
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

상세보기
Jung JS, Hur YK, Choi JK. Evaluation of quality of life in patients with temporomandibular disorders. Korean J Oral Med 2006;31:127-139
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

상세보기
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

상세보기
Kafas P, Leeson R. Assessment of pain in temporomandibular disorders: the bio-psychosocial complexity. Int J Oral Maxillofac Surg 2006;35:145-149

상세보기

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