Avaliação dos aspectos clínicos e psicossomáticos em pacientes com disfunção temporomandibular e dor crônica

Abstract

Temporomandibular Disorders (TMDs) and the diversity of symptoms presented by this con dition make it necessary to have adequate knowledge of the disease and careful studies for its correct elucidation.OBJECTIVE: The objective of this study was to evaluate patients with TMD and chronic pain in the face of the aspects clinical and psychosomatic. METHODOL OGY: A cross-sectional study was carried out, with a sample of 100 patients, between 18 and 65 years old, diagnosed as having TMD; according to DC / TMD (Diagnostic Criteria for Tem poromandibular) and chronic pain, according to EGDC (Graded Chronic Pain Scale). Chronic Pain Intensity (ICD) and pain disability points were the dependent variables of the study, which found an association with clinical aspects of DC / TMD, such as: maximum mouth opening, pain in mouth opening, protrusion, laterality and on palpation, as well as on depression, anxiety and catastrophization, using the PHQ-9, GAD-7 and PCS questionnaires, respectively. Cluster analysis was also carried out to characterize and define the group of participants with more and less symptoms of anxiety and depression according to the scores of the GAD-7 and PHQ9 in struments. The variable generated in this analysis was used as a dependent variable and associ ated with sleep disturbance factors, hypervigilance, somatization of physical symptoms and parafunctional habits, using the PSQI, PVAQ, PHQ-15 and OBC questionnaires. Adjusted Poisson regression models were performed to assess the association of independent variables with the outcome variable of each analysis plan.RESULTS: In pain intensity, 66.3% had high intensity, with higher catastrophic scores associated with the outcome in the adjusted model and high predictive value (PR: 1.02; 95% CI 1.01-1.03). Regarding pain disability, with a mean value of 1.7 (SD = 2), they remained associated with the outcome in the adjusted pain model during mouth opening (RR: 2.25; 95% CI 1.04-4.84) and catastrophization (RR: 1.03; 95% CI 1.01-1.06). There was also a positive and moderate correlation between the anxiety and depres sion scores (r = 0.70), and positive and weak correlations between the average palpation and anxiety scores (r = 0.24), and a positive, weak correlation. and significant between catastro phizing and anxiety scores (r = 0.24) and between palpation pain and anxiety (r = 0.22). Most participants were female (70.5%), with an average age of 39.7 years (SD = 13.6). In the bivari ate analysis, higher scores on sleep disorder, physical symptoms and parafunctional habits were associated with greater signs and symptoms of anxiety and depression. The variables that re mained associated with the outcome in the adjusted final model were sleep disorder (PR: 1.10; 95% CI 1.02-1.19) and somatization (PR: 1.11; 95% CI 1.05-1.16 CONCLUSION: From the clinical and psychosomatic point of view included in the present study, catastrophization is the best predictor of pain intensity, while pain and mouth opening are the best predictors of pain related disability in patients with TMD and pain chronic. The highest scores for sleep disorders and physical symptoms were associated with more signs and symptoms of anxiety and depres sion in patients with TMD and chronic pain.