Dor generalizada, sensibilização central e qualidade de vida em adolescentes com disfunções temporomandibulares dolorosas
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Data
2019-01-24
Autores
Campi, Letícia Bueno
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Em adultos, a disfunção temporomandibular (DTM) frequentemente está associada com outras condições dolorosas, como a fibromialgia (FM). Os tender points (TPs), que são parte dos critérios diagnósticos para FM, indicam um aumento da sensibilidade à dor generalizada. Objetivos: Investigar a associação entre DTM dolorosa e o número de TPs em adolescentes, bem como a relação entre o número de TPs e o limiar de dor à pressão (LDP) para dor local, regional e generalizada, como possíveis indicativos de sensibilização central (SC). Ainda, explorar a associação entre DTM dolorosa e FM, investigar o impacto da DTM dolorosa na qualidade de vida (QV) do adolescente e a influência de outras condições comórbidas (dor no corpo, qualidade do sono, doenças sistêmicas, sedentarismo, obesidade, sintomas depressivos) nessa associação. Métodos: A amostra foi composta por 690 adolescentes brasileiros com (n=112) e sem DTM dolorosa (n=578), de 12 a 14 anos. A DTM dolorosa foi classificada de acordo com os Critérios de Diagnóstico de Pesquisa para DTM (RDC/TMD) - Eixo I. Os critérios estabelecidos por Yunus foram aplicados para avaliar a FM juvenil e os TPs. O questionário Pediatric Quality of Life InventoryTM foi aplicado para avaliar a QV. Estatísticas descritivas foram utilizadas para caracterizar os participantes, estratificando pela presença de DTM dolorosa. Testes de Mann-Whitney e χ2 foram aplicados para testar a associação entre DTM dolorosa e variáveis demográficas. Modelos de regressão foram usados para estimar a associação entre DTM dolorosa e TPs e determinar quais variáveis preditivas adicionais estavam associadas aos TPs. Análises de regressão foram realizadas para testar as associações entre os valores de LDP e número de TPs. O teste de Fisher foi utilizado para estimar a associação entre DTM dolorosa e FM. Análises de regressão linear foram realizadas com DTM dolorosa e cada um dos possíveis preditores no modelo para estudar sua associação com a QV. Resultados: Foram encontradas associações significativas entre DTM dolorosa e TPs (p<0,001), assim como entre os TPs e os valores de LDP para dor local, regional e generalizada (p<0,001). Não foi encontrada associação entre DTM dolorosa e FM (p=0,158). Houve associação significativa entre QV e DTM dolorosa (p<0,001). Ao incluir os sintomas depressivos, qualidade do sono, dor no corpo, idade, sexo/gênero e atividades físicas, houve um aumento progressivo da variância explicada (R2). Entre os possíveis preditores, os sintomas depressivos apresentaram associação de maior magnitude com a QV (p<0,001). Conclusão: Adolescentes com DTM dolorosa apresentaram mais TPs em relação aos sem dor. Ainda, quanto maior o número de TPs, menor o LDP. Este achado sugere que os adolescentes com DTM dolorosa têm maior risco de apresentar SC. A QV dos adolescentes é afetada principalmente pela presença de DTM dolorosa e sintomas depressivos, mas também pela má qualidade do sono, presença de dor no corpo, maior idade, sexo/gênero feminino e sedentarismo. Esses fatores isolados pioram a QV, porém, quando presentes simultaneamente, comprometem ainda mais o bem-estar físico, social e emocional do adolescente.
Temporomandibular disorder (TMD) in adults is often associated with other painful conditions, such as fibromyalgia (FM). The tender points (TPs), which are part of the diagnostic criteria for FM, indicate increased sensitivity to generalized pain. Aims: To investigate the association between painful TMD and the number of TPs in adolescents, as well as the relationship between the number of TPs and the pressure pain threshold (PPT) for local, regional and generalized pain, as possible indicative of central sensitization (CS). Also, to explore the association between painful TMD and FM, to investigate the impact of painful TMD on adolescent’s quality if life (QoL) and the influence of other comorbid conditions (body pain, sleep quality, systemic diseases, sedentary lifestyle, obesity, depressive symptoms). Methods: The sample consisted of 690 Brazilian adolescents with and without painful TMD, aged 12-14 years old. Painful TMD was classified according to the Research Diagnostic Criteria for TMD (RDC/TMD) – Axis I. The criteria that were established by Yunus were applied to assess juvenile fibromyalgia and TPs. The generic Pediatric Quality of Life InventoryTM was applied to evaluate the QoL. Descriptive statistics were used to characterize the participants, stratifying by the presence of painful TMD. Mann-Whitney and χ2-tests were applied to test the association between painful TMD and demographic variables. Regression models were used to estimate the association between painful TMD and TPs and to determine which additional predictive variables were associated with TPs. Regression analyses were performed to test the associations between the PPT values and number of TPs. Fisher's test was used to estimate the association between painful TMD and FM. Linear regression analyzes were performed with painful TMD and one of the other possible predictors in the model to study their association with QoL. Results: Significant associations between painful TMD and the number of TPs (p<0.001) as well as between TPs and the PPT values for local, regional and widespread pain (p<0.001) were found. No association between painful TMD and fibromyalgia was found (p=0.158). A significant association was found between QoL and the presence of painful TMD (p<0.001). By including the variables depressive symptoms, sleep quality, body pain, age, gender and physical activities, there was a progressive increase in explained variance (R2). From the other possible predictors, depressive symptoms showed the strongest association with QoL (p<0.001). Conclusion: Individuals with painful TMD presented with more TPs compared to pain-free adolescents. Moreover, the higher the number of TPs, the lower the PPT. This finding suggests that adolescents with painful TMD are at increased risk of presenting with CS. Adolescents' QoL is mostly affected by the presence of painful TMD and depressive symptoms but it can also be affected by poor sleep quality, presence of body pain, older age, female gender and physical inactivity. These isolated factors worsen QoL, but when present simultaneously, they further compromise the adolescent's physical, social and emotional well-being.
Temporomandibular disorder (TMD) in adults is often associated with other painful conditions, such as fibromyalgia (FM). The tender points (TPs), which are part of the diagnostic criteria for FM, indicate increased sensitivity to generalized pain. Aims: To investigate the association between painful TMD and the number of TPs in adolescents, as well as the relationship between the number of TPs and the pressure pain threshold (PPT) for local, regional and generalized pain, as possible indicative of central sensitization (CS). Also, to explore the association between painful TMD and FM, to investigate the impact of painful TMD on adolescent’s quality if life (QoL) and the influence of other comorbid conditions (body pain, sleep quality, systemic diseases, sedentary lifestyle, obesity, depressive symptoms). Methods: The sample consisted of 690 Brazilian adolescents with and without painful TMD, aged 12-14 years old. Painful TMD was classified according to the Research Diagnostic Criteria for TMD (RDC/TMD) – Axis I. The criteria that were established by Yunus were applied to assess juvenile fibromyalgia and TPs. The generic Pediatric Quality of Life InventoryTM was applied to evaluate the QoL. Descriptive statistics were used to characterize the participants, stratifying by the presence of painful TMD. Mann-Whitney and χ2-tests were applied to test the association between painful TMD and demographic variables. Regression models were used to estimate the association between painful TMD and TPs and to determine which additional predictive variables were associated with TPs. Regression analyses were performed to test the associations between the PPT values and number of TPs. Fisher's test was used to estimate the association between painful TMD and FM. Linear regression analyzes were performed with painful TMD and one of the other possible predictors in the model to study their association with QoL. Results: Significant associations between painful TMD and the number of TPs (p<0.001) as well as between TPs and the PPT values for local, regional and widespread pain (p<0.001) were found. No association between painful TMD and fibromyalgia was found (p=0.158). A significant association was found between QoL and the presence of painful TMD (p<0.001). By including the variables depressive symptoms, sleep quality, body pain, age, gender and physical activities, there was a progressive increase in explained variance (R2). From the other possible predictors, depressive symptoms showed the strongest association with QoL (p<0.001). Conclusion: Individuals with painful TMD presented with more TPs compared to pain-free adolescents. Moreover, the higher the number of TPs, the lower the PPT. This finding suggests that adolescents with painful TMD are at increased risk of presenting with CS. Adolescents' QoL is mostly affected by the presence of painful TMD and depressive symptoms but it can also be affected by poor sleep quality, presence of body pain, older age, female gender and physical inactivity. These isolated factors worsen QoL, but when present simultaneously, they further compromise the adolescent's physical, social and emotional well-being.
Descrição
Palavras-chave
Síndrome da disfunção da articulação temporomandibular, Sensibilização do sistema nervoso central, Adolescente, Temporomandibular joint dysfunction syndrome, Central nervous system sensitization, Adolescent