| Abstract | Uvod: Kronična bol žvačnih mišića veliki je dijagnostički i terapijski izazov za stomatologe i
liječnike. Proizlazi iz skeletnih mišića, tetiva i njihovih fascija. Uzroci i mehanizam nastanka
te boli nisu u potpunost razjašnjeni. Liječenje kronične mišićne boli najčešće mora biti
zbrinuto multidisciplinarnim pristupom.
Cilj istraživanja bio je utvrditi prevalenciju kliničkih dijagnoza temporomandibularnih
poremećaja (TMP), psihološkog distresa, ograničenja oralnih funkcija u bolesnika s
posttraumatskim stresnim poremećajem (PTSP). Također, cilj je bio utvrditi utjecaj različitih
etioloških čimbenika: psiholoških i okluzijskih čimbenika, parafunkcijskih aktivnosti, te
razine tvari P i dopamina na nastanak kronične boli žvačnih mišića.
Ispitanici i postupci: U studiji je sudjelovalo 65 ispitanika s kroničnim PTSP-om
uzrokovanim ratnom psihotraumatizacijom, te 60 kontrolnih ispitanika koji nemaju PTSP. Svi
ispitanici pregledani su prema dijagnostičkim kriterijima za istraživanje TMP. Prag bolnosti
žvačnih mišića mjeren je mehaničkim algometrom. Intenzitet i karakter boli žvačnih mišića
određivani su anamnestički vizualnoanalognom skalom, ucrtavanjem lokalizacije boli na
shemi glave i vrata, McGill upitnikom za bol, te digitlnom palpacijom žvačnih mišića. Razina
tvari P i dopamina u plazmi određivani su enzimskim imunotestom.
Rezultati: Najčešća TMP dijagnoza u PTSP ispitanika bila je miofascijalna bol (47,8%), dok
je u kontrolnoj skupini najčešće dijagnosticiran pomak diska s redukcijom (8,3%). PTSP
ispitanici su imali značajno više dijagnoza TMP iz skupina I i III u usporedbi s kontrolnim
ispitanicima (p<0,005). PTSP ispitanici mišićnu su bol najčešće opisivali kao zatežuću,
probadajuću i pulsirajuću, koja ih iscrpljuje i tišti. Razina tvari P i dopamina u plazmi PTSP
ispitanika bila značajno viša nego u kontrolnih. Utvrđena pozitivna korelacija između
koncentracije tvari P i broja bolnih točaka žvačnih mišića (r=0,65; p<0,001), te koncentracije
dopamina i broja bolnih točaka žvačnih mišića (r=0,50; p<0,001). PTSP ispitanici imali su značajno manji broj ukupnih zuba i okludirajućih zuba nego kontrolni ispitanici. Također,
parafunkcijske navika bile su zastupljenije u PTSP ispitanika nego u kontrolnih. Multiplom
regresijskom analizom utvrđeno je da somatizacija pridonosi 15,8%, tvar P 26,7%, te
stiskanje i škripanje zuba 10,4% u nastanku boli žvačnih mišića.
Zaključci: U PTSP ispitanika najčešća dijagonza TMP bila je miofascijalna bol. Boli žvačnih
mišića bila je češća i intenzivnija u PTSP ispitanika nego u kontrolnih ispitanika.
Najznačajniji etiološki čimbenici u nastanku kronične mišićne bol u PTSP ispitanika su
somatizacija, tvar P, te stiskanje i škripanje zuba. |
| Abstract (english) | Introduction: Chronic pain of the masticatory muscles is a major diagnostic and therapeutic
challenge for the dentists and general medicine practitioners. The pain origins from the
skeletal muscles, tendons, and their fascias. The causes and the exact mechanism of the pain
development are not completely understood. The therapy of the chronic muscle pain in most
cases has to be resolved by a multidisciplinary approach.
The aim of the study was to determine the incidence of the clinical temporomandibular
disorder (TMD) diagnoses, psychological distress, and jaw disabilities in post traumatic stress
disorder (PTSD) patients. The goal was also to determine the role of certain etiological factors
like psychological and occlusal factors, parafunctional activities and levels of substance P and
dopamine in the onset of the chronic masticatory muscle pain.
Examinees and procedures: The study included 65 subjects with chronic PTSD caused by
war psychotrauma and 60 subjects without PTSD. All the examinees were examined
according the diagnostic criteria for the TMD. Pressure pain threshold of the muscles was
measured by a mechanical algometer. The intensity and the character of the pain were
determined trough the history questionnaire, visual analog scale and marking of pain
localization on the head and neck image, McGill pain questionnaire and digital palpation of
the masticatory muscles. The levels of the substance P and dopamine were determined by
enzymatic immunotest.
Results: The most common TMD diagnosis in the PTSD group was a myofacial pain
(47.8%), while in the control group the most frequent diagnosis was disk displacement with
reduction (8.3%). The PTSD patients had significantly more TMD diagnoses from the group I
and III compared to the control subjects (p<0.005). The PTSD patients described the pain as
stringing, stabbing, pulsing and excruciating. The plasma levels of the substance P and
dopamine in the PTSD group were significantly higher than in the control group. A positive correlation between the plasma levels of substance P and the number of muscle pain locations
was established (r=0.65; p<0.001), as well as the correlation of the dopamine levels and the
number of muscle pain locations (r=0.50; p<0.001). PTSD patients had significantly lower
general number of teeth and occluding pares than the control subjects. The parafunctional
activities were more present at the PTSD patients than in the control subjects. By the means
of the multiple regression analyses it was determined that the somatization contribute 15.8%,
substance P 26.7% and teeth grinding 10.4% in the development of the muscle pain.
Conclusions: The most common diagnosis in the PTSD patients was the myofacial pain. The
pain of the masticatory muscles was more frequent and more intense in the group of PTSD
patients than in the control group. The most significant etiological factors in the development
and onset of the chronic myofacial pain at PTSD patients are somatization, substance P and
teeth grinding. |
