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1.
Graded chronic pain status: an epidemiologic evaluation   总被引:9,自引:0,他引:9  
In epidemiologic research on chronic pain, differentiation of recurrent, persistent and disabling pain states is critical in the investigation of burden, natural history, effective intervention and causal processes. We report population-based data concerning the development and evaluation of a graded classification of pain status. In a probability sample of 1016 health maintenance organization enrollees, recurrent or persistent pain was observed in 45%; severe and persistent pain in 8%; severe and persistent pain with 7 or more days of pain-related activity limitation in 2.7%; and severe, persistent pain with activity limitation and 3 or more indicators of pain dysfunction in 1.0% of the population sample. Graded chronic pain status was associated with psychological impairment, unfavorable appraisal of health status, and frequency of use of pain medications and health care. The presence of severe and persistent pain increased the likelihood of multiple indicators of pain dysfunction, but there was considerable heterogeneity in pain dysfunction among persons with comparable pain experience. Our data suggest grading chronic pain in terms of 3 axes: time (persistence); severity; and impact (disability and dysfunctional illness behaviors).  相似文献
2.
颞颌关节功能锻炼预防鼻咽癌放疗后张口受限的效果观察   总被引:6,自引:0,他引:6  
王志惠  姜永亲 《天津护理》2001,9(4):162-163
为观察颞颌关节功能锻炼对预防鼻咽癌放疗后张口受限的效果.对38例鼻咽癌放疗患者开展了颞颌关节功能锻炼,对照组20例在放疗期间无特殊锻炼.结果实验组中无张口受限发生13例,Ⅰ度17例,Ⅱ度7例,Ⅲ度仅1例;对照组中无张口受限发生0例,Ⅰ度2例,Ⅱ度10例,Ⅲ度8例.实验组与对照组张口受限程度比较有显著性差异(p<0.01).在鼻咽癌患者开始接受放射治疗的同时,开展颞颌关节功能锻炼,直到放射治疗结束,能够有效地预防放疗所致的张口受限.  相似文献
3.
颞下颌关节盘变形与关节疼痛关系的MRI研究   总被引:5,自引:0,他引:5  
目的:研究颞下颌关节盘变形与关节疼痛的关系。方法:利用MRI对44例单侧关节疼痛颞下颌关节紊乱病(TMD)患者88侧关节完成开闭口斜矢状位T1加权成像,观察盘突关系及盘形态改变;利用可视疼痛模拟标尺(VAS)进行疼痛程度的判定,比较盘变形组与无盘变形组有无差异。结果:正常盘突关系(NDCR)关节中9.6%(5/52)发生关节盘变形,全部表现为均厚型,在颞颌关节内紊乱(TMJID)中94.4%(34/36)发生关节盘变形,后带膨大型13例,折叠型7例,伸长型6例,圆型5例,均厚型3例。在44个疼痛关节中,经MRI确认盘变形为35个关节(88.6%),而44个非疼痛关节中仅4例表现为变形的关节盘占9%,经统计学分析,颞颌关节疼痛与盘变形有相关性(P<0.005);关节盘无变形组VAS平均值为40±29.5,关节盘变形组VAS平均值为43±20.1,关节盘变形组比关节盘无变形组高,但经t检验统计学分析两组无差别(P=0.763)。结论:关节疼痛与关节盘变形密切相关,但疼痛程度与其无关,提示TMD患者颞颌关节疼痛程度不能反映关节盘的损害程度,关节盘损害程度的确定尚需关节造影、MRI甚至关节镜检查。  相似文献
4.
Forty patients with tension headache and 40 healthy comparable control persons were palpated by the same "blinded" observer. Tenderness in 10 pericranial muscles on each side was rated on a four-point scale. A Total Tenderness Score was calculated for each individual by adding the scores from all palpated areas. Headache patients had significantly higher scores than controls and also significantly higher tenderness in each point separately. Median normal values and confidence limits for tenderness are given. Among 23 patients with daily headache a correlation was found between headache intensity and Total Tenderness Score. It is likely that the pathologic tenderness in patients with tension headache is the source of nociception, but pain mechanisms are more complex, as evidenced by discrepancy between tenderness and pain in some patients. Pathologic tenderness should be a contributing criterion to the diagnosis of tension headache (muscle contraction headache).  相似文献
5.
多层面螺旋CT在颞下颌关节盘损伤诊断中的应用   总被引:3,自引:0,他引:3  
[目的]探讨多层面螺旋CT在颞下颌关节盘损伤诊断中的准确性和临床应用价值。[方法]对28例下颌骨骨折的患者,行多层面螺旋CT扫描,扫描分张口位和闭口位。螺旋扫描结束后,对原始数据进行薄层重建,将重建数据传输至工作站,在工作站上进行多平面容积重组,显示颞下颌关节盘,结合轴位影像,评价颞下颌关节盘的损伤程度。[结果] 28例下颌骨骨折的患者中5例关节盘碎裂、出血,8例关节盘前移,1例关节盘后移,3例关节囊积液,11例关节盘未见异常。[结论]多层面螺旋CT可以较准确的诊断颞下颌关节盘损伤。  相似文献
6.
目的探讨关节腔内注射糖皮质激素曲安奈德、粘弹剂透明质酸钠或二者联合使用治疗颞下颌关节紊乱病的疗效。方法应用半随机同期对照设计对3种治疗方案进行比较:①关节腔内单纯注射曲安奈德3次(8mg/次),②关节腔内单纯注射透明质酸钠(1%,1ml/次)4次,③关节腔内先注射曲安奈德2次再注射透明质酸钠2次。均为关节上腔灌洗后注射药物,每10日注射1次。第1个月、12个月及24个月进行随访,综合症状体征改善情况评定为优、良者计为有效,比较各组有效率。结果每组均纳入188例颞下颌关节紊乱病患者,24个月失访率为6.9%~10.1%。治疗1个月时,曲安奈德组有效率最高达92.0%:治疗12个月、24个月时透明质酸钠组有效率高于曲安奈德组(12个月84.6%vs.54.1%,24个月83.4%vs.40.4%),合并用药组有效率在12个月、24个月分别为90.4%和66.3%。结论关节腔内注射糖皮质激素曲安奈德关治疗颞下颌关节紊乱病短期疗效较好,关节腔内注射透明质酸钠则具有较好的远期效果.  相似文献
7.
下颌神经阻滞结合微波治疗颞颌关节紊乱病   总被引:2,自引:0,他引:2  
目的:了解下颌神经阻滞结合微波治疗颞颌关节紊乱病(简称TMJD)的疗效与安全性。方法:选择诊断明确的单侧TMJD初诊病人50例,随机分成下颌神经阻滞组和对照组(单纯微波组),每组各25例,下颌神经阻滞组行患侧下颌神经阻滞1次/4天,治疗3~5次;配合每日一次局部微波治疗。对照组每日两次局部微波治疗。两组微波治疗均进行15~20天。结果:下颌神经阻滞组治愈16例(64%),好转5例(20%),显效4例(16%),无效0例,平均显效时间1.5±0.8天。对照组治愈10例(40%),好转4例(16%),显效10例(40%),无效1例(4%),平均显效时间6.1±1.3天。半年复发率下颌神经阻滞组4例(16%),对照组13例(52%)。经统计学处理,两组间治愈率和半年复发率有显著性差异(P<0.05)。两组病例均未发现明显不良反应。结论:下颌神经阻滞结合微波能有效提高TMJD的治愈率,缩短显效时间,降低复发率。  相似文献
8.
To analyse the effect of treatment of mandibular dysfunction on headache, 35 patients with migraine, 20 patients with combination headache and 36 patients with muscle contraction headache were studied in a clinical double-blind trial. Patients in the treatment group received occlusal adjustment and those in the placebo group mock occlusal adjustment. After eight months and four months, respectively, the neurologist evaluated the treatment outcome. The frequency of headache was reduced in 79% and the intensity in 53% of patients suffering from muscle contraction headache or combination headache in whom the adjustment of the dental occlusion had been successfully accomplished. The difference from the placebo group was statistically significant. The decrease in headache frequency as calculated from the headache diaries correlated with the decrease in the index of clinical signs of mandibular dysfunction.  相似文献
9.
Abstract:   The present study was undertaken to compare emotional distress and functional ability between two common pain populations—acute jaw pain (JAW; n  = 135) and acute low back pain (LB; n  = 71). Patient groups were evaluated and compared on a variety of biopsychosocial measures, including the Beck Depression Inventory (BDI), Multidimensional Pain Inventory (MPI), Characteristic Pain Intensity (CPI), and Ways of Coping Questionnaire. Specific diagnoses were assessed using the Structured Clinical Interview of the Diagnostic and Statistical Manual (DSM-IV)—I and II, and rates of Axis I and II diagnoses in these groups were further compared to base rates in the general population. Additionally, medication usage was evaluated to determine group differences. Results revealed that JAW patients had lower BDI and CPI scores, as well as a higher level of functioning on the Global Assessment of Functioning assessed by the DSM-IV. Both acute pain groups also had significantly more Axis I and II disorders than the general population. Additionally, it was found that the JAW group used more benzodiazepines, while the LB group used more schedule II narcotics. A logistic regression model created from these variables found a six-factor model, composed of the CPI, MPI coping style anomalous, Ways of Coping problem-solving, Global Assessment of Functioning, anxiety disorders, and Cluster C personality disorder diagnoses, that differentiated the JAW from the LB group. Overall, these findings suggest that the differences identified between these two groups should be considered in developing tailored treatments for individuals with acute low back and jaw pain.  相似文献
10.
颞下颌关节内窥镜手术的配合   总被引:1,自引:1,他引:0  
笔者报道了68例颞下颌关节内窥镜手术的配合体会,强调术前充分的物品准备,术中洗手护士熟悉手术步骤及颞下颌关节内压力测量仪和颞下颌关节内窥镜的使用时机和方法,巡回护士注重患者的心理护理和注意观察仪器的使用状况.术后对仪器的正确消毒和保养,是手术顺利开展的重要保证。  相似文献
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