依疾病嚴重度分組治療咀嚼系統肌筋膜疼痛症候群病人

Discriminative treatment of patients with myofascial pain syndrome of the masticatory system according to disease severity

黃于珊(Yu-Shan Huang)

指導教授 ： 陳中和

共同指導教授 ： 黃逸岳(I-Yueh Huang)

高雄醫學大學/口腔醫學院/牙醫學研究所/碩士(2007年)

https://doi.org/10.6832/KMU.2007.00135

摘要

許多人都有肩頸疼痛的困擾。肩頸疼痛是咀嚼系統肌筋膜疼痛症候群(myofascial pain syndrome，簡稱MPS)的典型症狀之ㄧ。咀嚼系統MPS雖有琳瑯滿目的治療選擇，許多病人仍沒有很好的改善。若依咀嚼系統MPS病情嚴重度分組治療，是否能提高治癒率？
為解決我們的疑惑，將咀嚼系統肌筋膜症候群病人分為單純性和複雜性，單純性病人接受兩週衛教治療，複雜性病人接受兩週超音波、按摩、衛教治療，觀察分組治療成效。並且利用簡易疼痛量表評估疼痛詳情、下顎運動功能評估量表評估下顎運動功能、SF-36生活品質量表評估生活品質、貝氏焦慮量表評估壓力、匹茲堡睡眠品質量表評估睡眠品質，觀測這些指標是否有助了解咀嚼系統MPS嚴重度及治療效果。
實驗結果顯示:治療後單純性與複雜性MPS病人在以下項目皆有顯著改善：下顎運動功能評估量表，簡易疼痛量表(最嚴重疼痛、平均疼痛、疼痛對一般活動的影響、疼痛對心情的影響、疼痛對睡眠的影響、疼痛對生活樂趣的影響)及生活品質量表(一般健康子量表)。
複雜性咀嚼系統MPS病人接受超音波治療、按摩、衛教；簡單性咀嚼系統MPS病人接受衛教治療在疼痛緩解及下顎運動功能都有顯著差異，且疼痛改善對心情、睡眠、生活樂趣似乎都有某種程度的改善。
所有量表都需進一步實驗證實是否適合用在咀嚼系統MPS觀測上，簡易疼痛量表初步觀察似乎適合偵測咀嚼系統MPS疼痛詳情。
就我們知識所及，這是第一個研究分組治療結果的實驗；我們強調症狀治療同時注重致病因子改善，也與其他文獻強調多種療法合併治療的觀念不同。本實驗發現兩週(共6次治療)在下顎運動功能、疼痛緩解方面有顯著差異。推測咀嚼系統MPS治療效果不佳的原因，大多是無法有效找出致病因子，或是致病因子難以阻斷，而非需要長時間症狀治療。
我們特別重視幫助病人釐清致病因子，在實驗中觀察到，除了不良口腔習慣(磨牙、咬牙、咬指甲、吸嘴唇、嚼口香糖…)、壓力、睡眠障礙…等原因外，姿勢不良、其他區域轉移痛、中樞神經系統、頸椎功能障礙也可能導致咀嚼系統MPS。因此在衛教上我們特別針對不良姿勢、頭前傾姿勢等問題做肌肉強化、姿勢矯正訓練。並轉介病人至相關科別解決其他致病因子。
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關鍵字

顳顎關節障礙 ； 咀嚼系統肌筋膜疼痛症候群 ； 超音波 ； 按摩 ； 依疾病嚴重度分組治療咀嚼系統肌筋膜疼痛症候群 ； 頭頸部肌肉疼痛

並列摘要

Background: Head and neck muscle pain are common symptoms of myofascial pain syndrome (MPS) of masticatory system. Though treatments of MPS of masticatory system are various, many patients have little response to the treatment. Shall we treat patients with MPS of the masticatory system according to disease severity?
To evaluate the severity of MPS of masticatory system, commonly used parameters (maximum mouth opening and visual analog scale) are not enough. May we evaluate the severity of MPS of masticatory system in mandibular function impairments, pain, life quality disturbance, stress and sleep quality of patients?
Methods: we divided patients into simple and complex groups, 9 patients in each group. Both groups were treated for 2 weeks, education for simple group; ultrasound, massage and education for complex group. The following parameters were taken at the beginning and ending of the TX: Brief Pain Inventory for pain details, Mandibular Function Impairment Questionnaire for jaw function assessment, Short Form 36 Health Survey for life quality evaluation, Beck Anxiety Inventory for anxiety assessment and Pittsburgh Sleep Quality Index for sleep quality evaluation. The data were analyzed with Wilcoxon Signed-Rank Test.
Results: Both group have significant improvement in Mandibular Function Impairment Questionnaire and Brief Pain Inventory. Education is useful for patients with simple MPS of masticatory system; ultrasound, massage and education are useful for patients with complex MPS of masticatory system. Brief Pain Inventory and Mandibular Function Impairment Questionnaire seem useful in evaluating the treatment effects and severity of MPS of masticatory system; Beck Anxiety Inventory and Pittsburgh Sleep Quality Index are helpful in understanding Pt’s anxiety and sleep quality..
Conclusion: To our knowledge we are the first experiment to treat patients with MPS of the masticatory system according to disease severity. We focus on simple TX and blocking etiologic factors, different from the concept using multiple therapies. It seems if we both release the symptoms and block etiologic factors, may be we can shorten the treatment period of patients with MPS of masticatory system.

並列關鍵字

temporomandibular disorder ； discriminative treatment of myofascial pain syndrome according to disease severity ； ultrasound ； massage

參考文獻

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