• The Korean Journal of Pain
• /
• v.27 no.1
• /
• pp.30-34
• /
• 2014

Background: Myofascial pain dysfunction syndrome (MPDS), otherwise called myofascial pain is one of the most common temporomandibular disorders, which in turn is the most common cause of orofacial pain of non-dental origin. Its etiology is multifactorial and still poorly understood. Psychological factors have been shown to play a role in the etiology. The aim of the study was to evaluate the association between anxiety and salivary cortisol levels in patients with myofascial pain. Methods: Twenty patients suffering from myofascial pain were recruited as the study group. The same number of age and sex matched healthy individuals were taken as the control group. The salivary samples collected between 9-9:15 am from both groups were analyzed for cortisol levels with the competitive enzyme-linked immunosorbent assay method. Anxiety levels of 40 patients were measured using Hamilton's anxiety scale. Results: The mean serum cortisol level of the MPDS group showed a highly significant difference (P < 0.001) from the controls. The mean anxiety scores of the MPDS group showed a highly significant difference (P < 0.001) from the controls. A positive correlation was found between anxiety and the salivary cortisol levels in MPDS patients. Conclusions: These findings suggest that anxiety plays a vital role in the etio-pathogenesis of MPDS; thus, besides pharmacological treatment, psychological support is also needed.

• Journal of Oral Medicine and Pain
• /
• v.23 no.3
• /
• pp.295-299
• /
• 1998

Pain is a multidimensional experience that involves a complex interaction of sensory,affective and cognitive components. And especially, because of the emotional significance of orofacial pain, it is often a puzzing problem that clinicians are forced with from day to day. This case report describes differential diagnosis and management of dental and myofacial pain affected by psychological factors.

• Journal of Oral Medicine and Pain
• /
• v.41 no.2
• /
• pp.48-53
• /
• 2016

Purpose: The purpose of this study was to compare the differences in clinical signs and symptoms, and psychological profiles of temporomandibular joint osteoarthritis (TMJ OA) between juvenile and adult patients. Methods: Two-hundred eighty-three TMJ OA patients who visited the Orofacial Pain Clinic of Seoul National University Dental Hospital were classified by juvenile (153 patients; mean age $14.2{\pm}1.7$ years, range 9-16 years) and adult (130 patients; mean age $34.0{\pm}2.8$ years, range 30-40 years) groups, and compared the clinical symptoms based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I guidelines including Graded Chronic Pain (GCP) scale, mandibular range of motion, and the associated symptoms. Psychological profiles were also evaluated using the Symptom Checklist 90-Revision (SCL-90-R). Results: Juvenile patients reported lower pain intensity and a lower prevalence of headache and clenching than adult patients. Their mandibular range of motion was also higher than adult patients. Juvenile patients showed a lower percentage of patients with T-score above 50 in somatization (SOM), obsessive-compulsive (O-C), interpersonal sensitivity (I-S), and paranoid ideation (PAR) than adults. Based on the GCP scale, the percentage of the high disability group was lower in juveniles. Conclusions: Juvenile TMJ OA patients generally showed milder clinical symptoms than adults. Adult patients showed higher prevalence of psychological problems and higher disability than juvenile patients. Age should be considered in evaluation and treatment of TMJ OA patients to achieve better treatment results and understanding its pathophysiology.

• Journal of Korean Physical Therapy Science
• /
• v.31 no.2
• /
• pp.1-14
• /
• 2024

Background: Many patients with chronic low back pain have reduced movement due to pain. For that reason, muscle strength weakens, which leads to pain again. The pain caused by such a vicious circle is not only caused by structural problems, but also by physical function, activity disorder, or psychological depression due to biopsychosocial approaches and pain neuroscience education was applied as an intervention to find out its effect. Therefore, this study was experimented with to find out the effects of pain neuroscience education on pain, physical function, activity disorder, and depression in patients with chronic low back pain. Design: Randomized control trial Method: The study subjects were 39 patients with chronic low back pain, and the study subjects were randomized through computers to the experimental group applying pain neuroscience education and the control group applying only general physical therapy and myofascial release techniques, and the experiment was conducted for 4 weeks. Pressure Pain Threshold , Schober test, Korean Roland-Morris Disability Questionnaire, Korean Oswestry Disability Index, and Korean Depression Screening Assessment were measured. Results: As a result of the study, there was no significant difference in pain neuroscience education compared to the group that applied only general physical therapy and myofascial release techniques in both lumbar pressure pain thresholds, Schober test, Korean Roland-Morris disability questionnaire, and Korean Oswestry disability questionnaire. However, the Korean Depression Screening Assessment which is the result of measuring depression, showed significant results(p<0.05). Conclusion: Therefore, it is believed that it can be a way to mediate the psychological part through pain neuroscience education for patients with chronic low back pain in the future.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
• /
• v.25 no.2
• /
• pp.65-72
• /
• 2019

Background: The purpose of this study was to investigate into the effects of physical therapy intervention with local vibration on pain, ROM (range of motion) and psychological status in multiple trauma patients caused by traffic accident. Methods: A patient with multiple trauma were recruited. Before treatment, he was evaluated using numeric pain rating scale (NPRS), Korean-version impact of event scale-revised (IES-R-K), Beck Depression inventory (BDI), passive and active range of motion, and were reevaluated after 4 and 8 weeks of treatment. Results: As a result of comparing the participant before and after the experiment, the score of the IES-R-K and BDI decreased. And the passive and active ROM increased. Conclusion: According to the results above, physical intervention with local vibration by Blackroll Releazer can help improve pain, physical function and psychological status. Also, physical intervention with Blackroll's Releazer technique was able to select interventions depending on the patient's conditional and the desired goal.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.20 no.5
• /
• pp.109-117
• /
• 2019

This study was conducted to provide for the development of psychological interventions through meta-analysis of the effects of psychological intervention for pain reduction in patients with osteoarthritis. R version 3.5.1 program was used to identify the effectiveness of psychological mediating by December 30, 2018, while the Korean and foreign literature published by PubMed, EMBASE, Ovid-MEDLINE, CINAHL, and Korean databases were searched. As a result, 12 studies with a total of 1,847 participants were analyzed in a total of 1,822 literature. The results showed that the overall effect size of psychological intervention for pain reduction in osteoarthritis patients was small effect -0.31(95% CI: -0.50, -0.11, p<.001). In the moderator analysis, the effect size showed a significant difference depending on the intervention type, intervention duration and the intervention provider. The funnel plot analysis was used to analyze the publication bias, and it was visually asymmetric but not asymmetric after the egger's regression test (bias = -3.24, p = .077). The results of this study suggest a standard of efficacy for psychological interventions to improve pain symptoms, which is a major symptom of osteoarthritis, although the number of studies included in the meta-analysis is low and has provided a clinical basis during intervention and intervention providers.

• Journal of Oral Medicine and Pain
• /
• v.48 no.3
• /
• pp.87-95
• /
• 2023

Purpose: To quantify the relationship between perceived pain intensity and psychological variables in a sample of participants with temporomandibular disorder, with or without central sensitization (CS). Methods: A cross-sectional study with nonprobability convenience sampling was conducted from January 1, 2022, to June 30, 2023. Pain intensity (Numeric Pain Rating Scale), anxiety (State-Trait Anxiety Questionnaire, STAI), catastrophizing (Pain Catastrophizing Scale, PCS), perceived stress (Perceived Stress Scale, PSS), and sleep quality (Pittsburgh Sleep Quality Index, PSQI) were assessed. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Co.), which included descriptive and normality analyses and the calculation of strength of multiple correlational regression. Results: A total of 52 (n=34 female 65.4%; n=18 male 34.6%) subjects with diagnosis of temporomandibular disorders (TMD) were finally included. A total of 26 participants (n=26, 50.0%) were cases suffered from CS (TMD-CS mean=46.62±11.24) while the remaining participants (n=26, 50.0%) were the controls (TMD-nCS mean=26.77, standard deviation [SD]=8.42). The pain intensity was moderate in both groups TMDCS (mean=7.62, SD=0.83) and TMD-nCS (mean=7.05, SD=0.86), anxiety (TMD-CS STAI mean=53.27, SD=11.54; TMD-nCS STAI mean=49, SD=11.55), catastrophizing (TMD-CS PCS mean=46.27, SD=9.75; TMD-nCS PCS mean=26.69, SD=4.97), perceived stress (TMDCS PSS mean=30.35, SD=4.91; TMD-nCS PSS mean=26.12, SD=6.60) and sleep quality (TMD-CS PSQI mean=15.81, SD=3.65; TMD-nCS PSQI mean=12.77, SD=2.76) levels were measured in both groups. In TMD-CS and TMD-nCS, higher anxiety levels were moderately and significantly associated with greater pain intensity β=0.4467 (t=2.477, p=0.021) and β=0.5087 (t=2.672, p=0.014). Nevertheless, catastrophizing, perceived stress and sleep quality were not associated to pain intensity in neither of group. Conclusions: In both TMD-CS and TMD-nCS patients, elevated anxiety levels were moderately and significantly associated with increased pain intensity. However, heightened levels of pain catastrophizing, perceived stress, and poor sleep quality were not significantly associated with increased pain intensity in either of the two analyzed groups.

• The Korean Journal of Pain
• /
• v.25 no.4
• /
• pp.245-253
• /
• 2012

Background: Prevalence of chronic pain and its association with demographic characteristics have been reported by different studies from different geographical regions in the world. However, data from many Middle East countries including Iran (especially southern Iran) are scare. The aim of the present study was to demonstrate the prevalence of chronic pain and its association with demographic, psychological and socioeconomic factors in an Iranian population. Methods: In this population-based survey, the target population was comprised of subjects aged 20 to 85 years residing in Jahrom, southern Iran during 2009-2011. All eligible subjects were invited to participate in the study. Before a detailed questionnaire was given; face to face interviews were done for each individual. Results: There were 719 men and 874 women with an average age of 40.5 years at the onset of the study. Among the study population, 38.9% (620/1,593) complained of chronic pain, of whom 40.8% (253/620) were men and 59.2% (367/620) were women. Foot and joint pain were observed in 31.9%. Hip and spine pain, migraine and tension headaches, heart pain, and abdomen pain were observed in 21.5%, 15.5%, 9.5%, and 8.0% of chronic pain cases, respectively. There was a significant association among the covariables age, sex, overweight, educational level, income, and type of employment with chronic pain as the dependent variable (P < 0.0001). Conclusions: Our findings show the prevalence of chronic pain and its association with demographic, psychological and socioeconomic factors. Individuals with low incomes and less education became accustomed to pain due to a lack of knowledge.

• Journal of Oral Medicine and Pain
• /
• v.44 no.3
• /
• pp.92-102
• /
• 2019

Purpose: To investigate the masticatory function of patients with different temporomandibular disorders (TMD) phenotypes, and to explore the risk factors for the masticatory function of TMD patients among multiple biopsychosocial variables using patient-reported outcomes (PROs). Methods: Clinical features and TMD diagnoses of 250 cases were investigated by reviewing medical records. Psychosocial factors were evaluated using four questionnaires representing pain severity and pain interference (Brief Pain Inventory), pain catastrophizing (Pain Catastrophizing Scale, PCS), psychological distress (Symptom Check List-90-Revised, SCL-90R) and kinesiophobia (Tampa Scale for Kinesiophobia for Temporomandibular Disorders, TSK-TMD). Masticatory function, as a dependent variable, was determined using the Jaw Functional Limitation Scale (JFLS). Kruskal-Wallis test and Spearman's rank correlation were used for analyses. Results: A total of 145 cases were included and classified into four subgroups including group 1: TMD with internal derangement without pain (n=14), group 2: TMD with muscle pain (n=32), group 3: TMD with joint pain (n=60) and group 4: TMD with muscle-joint combined pain (n=39). Pain severity (p=0.001) and interference (p=0.022) were the highest in group 2, but the mean global score of JFLS was the highest in group 3, followed by group 4, group 2, and group 1 (p=0.013). Pain severity, pain interference, the mean global score of PCS and the mean global score of TSK-TMD showed significant and moderate correlation with the mean global score of JFLS. All subdimensions and the global severity index of SCL-90R had significant, but weak correlations with all scores of JFLS. Conclusions: The results suggest that masticatory functional limitation depends on the TMD phenotypes. Among the various PROs, pain perception, pain catastrophizing and kinesiophobia seem to be more influential risk factors on jaw function than psychological distress, such as depression and anxiety.

• The Korean Journal of Pain
• /
• v.31 no.3
• /
• pp.155-173
• /
• 2018

Chronic postsurgical pain (CPSP) is an unwanted adverse event in any operation. It leads to functional limitations and psychological trauma for patients, and leaves the operative team with feelings of failure and humiliation. Therefore, it is crucial that preventive strategies for CPSP are considered in high-risk operations. Various techniques have been implemented to reduce the risk with variable success. Identifying the risk factors for each patient and applying a timely preventive strategy may help patients avoid the distress of chronic pain. The preventive strategies include modification of the surgical technique, good pain control throughout the perioperative period, and preoperative psychological intervention focusing on the psychosocial and cognitive risk factors. Appropriate management of CPSP patients is also necessary to reduce their suffering. CPSP usually has a neuropathic pain component; therefore, the current recommendations are based on data on chronic neuropathic pain. Hence, voltage-dependent calcium channel antagonists, antidepressants, topical lidocaine and topical capsaicin are the main pharmacological treatments. Paracetamol, NSAIDs and weak opioids can be used according to symptom severity, but strong opioids should be used with great caution and are not recommended. Other drugs that may be helpful are ketamine, clonidine, and intravenous lidocaine infusion. For patients with failed pharmacological treatment, consideration should be given to pain interventions; examples include transcutaneous electrical nerve stimulation, botulinum toxin injections, pulsed radiofrequency, nerve blocks, nerve ablation, neuromodulation and surgical management. Physical therapy, cognitive behavioral therapy and lifestyle modifications are also useful for relieving the pain and distress experienced by CPSP patients.