Тревога, депрессия: коморбидное расстройство хронической орофациальной боли при синдроме дисфункции височно-нижнечелюстного сустава

Постоянная орофациальная боль относится к ряду болевых состояний нестоматологической этиологии в области лица и рта, оказывает значительное влияние на качество жизни и имеет биопсихосоциальную природу. Синдром болевой дисфункции височно-нижнечелюстного сустава (СБД ВНЧС) является одной из наиболее распространенных причин хронических болей в орофациальной области, затрагивающих жевательную мускулатуру; это мышечно-скелетное расстройство, характеризующееся болью и дискомфортом в мышцах и суставах, участвующих в жевании и движении челюсти. Важную роль в возникновении и поддержании постоянных болей и мышечной дисфункции в орофациальной области играют такие психопатологические факторы, как тревога и депрессия. Цель исследования: Исследование степени выраженности проявленности тревоги и депрессии у пациентов с хронической орофациальной болью при синдроме дисфункции височно-нижнечелюстного сустава. Материалы: Обследовано 354 пациента с хроническими орофациальными болями, с превалированием в клинической картине заболевания болевой симптоматики и выраженными мышечно-тоническими нарушениями жевательной мускулатуры, при развитии которых коморбидно формируется тревожное и депрессивное расстройство (код по МКБ-10 — К07.8+F43; F45.8) Средний возраст обследованных составил 48,6±12,9 года. Результаты: В исследуемой группе пациентов выявляются высокие, отличные от здоровой популяции, показатели тревоги и депрессии. Проявления эти носят в большинстве случаев субклинический характер и на практике представляют собой ряд соматизированных жалоб и легкую тревогу, а также критику к своему внешнему виду. Пациенты с жалобами на мышечно-тонические расстройства и боли в орофациальной области без выраженных проявлений тревоги и депрессии составляли 52,0 %. Пациентов с выраженным тревожным расстройством на фоне орофациальной дисфункции было 6,8 %, а у 41,2% пациентов было диагностировано депрессивное расстройство различной степени выраженности. В возникновении и развитии болевой дисфункции ВНЧС и коморбидных тревожно-депрессивных расстройств участвуют соматические и психологические группы факторов, что делает целесообразным рассмотрение данной патологии с психосоматических позиций.

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