Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20220063-en
Brazilian Journal of Pain
Original Article

Influence of cognitive performance on the response to pain education guidelines in patients with chronic painful temporomandibular disorders

Influência do desempenho cognitivo na resposta às orientações de educação sobre a dor em pacientes com disfunção temporomandibular dolorosa crônica

Amaury Martins Prado; Mirela Cristina da Silva; Alex Moreira Mélo; Melissa de Oliveira Melchior; Laís Valencise Magri

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Abstract

BACKGROUND AND OBJECTIVES: Patients with painful temporomandibular disorders (TMD) may present cognitive performance alterations, making it difficult to understand and adhering to self-management strategies offered in pain education interventions. The aim of this study was to analyze the response to self-management guidelines in patients with chronic painful TMD due to cognitive performance.
METHODS: Sample of 45 patients (35.5 years) with chronic painful TMD according to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) test. The Brazilian Portuguese Central Sensitization Inventory (CSI-BP) was also applied to measure central sensitization and numerical rating scale to assess the perception of pain intensity. The intervention consisted of self-care guidelines for pain management with homemade methods, through a video and a printed tutorial. After an interval of 15 days, a new evaluation was made to verify whether the self-management guidelines promoted pain-related changes in the sample studied and whether there were differences between participants with adequate and altered cognitive performance (groups obtained after the application of the test).
RESULTS: The mean MoCA for the sample was 23.3±2.5 (lower than expected cognitive performance). A strong inverse correlation was found between the cognitive performance and pain intensity scores, indicating the tendency to have lower cognitive performance when there is greater intensity of pain (r=-0.77 and p=0.03). There was no correlation between cognitive performance and central sensitization (p>0.05). The group with better cognitive performance presented better response to pain education strategies.
CONCLUSION: There is a trend towards worse cognitive performance according to the increase in perception of painful intensity. In addition, low cognitive performance seems to impair the use and efficacy of pain education-based intervention for patients with painful TMD, which is considered an important strategy for its management.
HIGHLIGHTS 
• Pain intensity has an inverse association with cognitive performance in patients with painful temporomandibular disorders.
• Cognitive performance appears to interfere with the utilization and effectiveness of pain education-based intervention for patients with painful temporomandibular disorders. 
• Patients with painful temporomandibular disorders tend to have lower than expected cognitive performance. 

Keywords

Cognition, Temporomandibular joint disorders, Chronic pain.

Resumo

JUSTIFICATIVA E OBJETIVOS: Pacientes com disfunção temporomandibular (DTM) dolorosa podem apresentar alterações de desempenho cognitivo dificultando a compreensão e adesão às estratégias de automanejo oferecidas em intervenções de educação sobre dor. O objetivo deste estudo foi analisar a resposta às orientações de automanejo em pacientes com DTM dolorosa crônica em função do desempenho cognitivo.
MÉTODOS: Amostra de 45 pacientes, com idade média de 35,5 anos, com DTM dolorosa crônica segundo o Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). O desempenho cognitivo foi avaliado por meio do teste Montreal Cognitive Assessment (MoCA). Foi também aplicado o Brazilian Portuguese Central Sensitization Inventory (CSI-BP) para mensuração da sensibilização central e a escala numérica para avaliar a percepção de intensidade dolorosa. A intervenção consistiu em orientações de autocuidado para o manejo da dor com métodos caseiros, por meio de um vídeo e de um tutorial impresso. Após um intervalo de 15 dias, foi feita nova avaliação para verificar se as orientações de automanejo promoveram mudanças relacionadas à dor na amostra estudada e se houve diferenças entre os participantes com desempenho cognitivo adequado e alterado (grupos obtidos após a aplicação do teste). 
RESULTADOS: A média do MoCA para a amostra foi de 23,3 ± 2,5 (desempenho cognitivo abaixo do esperado). Foi encontrada forte correlação inversa entre os escores do desempenho cognitivo e da intensidade de dor, indicando a tendência de haver menor desempenho cognitivo ao passo que há maior intensidade de dor (r=-0,77 e p=0,03). Não houve correlação entre o desempenho cognitivo e a sensibilização central (p>0,05). O grupo com melhor desempenho cognitivo apresentou melhor resposta às estratégias de educação sobre a dor. 
CONCLUSÃO: Há uma tendência de pior desempenho cognitivo de acordo com o aumento na percepção de intensidade dolorosa. Além disso, o baixo desempenho cognitivo parece prejudicar o aproveitamento e eficácia da intervenção baseada em educação sobre a dor para pacientes com DTM dolorosa, a qual é considerada importante estratégia para seu manejo. 
DESTAQUES 
• A intensidade de dor tem associação inversa com o desempenho cognitivo em pacientes com disfunção temporomandibular dolorosa.
• O desempenho cognitivo parece interferir no aproveitamento e eficácia da intervenção baseada em educação sobre a dor para pacientes com disfunção temporomandibular dolorosa. 
• Pacientes com disfunção temporomandibular dolorosa tendem a apresentar desempenho cognitivo abaixo do esperado. 

Palavras-chave

Cognição, Disfunção temporomandibular, Dor crônica. 

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Submitted date:
08/31/2022

Accepted date:
12/16/2022

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