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
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
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
Referências
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Submetido em:
31/08/2022
Aceito em:
16/12/2022
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