Miofascijalna bol kod branitelja liječenih od posttraumatskog stresnog poremećaja

INTRODUCTION: The aim of this research was to analyze the incidence of myofascial pain among war veterans treated for posttraumatic stress disorder (PTSD). Myofascial pain affects muscles and fasciae. The head and neck region with its muscels is a high frequency area for developing of myofascial pain. Myofascial pain is characterized by the presence of trigger points, which can be defined as descrete hyperirritable spots in muscle fibres. Trigger points can be either active or latent. In addition to the occurence of trigger points, limited function and pain are also characteristic in affected muscles. AIMS OF THE RESEARCH: The aim of this research was to determine the influence of war-induced stress on the occurence of myofascial pain in the head and neck region among Croatian war veterans treated for PTSD. Hypothesis was that there is a correlation between PTSD and myofascial pain. According to this hypothesis, myofascial pains occurs more often among examinees that suffer from PTSD than among members of the control group. It was assumed furthermore that myofascial pain influences the symptomatology of patients with PTSD, as well as that there is a need to engage a doctor of dental medicine educated for treating disorders of the temporomandibular joint and other painful disorders of the head and neck region in the treatment of those patients. The aim of this research was to: determine the degree of attention that war veterans with PTSD devote to their own health and their attitudes towards it, and compare their results with the control group; compare, determine and test the influence of PTSD and eventual traumatization of the stomatognathic system during intubation as two possible etiologic factors for the emergence of myofascial pain in war veterans treated for PTSD; analyze the incidence of oral parafunctions and inappropriate habits among war veterans treated for PTSD and the control group; compare the incidence of pain and temporomandibular joints sounds among war veterans treated for PTSD and the control group; analyze and compare the incidence of muscle pain in the head and neck region among war veterans treated for PTSD and the control group; determine the incidence of myofascial pain among war veterans treated for PTSD; determine the localization of trigger points; present conclusions about the incidence of myofascial pain among war veterans treated for PTSD and define the exact role of doctors of dental medicine in the treatment of those patients. PATIENTS AND METHODS: 202 examinees, divided into two groups, took part in the research. The first group consisted of 101 Croatian war veterans with PTSD. All the examinees were being hospitalized in the Psychiatric Hospital Vrapce. The diagnosis of PTSD was issued in accordance to the International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The control group consisted of 101 examinees volunteers that visit the hospital in order to perform a systematic health examination. Individuals with psychiatric or neurological disorders, rheumatic diseases (rheumathoid arthritis), collagenosis, orofacial pain, hormonal disorders, odontogenic abscesses, developmental anomalies and maxillofacial traumas were not included in the control group. Individuals that therapeutically use analgesics and opiates were eliminated from the control group. An analysis of the following muscels was performed bilaterally: masseter muscle, temporal muscle, temporal muscle tendon, medial pterygoid muscle, lateral pterygoid muscle, sternocleidomastoid muscle, splenius capitis and trapezius muscle. RESULTS: The research showed that war veterans treated for PTSD asses their health condition as generally poor (72,3%) or extremely poor (18,8%), the condition of the mouth as poor (47,5%) or extremely poor (17,8%), the attention devoted to their health as deficient (26,7%) and extremely deficient (6,9%). This results are to a considerable extent worse than the results of examiness in the control group. In comparison with the control group, a significantly higher comorbidity with the following diseases among war veterans with PTSD was determined: rheumatoid arthritis, collagenosis and psoriasis (35,6%), depression (99%), hearing impediments and problems with ears (51,5%), vertigo (58,4%), frequent headaches (64,4%), high blood pressure (41,6%), hormonal disorders (18,8%), problems with concentration (93,1%), sleeping disorders (100%), problems with sinuses (51,5%) and problems with cervical spine (80,2%). There was no difference between the two groups as far as the use of heart drugs is concerned, whereas other drugs, like tranquilizers, analgesics, sleeping medications and medicaments againts hypertension were considerably more frequently used by examinees with PTSD. The analyzed sample showed that there is no statistically significant difference between the incidence of myofascial pain in veterans who had been intubated and those who had not undergone intubation. The following symptoms were determined to be significantly more frequent in war veterans than in the control group: limited ability to open the mouth in the morning (29,7%) and in the evening (22,9%), a sideways shift when opening the mouth (20,8%), clenching of the teeth during the day (73,3%), teeth grinding while sleeping (47,5%), pain and tension in the jaws in the morning (37,6%) discomfort and instability when closing the mouth (54,5%). Inappropriate habits parafunctions (41,6%), and the sensation of tension and stiffness in jaw muscles (64,3%) are also significantly more frequent in the population of war veterans. Furthermore, the sound of the temporomandibular joints and pain in those joints were determined to be more frequent among war veterans with PTSD (left joint 31.7%, right joint 34,7%) than in the examinees from the control group. At the same time, war veterans display a greater incidence of muscle pain than examinees from the control group. Trigger points are mostly located in the following muscles: splenius capitis (12,9%), right temporal muscle (11,9%), left temporal muscle (7,9%) right masseter muscle (5,9%). In the control group the overall incidence of myofascial pain was much lower (8,9), and trigger points were detected only in the left temporal muscle (4%) and in the splenius capitis (5% ). A significantly higher incidence of myofascial pain in the head and neck region among war veterans with PTSD (58,4%) than in the control group (8,9%) was determined, what confirms the initial hypothesis. CONCLUSION: In accordance to the results obtained during the research, there exist a mutually enhancing relationship between PTSD and chronic pain myofascial pain. Because of that, there is a need to engage a doctor of dental medicine, educated for treating stomatognatic system disorders as well as painful disorders in the head and neck region, in a multidisciplinary team that treats Croatian war veterans with PTSD