Concordancia entre los criterios diagnósticos RDC/TMD y su actualización DC/TMD, aplicados a la patología inflamatoria de la articulación temporomandibular / Agreement between Diagnostic Criteria RDC/TMD and its update DC/TMD, applied to the inflammatory pathology of the Temporomandibular Joint

RESUMEN: Objetivo: Evaluar el grado de concordancia entre las prevalencias de trastornos articulares inflamatorios (TAI) de las Articulaciones Temporomandibulares (ATM), obtenidas con los Criterios Diagnósticos de Investigación para Trastornos Temporomandibulares (RDC/TMD) y los Criterios Diagnósticos para Trastornos Temporomandibulares (DC/TMD). Materiales y métodos: 59 pacientes adultos chilenos fueron examinados según el Eje I de los RDC/TMD y el Eje I de los DC/TMD para determinar la prevalencia de TAI. Luego se compararon los resultados obtenidos de cada protocolo con el test Kappa de Cohen para evaluar la concordancia entre ambos. Resultados: La prevalencia de TAI para ambos criterios fue de 22%, con una concordancia casi perfecta (kappa=0,91). Al comparar las prevalencias de TAI por articulación, se obtuvo un grado de acuerdo sustancial (kappa=0,77) para la ATM derecha y un grado de acuerdo casi perfecto (kappa=0,94) para la ATM izquierda. Al comparar las prevalencias de TAI según género y edad se obtuvo una concordancia estadísticamente significativa en la mayoría de los casos. Conclusión: Hay concordancia estadísticamente significativa entre los datos obtenidos con los RDC/TMD y los DC/TMD, en el diagnóstico de trastornos articulares inflamatorios.

ABSTRACT: Aim: To assess the agreement between the prevalence of inflammatory joint disorders (IJD) obtained with Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Materials and methods: 59 Chilean adult patients were examined according to Axis I of the RDC/TMD and Axis I of the DC/TMD to determine prevalence of IJD. Then, the results obtained from each protocol were compared with Cohen's Kappa test to assess the agreement between them. Results: The prevalence of IJD for both criteria was 22%, with almost perfect agreement (kappa = 0.91). When comparing the prevalences of IJD per joint, a substantial agreement (kappa = 0.77) was obtained for the right TMJ and an almost perfect agreement (kappa = 0.94) for the left TMJ. When comparing the prevalences of IJD according to gender and age, a statistically significant agreement was obtained in the majority of cases. Conclusion: There is statistically significant agreement between the data obtained with the RDC/TMD and the DC/TMD, in the diagnosis of inflammatory joint disorders.

Prevalencia de Trastornos Temporomandibulares según los CDI/TTM, en un Grupo de Adultos Mayores de Santiago, Chile / Prevalence of Temporomandibular Disorders According to RDC/TMD in Older People of Santiago, Chile

En la población chilena, los adultos mayores representan un 13% de la población total del país (2,2 millones), proyectándose para el 2020 un aumento del grupo de 60 años o más en un 45%. Todos los seres humanos sufren un proceso de envejecimiento y, los tejidos orales y periorales no escapan de este proceso. Las repercusiones sobre el sistema estomatognático, podrían manifestarse a través de sintomatología en alguno de sus componentes, compatible con un trastorno temporomandibular (TTM). El objetivo de este trabajo, fue determinar la prevalencia de TTM según los Criterios de Investigación Diagnóstica ó CDI/TTM (Eje I), en adultos mayores examinados en la Clínica Odontológica de la Facultad de Odontología de la Universidad de Chile (FOUCh), durante el año 2012 y establecer la relación entre ambos sexos. Este estudio determinó, que existe una alta prevalencia de TTM en la muestra de adultos mayores chilenos estudiados (47%), principalmente diagnósticos de tipo articular y sin una relación significativa entre ambos sexos.

In Chilean population, elders represent a 13% of the overall population (2.2 million), projected for 2020 an increase of 45%, from the group of 60 and over. All humans undergo a process of aging. Oral and perioral tissues do not escape from this process, whose impact on the condyle and articular disc could be observed, in the presence of symptoms consistent with temporomandibular disorders (TMD). The aim of this study was to determine the prevalence of TMD according to the Research Diagnostic Criteria or RDC/TMD (Axis I), in older adults examined at the Dental Clinic of the Faculty of Dentistry, University of Chile during 2012, and establish the relationship between the sexes. In conclusion, this study found that there is a high prevalence of TMD in Chilean elderly sample studied (47%), mainly articular diagnoses without a statistically significant relationship between the sexes.

Construção e validação de questionário simplificado para triagem de pacientes com disfunção temporomandibular (QST/DTM) / Construction and validation of a simplified questionnaire for screening of patients with temporomandibular disorders (QST / TMD)

As disfunções temporomandibulares (DTM) representam a maior causa de dor não dentária da região orofacial. Dada sua alta prevalência na população em geral e a existência de inúmeros instrumentos diagnósticos não padronizados, buscou-se elaborar e validar um questionário simples, de acessibilidade ampla e aplicação prática, com vistas a contribuir para o diagnóstico e o estudo epidemiológico das mesmas. A estratégia utilizada na montagem do instrumento foi estabelecida com base na avaliação criteriosa de questionários já existentes na literatura, validação de expertos na área de DTM, validação fatorial, de face (na primeira fase do estudo) e, frente ao padrão ouro (RDC/TMD), na segunda fase do estudo. Na primeira fase, participaram 160 indivíduos. A consistência interna resultou num Coeficiente Alfa de Cronbach de 0,752 para o questionário com sete itens; enquanto que para o questionário com cinco itens, este resultado foi de 0,694, não sendo o mesmo, considerado baixo por avaliar apenas cinco questões e ainda, em razão do tema central da pesquisa ser bastante subjetivo. A análise fatorial confirmatória apontou para uma variância total dos fatores extraídos do questionário com sete itens, de 58,2 % e do questionário com cinco itens de 70,04%. Portanto, o questionário com cinco questões, apresentou resultados estatísticos superiores ao de sete questões. Na validação frente ao padrão ouro (RDC/TMD), foram avaliados 99 indivíduos tendo sido testados os dois questionários, com sete e com cinco questões. Na estrutura com sete questões, ao se categorizar as mesmas por totais de pontos obtidos, em quatro condições, obteve-se o melhor resultado quando se considerou com DTM a faixa entre 10 e 21 pontos, sendo 85,1% positivos também no RDC/TMD, com acurácia de 90,1% e Kappa 0,817. Nesta condição, a sensibilidade encontrada foi de 95% (IC 95%, 91 a 99), especificidade de 87% (IC 95%, 81 a 93), VPP 85%, VPN 96%, LR+ 7,3 e LR- 17,4. Quando os dados foram avaliados para o questionário com cinco questões (QST/DTM), pode-se observar que o melhor ponto de corte foi quando se considerou como portadores de DTM, os indivíduos na faixa entre 7 e 15 pontos, com acurácia de 85,8% e Kappa 0,817. Nesta condição, a sensibilidade foi 88% (IC 95%, 81,6 a 94,4), especificidade 84% (IC 95%, 76,8 a 91,2), VPP 80%, VPN 90,5%, LR+ 5,5 e LR- 7,0. A simplicidade do presente questionário (QST/DTM) com apenas cinco questões, possibilita seu uso como elemento de triagem inicial na área da dor orofacial em disfunção temporomandibular, com boa compreensibilidade, confiabilidade, reprodutibilidade e possibilidade de aplicação em pesquisas epidemiológicas. Concluiu-se que o questionário aqui validado, permite sua aplicação de forma simples tanto por profissionais e pesquisadores da Odontologia como de outras áreas da saúde. (AU)

Temporomandibular disorders (TMD) represent the biggest cause of non-dental pain in the orofacial region. In reason of its high prevalence in the general population and the existence of numerous non-standardized diagnostic tools, it was sought to develop and validate a simple questionnaire, with wide accessibility and practical application, in order to contribute to the diagnosis and epidemiological study of the same. The strategy used in the assembly of the instrument was based on careful evaluation of existing questionnaires in the literature, validation of experts in the field of TMD, face and factorial validity (at the first moment of the study) and validation against the gold standard (RDC/TMD), at the second moment of the study. At the first stage, participated 160 individuals. The internal consistency resulted in a Cronbach alpha of 0,752 for the questionnaire with seven items, while for the questionnaire with five items, this result was 0,694, not being the same considered a low value since it evaluated only five questions and yet, in reason of the subjectivity of the main theme of the research. Confirmatory factor analysis indicated a total variance of the factors extracted from the questionnaire with seven items of 58,2% and for the questionnaire with five items of 70,04%. Therefore, the questionnaire with five questions presented better statistical results them the one with seven questions. In the validation against the gold standard (RDC/TMD), 99 individuals were evaluated, being tested both questionnaires, with five and seven questions. In the structure with seven issues, when categorizing them by total points earned, on four conditions, we obtained the best result when considering with TMD the range between 10 and 21 points, being 85,1% positive also in the RDC/TMD, with an accuracy of 90,1% and Kappa 0,817. In this condition, the sensitivity was 95% (CI 95%, 91 to 99), specificity of 87% (CI 95%, 81 to 93), PPV 85%, NPV 96%, LR+ 7,3 and LR- 17,4. When the data were evaluated for the questionnaire with five questions (QST/DTM), one can observe that the best cutoff point was when considered as with TMD the individuals aged between 7 and 15 points, with an accuracy of 85,8% and 0,817 Kappa. In this condition, the sensitivity was 88% (CI 95%, 81,6 to 94,4), specificity 84% (CI, 95%, 76,8 to 91,2), PPV 80%, NPV 90,5%, LR+ 5,5 and LR- 7,0. The simplicity of this questionnaire (QST/DTM) with only five issues permits its use as an initial screening in the area of orofacial pain in temporomandibular disorders, with good responsiveness, reliability, reproducibility and possibility of application in epidemiologic researches. It was concluded that the questionnaire here validated, enables its application in a simple manner by both practitioners and researchers of Dentistry as in other areas of health. (AU)

Do women with migraine have higher prevalence of temporomandibular disorders? / Mulheres com enxaqueca têm maior prevalência de disfunção temporomandibular?

OBJECTIVES: The aim of this study was to assess the prevalence of Temporomandibular Disorders (TMD), using the Research Diagnostic Criteria for TMD (RDC/TMD) in women with episodic and chronic migraine (M and CM), as well as in asymptomatic women. METHOD: Sample consisted of 61 women, being 38 with M and 23 with CM, identified from a headache outpatient center; we also investigated 30 women without headaches for at least 3 months (women without headache group - WHG). Assessment of TMD was conducted by a physical therapist who was blind to the headache status. RESULTS: The prevalence of TMD, assessed through the RDC, was 33.3% in the WHG, 86.8% in the M group and 91.3% of the CM group. Differences were significant when comparing M and CM groups with WHG (p<0.001), but not when comparing M and CM (p>0.05) as well as higher risk for TMD [odds ratio (OR)=3.15, 95% confidence interval (CI) 1.73-5.71 and OR=3.97, 95%CI 1.76-8.94]. CONCLUSION: Women with migraine are more likely to have muscular and articular TMD, suggesting that both disorders might be clinically associated, which demonstrate the importance of physical therapy assessment in the multidisciplinary team.

OBJETIVOS: Avaliar a presença de disfunção temporomandibular (DTM) usando o Critério Diagnóstico em pesquisa para disfunção temporomandibular (RDC/TMD) em mulheres com migrânea episódica e migrânea crônica (M e MC), bem como em mulheres sem nenhuma cefaleia. MÉTODO: A amostra foi composta por 61 mulheres, 38 com M e 23 com MC, selecionadas em um centro terciário de saúde; também foram avaliadas 30 mulheres sem nenhuma cefaleia nos últimos três meses (grupo de mulheres sem cefaleia - MSC). A avaliação da DTM foi realizada por um fisioterapeuta que não tinha conhecimento do diagnóstico das pacientes. RESULTADOS: Por meio do RDC/TMD, a frequência de DTM foi de 33.3% no grupo MSC, 86.8% no grupo M e 91.3% no grupo MC. A diferença foi significativa entre os grupos com migrânea e o grupo MSC (p<0.001), porém não houve diferença entre os grupos M e MC (p>0,05), bem como maior fator de risco de DTM [odds ratio (OR)=3,15, intervalo de confiança (IC) de 95% 1,73-5,71 e OR=3,97, IC95% 1,76-8,94]. CONCLUSÃO: Mulheres com migrânea têm maior frequência de DTM muscular e articular, sugerindo que essas condições estão clinicamente associadas, evidenciando a importância do fisioterapeuta na equipe de avaliação multidisciplinar.

Depression and TMD in the elderly: a pilot study / Depressão e DTM em idosos: estudo piloto

Temporomandibular dysfunction (TMD) is a painful syndrome that affects orofacial region, with deleterious effects in patients’ quality of life. Several aspects of TMD in the elderly are still controversial in the literature. The aim of this paper is to verify the prevalence of TMD among the elderly people in Taubaté – Brazil, and its possible association with other co-morbidities. Sixty-eight elderly individuals, presenting an average age of 69.5 years (SD 8.5), participated in this study, 37 of which were women. The Research Diagnostic Criteria for Temporomandibular Dysfunction (RDC/TMD) was used to verify TMD and its possible association with other co-morbidities. The studied sample presented a low prevalence of TMD according to RDC/TMD (10.3%). Women presented more non-specific physical symptoms – pain items included – than men (pain items included, p=0.016, x2 test). Depression and non-specific physical symptoms – pain items excluded – did not correlate with patients’ gender. Associations were found among depression and characteristic pain intensity (p=0.027, ANOVA), non-specific physical symptoms - pain items included (p<0.001), non-specific physical symptoms – pain items excluded (p=0.001) and chronic pain grade (p=0.004), whereas the more depressed the patients, the higher were their pain scores. One can conclude that psychological factors, such as depression, were associated with TMD prevalence, thus reinforcing the need for a multidisciplinary approach for TMD treatment.

A disfunção temporomandibular (DTM) é uma síndrome dolorosa que afeta a região orofacial, com efeitos deletérios na qualidade de vida dos pacientes. Diversos aspectos à respeito da DTM em idosos são controversos na literatura. O objetivo neste estudo foi verificar a prevalência de DTM em idosos da cidade de Taubaté – Brasil, e as possíveis associações com outras co-morbidades. Sessenta e oito indivíduos, apresentando idade media de 69,5 anos (DP 8,5), participaram neste estudo, sendo 37 mulheres. O Research Diagnostic Criteria for Temporomandibular Dysfunction (RDC/TMD) foi usado para verificar DTM e as possíveis associações com outras co-morbidades. A população estudada apresentou baixa prevalência de DTM de acordo com o RDC/TMD (10,3%). Mulheres apresentaram mais sintomas não específicos – itens de dor incluídos – que homens (itens de dor incluídos, p-0.016, x2 test). Depressão e sintomas físicos não específicos – itens de dor excluídos – não correlacionaram com o sexo do paciente. Associações foram encontradas entre depressão e a intensidade das características de dor (p=0.027, ANOVA), sintomas físicos não específicos – itens de dor incluídos (p<0.001), sintomas físicos não específicos – itens de dor excluídos (p=0.001) e a escala de dor crônica (p=0.004), sendo que paciente mais deprimidos apresentaram maiores escores para dor. Pode-se concluir que os fatores psicológicos, como a depressão, foram associados com a prevalência de DTM, reforçando assim a necessidade de uma abordagem multidisciplinar para o seu tratamento.

Possíveis fatores etiológicos para desordens temporomandibulares de origem articular com implicações para diagnóstico e tratamento / Possible etiological factors in temporomandibular disorders of articular origin with implications for diagnosis and treatment

Os fatores envolvidos na etiologia, diagnóstico e tratamento das desordens temporomandibulares (DTM) de origem articular foram revisados. Critérios específicos de inclusão e exclusão para o diagnóstico de DTM são essenciais, mas apresentam utilidade limitada. Atualmente, os Critérios Diagnósticos de Pesquisa para Desordem Temporomandibular (RDC/TMD) oferecem a melhor classificação baseada em evidências para os subgrupos mais comuns de DTM. O RDC/TMD inclui não apenas métodos para a classificação diagnóstica física, presentes em seu Eixo I, mas ao mesmo tempo métodos para avaliar a intensidade e a severidade da dor crônica e os níveis de sintomas depressivos e físicos não-específicos, presentes em seu Eixo II. Embora historicamente as más oclusões tenham sido consideradas como fatores de risco para o desenvolvimento das DTM, incluindo as predominantemente articulares, em muitos casos a associação estabelecida entre essas variáveis parece ter tomado direção oposta. No que diz respeito aos desarranjos internos da ATM, os resultados de estudos prévios sobre a redução induzida do ramo mandibular, secundária ao deslocamento anterior do disco articular, indicam que o reposicionamento do disco deslocado em crianças ou adolescentes jovens pode fazer mais sentido do que previamente imaginado. O uso terapêutico de suplementos alimentares, como o sulfato de glicosamina, parece uma alternativa segura ao uso dos medicamentos anti-inflamatórios normalmente utilizados para controlar a dor relacionada à osteoartrite da articulação temporomandibular (ATM), embora a evidência em torno de sua eficácia para a maioria dos pacientes de DTM não tenha sido completamente estabelecida.

The authors reviewed the factors involved in the etiology, diagnosis and treatment of temporomandibular joint disorders (TMD). Although essential, specific criteria for inclusion and exclusion in TMD diagnosis have shown limited usefulness. Currently, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) offer the best evidence-based classification for the most common TMD subgroups. The RDC/TMD includes not only methods for physical diagnostic classification, comprised in Axis I, but also methods to assess the intensity and severity of chronic pain and the levels of non-specific depressive and physical symptoms, in Axis II. Although historically malocclusions have been identified as risk factors for the development of TMD-including those predominantly joint-related-in many cases the association established between these variables seems to have taken opposite directions. Regarding internal TMJ derangements, the results of studies on the induced shortening of the mandibular ramus, secondary to anterior articular disk displacement, indicate that repositioning the displaced disk in children or young adolescents may make more sense than previously imagined. The therapeutic use of dietary supplements, such as glucosamine sulfate, seems to be a safe alternative to the anti-inflammatory drugs commonly used to control pain associated with TMJ osteoarthritis, although evidence of its effectiveness for most TMD patients has yet to be fully established.

Freqüência de relatos de parafunções nos subgrupos diagnósticos de DTM de acordo com os critérios diagnósticos para pesquisa em disfunções temporomandibulares (RDC/TMD) / Frequency of relates of parafunctions in the diagnostic subgroups of TMD according to research diagnostic criteria for temporomandibular disorders (RDC/TMD)

INTRODUÇÃO: as disfunções temporomandibulares (DTM) podem ser definidas como um conjunto de condições dolorosas e/ou disfuncionais, que envolvem os músculos da mastigação e/ou as articulações temporomandibulares (ATM). Um dos meios usados para o diagnóstico é o "Critério Diagnóstico para Pesquisa em Disfunções Temporomandibulares" (RDC/TMD). Hábitos parafuncionais são aqueles não relacionados à execução das funções normais do sistema estomatognático. O bruxismo é caracterizado por atividade parafuncional noturna involuntária dos músculos mastigatórios, enquanto o apertamento dentário é considerado uma parafunção diurna envolvendo esta musculatura, embora possa ocorrer também à noite. OBJETIVOS: o objetivo do presente estudo foi avaliar a freqüência do relato de parafunções orais diurna e/ou noturna em pacientes com DTM nos diferentes subgrupos diagnósticos do RDC/TMD. METODOLOGIA: foram utilizados dados provenientes de 217 pacientes que procuraram tratamento na Clínica de DTM e Dor Orofacial da Faculdade de Medicina de Petrópolis, sendo avaliados através do questionário e exame físico que compõem o RDC/TMD. RESULTADOS: dos 182 pacientes com DTM estudados, 76,9 por cento relataram algum tipo de parafunção, podendo ser diurna, noturna ou a associação de ambas. A parafunção diurna foi a mais freqüentemente relatada entre os subgrupos de DTM, sendo encontrada em 64,8 por cento dos casos contra 55,5 por cento dos casos com relato de bruxismo. O relato de ambas as parafunções foi constatado em 43,4 por cento dos pacientes com DTM. CONCLUSÕES: considerando cada subgrupo diagnóstico, os relatos de parafunções diurna e noturna foram mais freqüentes nos pacientes com dor miofascial.

INTRODUCTION: temporomandibular disorders (TMD) can be defined as a group of painful and/or dysfunctional conditions that involve masticatory muscles and/or the temporomandibular joints (TMJ). One of the methods used to the diagnostic is the "Research Diagnostic Criteria for Temporomandibular Disorders" (RDC/TMD). Parafunctional habits are those not related to the execution of normal functions of stomatognatic system. Bruxism is characterized by nocturnal involuntary parafunctional activity of masticatory muscles, while clenching is considered as a diurnal parafunction involving this musculature, although this may also occur at night. OBJECTIVE: the goal of the present study was to evaluate the frequency of relates of diurnal and/or nocturnal oral parafunctions in patients with TMD in different diagnostic subgroups of RDC/TMD. METHODOLOGY: it has been used data from 217 patients that seek for treatment at TMD and Orofacial Pain Clinic of Petropolis Medicine School, being evaluated through questionnaire and physical examination that compose RDC/TMD. RESULTS: from 182 TMD patients studied, 76.9 percent has related some kind of parafunction, that could be diurnal, nocturnal or both. Diurnal parafunction was the most frequent related among TMD subgroups, present in 64.8 percent of cases against 55.5 percent of cases with relates of bruxism. Relate of both parafunctions was verified in 43.4 percent of TMD patients. CONCLUSION: regarding each diagnostic subgroup, relates of diurnal and nocturnal parafunctions has been more frequent in patients of miofascial pain group.

The epidemiologic study of the patients with temporomandibular joint disorders, using Research Diagnostic Criteria for TMD (RDC/TMD): Preliminary Report

PURPOSE: This epidemiologic research was carried out to investigate the degree and aspects of symptoms of patients suffered from TMD using RDC/TMD. SUBJECTS AND METHODS: Subjects were the patients who had visited to SNUBH dental clinic from Jan. 2005 to Dec. 2005, and total 117 patients were included (M: 22, F:95). The signs and symptoms of physical, psychological and behavioral factors were retrospectively evaluated by questionnaires in the RDC/TMD. The patients were examined through clinical and radiological method, and diagnosed by same investigator. They were divided into 3 groups such as osteoarthritis group (group 1), internal deragnement (group 2), myofascial pain dysfunction syndrome group (MPDS, group 3). In addition, in patient with complex diagnosis they were divided into subgroups in detail (ex. group 1+group 2). In the questionnaire, several items were selected to calculate the graded pain score (grade 0~IV), depression and vegetative symptoms, nonspecific physical symptoms(pain items included) and nonspecific physical symptoms(pain items excluded) in each group. RESULTS: As a result of classification by diagnostic criteria of this study, the patients were distributed to 45 % of group 1, 47 % of group 2, 8 % of group 3 in this study. In younger patients (under 25-year old, n=40), group 2 was occupied 57 % (n=23) and group 1 was 35 % , group 3 was 8 %, while group 1 was occupied 75 % in elderly-patients (over 40-year old, n=28) in present study (group 2: 21 % , group 3: 4 %). In the analysis of depression and vegetative symptoms, majority of patients in Group 2 were included in 'normal? and in Group 3 it appeared to have larger proportion of 'moderate' & 'severe' than others. According to nonspecific physical symptoms, there have been tendencies of higher ratio of 'severe' in patients with MPDS. In graded pain score, more than half (58 %) of subjects were included in grade 0 and low disability (Grade I and II), and 27 % were revealed high disability (grade III, IV).

The epidemiologic study of the patients with temporomandibular joint disorders, using Research Diagnostic Criteria for TMD (RDC/TMD): Preliminary Report

PURPOSE: This epidemiologic research was carried out to investigate the degree and aspects of symptoms of patients suffered from TMD using RDC/TMD. SUBJECTS AND METHODS: Subjects were the patients who had visited to SNUBH dental clinic from Jan. 2005 to Dec. 2005, and total 117 patients were included (M: 22, F:95). The signs and symptoms of physical, psychological and behavioral factors were retrospectively evaluated by questionnaires in the RDC/TMD. The patients were examined through clinical and radiological method, and diagnosed by same investigator. They were divided into 3 groups such as osteoarthritis group (group 1), internal deragnement (group 2), myofascial pain dysfunction syndrome group (MPDS, group 3). In addition, in patient with complex diagnosis they were divided into subgroups in detail (ex. group 1+group 2). In the questionnaire, several items were selected to calculate the graded pain score (grade 0~IV), depression and vegetative symptoms, nonspecific physical symptoms(pain items included) and nonspecific physical symptoms(pain items excluded) in each group. RESULTS: As a result of classification by diagnostic criteria of this study, the patients were distributed to 45 % of group 1, 47 % of group 2, 8 % of group 3 in this study. In younger patients (under 25-year old, n=40), group 2 was occupied 57 % (n=23) and group 1 was 35 % , group 3 was 8 %, while group 1 was occupied 75 % in elderly-patients (over 40-year old, n=28) in present study (group 2: 21 % , group 3: 4 %). In the analysis of depression and vegetative symptoms, majority of patients in Group 2 were included in 'normal? and in Group 3 it appeared to have larger proportion of 'moderate' & 'severe' than others. According to nonspecific physical symptoms, there have been tendencies of higher ratio of 'severe' in patients with MPDS. In graded pain score, more than half (58 %) of subjects were included in grade 0 and low disability (Grade I and II), and 27 % were revealed high disability (grade III, IV).