Journal of orofacial pain最新文献

Cutaneous mastocytosis (CM) has been associated with urticaria, itching, and pain of the affected regions. Although the occurrence of CM in the facial skin is rare, it may be a cause of chronic facial pain, and pain characteristics may mistakenly be interpreted as trigeminal nerve pathology. However, the dermatological appearance of the different variants of cutaneous mastocytosis is distinct and should be considered as an uncommon differential diagnosis in an orofacial pain diagnostic algorithm. This article presents a case of telangiectasia macularis eruptiva perstans, a rare type of cutaneous mastocytosis, as the underlying cause of chronic facial pain, erythema, and swelling.

Aims: To evaluate the nature of the antinociceptive interaction of systemic administration of a combination of the anticonvulsant gabapentin with the antidepressant nortriptyline, by isobolographic analysis in the formalin orofacial pain test of mice.

Methods: The study was carried out in 168 male CF-1 mice weighing 30 g, and the protocol was to test each drug (at dosages of 1, 3, 10, 30, and 100 mg/kg of gabapentin and 0.1, 1, 3, 10, and 30 mg/kg of nortriptyline; ip) alone and in combination. The isobolographic assay has two phases: phase 1 corresponds to the 5-minute period starting immediately after the formalin injection and reflects a tonic acute pain due to peripheral nociceptor sensitization; phase 2 is recorded as the 10-minute period starting 20 minutes after the formalin injection and reflects an inflammatory pain state. Results were analyzed by Student t test for independent means.

Results: Gabapentin was 1.61 times more potent in phase 2 than in phase 1, and nortriptyline 1.37 times more potent in phase 2 than in phase 1. The combination of both drugs was synergic, with an index of interaction of 0.134 and 0.148 for phase 1 and phase 2, respectively. Differences in the pharmacological profiles of gabapentin and nortriptyline could underlie the synergism of the two drugs.

Conclusion: The findings of this study are important, because they are concordant with some clinical studies and also raise the possibility of potential clinical advantages of combining gabapentin and nortriptyline in pain management, since the low doses of the components may potentially have a lower incidence of adverse reactions.

Aims: To assess, by systematic review of the literature, (1) the prevalence and incidence of temporomandibular disorder (TMD) pain after whiplash trauma, and (2) whether treatment modalities commonly used for TMD are equally effective in patients with solely TMD pain and those with TMD/whiplash-associated disorders (WAD) pain.

Methods: A systematic literature search of the PubMed, Cochrane Library, and Bandolier databases was conducted from January 1966 through October 2012. The systematic search identified 125 articles. After an initial screening of abstracts, 45 articles were reviewed in full text. Two investigators evaluated the methodological quality of each identified study.

Results: Eight studies on prevalence/incidence of TMD pain in WAD and four studies on interventions in TMD pain and WAD met the inclusion criteria. The reported median prevalence of TMD pain after whiplash trauma was 23% (range 2.4% to 52%) and the incidence ranged from 4% to 34%. For healthy controls, the reported median prevalence was 3% (range 2.5% to 8%) and the incidence ranged from 4.7% to 7%. For patients with a combination of TMD pain and WAD, treatment modalities conventionally used for TMD, such as jaw exercises and occlusal splints, had less of an effect (median improvement rate of 48%, range 13% to 68%) compared to TMD patients without a whiplash injury (75%, range 51% to 91%).

Conclusion: There is some evidence that prevalence and incidence of TMD pain is increased after whiplash trauma. The poorer treatment outcome suggests that TMD pain after whiplash trauma has a different pathophysiology compared to TMD pain localized to the facial region.

Aims: To test the validity of the use of the Douleur Neuropathique en 4 Questions (DN4) questionnaire for burning mouth syndrome (BMS) patients, and to differentiate patients by measuring the time course of the pain in BMS patients over a period of 7 days with a visual analog scale (VAS).

Methods: Patients completed the DN4 questionnaire and a VAS every hour for 7 days. The data were expressed as mean ± SEM. Correlations were searched using the Spearman correlation test with a significance level at P < .05.

Results: Data were fully analyzed for the 22 patients (21 females, 1 male, mean [± SEM] age 62.7 ± 2.3 years) for the DN4 and 17 patients for the VAS. DN4 scores ranged from 2 to 7 (mean score: 3.9 ± 0.3), and 59% of the patients had a DN4 score ≥ 4. Burning was found in all the patients, followed by pricking pain (pins and needles) and allodynia (pain on brushing) (both 68%), tingling (45%), numbness (32%), itching (27%), and electrical discharges (23%). Monitoring the hourly time-course of the pain led to the identification of two groups with intermittent or constant pain. In the latter, averaging the VAS for 7 days enabled plotting a curve, the slope of which could be calculated. The range of the slopes was 0.00 to 0.59, and a regular increase of pain during the day was seen for the majority of the patients.

Conclusion: The findings support the use of DN4 as a tool for screening BMS and reinforce the view that BMS is a clinical manifestation of a neuropathic disease. The methodology of this study can be used for a better description of the patients and the identification of subgroups.

Aims: To translate the Pictorial Representation of Illness and Self Measure (PRISM) instrument from German to Portuguese (Brazilian) and adapt it to the Brazilian cultural context, and then assess its reliability and validity in orofacial pain patients.

Methods: The PRISM was translated to Portuguese then back-translated to German. The translated PRISM was evaluated by a multidisciplinary committee and administered as a pre-test to 30 Portuguese-speaking orofacial pain patients. Psychometric properties were obtained after testing 116 orofacial pain patients. Validity was obtained through correlation analyses of scores obtained from PRISM and other psychometric tests, including the Numerical Pain Scale (NPS), Insomnia Severity Index (ISI), and Hospital Anxiety and Depression Scale (HAD).

Results: The adapted instrument showed high levels of reliability, proven by means of the test-retest procedure, and calculation of the Intraclass Correlation Coefficient (ICC = 0.991). Significant correlations were found between PRISM and the other tests. Correlation with NPS was moderate (-0.42), whereas correlations with ISI (-0.24), HAD-anxiety (-0.25), and HAD-depression (-0.22) were weak.

Conclusion: The cross-cultural adaptation process of PRISM was successful and the adapted version offers reliable and valid psychometric properties in the Brazilian context.

Aims: To investigate cerebral cortical changes by using functional magnetic resonance imaging (fMRI) after denture renewal and to test how these relate to prosthodontic treatment adaptability as measured by chewing efficiency and maximum bite force.

Methods: Ten complete denture wearers (five women and five men, mean age ± standard deviation: 70.3 ± 9.1 years) participated in the study. Each had their complete dentures renewed and underwent an fMRI examination with three functional tasks (lip pursing; jaw tapping; jaw clenching) as well as a color-mixing test for chewing efficiency and unilateral maximum bite force measurements. Recordings were performed with the old dentures (T0) and with the new dentures on insertion (T1) and at 1 week (T2) and 3 months postinsertion (T3). At T1, denture stability and retention (S/T) were assessed by two independent operators. Wilcoxon signed rank tests and Spearman's rho correlation were carried out for data analysis.

Results: The right and the left precentral gyrus (PRCG) and postcentral gyrus (POCG) were identified with significant activation across all three functional tasks. A statistically significant increase in the level of activity between T0 and T2 (POCG: P = .022; PRCG: P = .017) was found during jaw clenching tasks. Both regions of interest (PRCG, POCG) appeared to correlate with S/T of the new dentures while the subject performed a lip-pursing task (PRCG: r = 0.689, P = .027; POCG: r = 0.665, P = .036). The chewing efficiency and maximum bite force increased significantly during the adaptation to replacement dentures (chewing efficiency: T1-T2 P = .032, T2-T3 P = .012; maximum bite force right side: T2-T3 P = .047).

Conclusion: Changes in brain activity occurred in the adaptation to replacement dentures and appeared to regain preinsertion activity levels during motor tasks involving the dental occlusion after 3 months postinsertion.

Aims: To assess the effects of intra-alveolar application of chlorhexidine gel on the incidence of alveolar osteitis (dry socket) and the severity of postsurgical pain.

Methods: A total of 160 impacted mandibular third molars were extracted in 80 patients enrolled in this trial. In each subject, a socket was randomly selected and packed to the crest of the alveolar ridge with a gelatin sponge dressing saturated in 0.2% chlorhexidine gel. The contralateral socket was packed with a dry dressing as the placebo. None of the included patients took antibiotics or analgesics. The occurrence of dry socket and patients' pain levels were assessed at the first and third postoperative days. The data were analyzed using Spearman correlation coefficient, McNemar, Wilcoxon, and chi-square tests.

Results: Chlorhexidine gel significantly reduced dry socket incidence from 32.6% to 11.3% (P ≤ .001 [McNemar and chi-square], absolute risk reduction = 21.2%, relative risk reduction = 65.4%, odds ratio = 0.263, relative risk = 0.345). It also significantly relieved postoperative pain on both sides in all the patients (P ≤ .001 [Wilcoxon]) and also in the 54 subjects who did not develop dry socket (P ≤ .001 [Wilcoxon]).

Conclusions: Besides decreasing the incidence of dry socket, chlorhexidine gel can reduce postsurgical pain in patients with and without dry socket.

Aims: To use a range of evaluation instruments to assess the content and quality of websites about temporomandibular disorders (TMD) and thereby provide guidance regarding the actual accuracy and comprehensiveness of the information of the sites.

Methods: Sixty-seven websites resulting from an Internet search with the word "TMD" were evaluated using Journal of the American Medical Association (JAMA), DISCERN, and Health on the Net (HON) criteria, along with an evaluation method to assess the scientific quality of the website contents. Results were compared according to reviewer, website type, and presence of HON seal. One-way analysis of variance (ANOVA), Student t test, chi-square test, and Pearson correlation analysis were used as appropriate.

Results: The mean content, HON, and DISCERN scores were 38.9%, below 50%, and 53.9% of the maximum possible score, respectively. Fewer than 50% of the sites displayed the author or reference of the information according to the JAMA benchmarks criteria. Every evaluation criteria showed good agreement among reviewers. Commercial websites were the most common, while sites of nonprofit organizations showed the highest content scores. The overall quality was poor to moderate for all website types.

Conclusion: Sites concerning TMD were poorly organized and maintained. Also, most sites contained insufficient or scientifically incorrect information that could have a negative effect on the treatment outcome and prognosis of TMD. Clinicians should guide patients to reputable sources of information that will enhance patient comprehension and better treatment outcomes.