Journal of orofacial pain最新文献

Aims: To investigate the influence of noxious stimulation of the temporomandibular joint (TMJ) on conditioned pain modulation (CPM) and the possible influence of gender on such CPM effects in the craniofacial region of humans.

Methods: Twenty healthy men and 20 healthy women participated in two sessions. Conditioning stimulation (CS) was standardized mechanical stimulation of pericranial muscles at a pain level of 5 on a 0 to 10 visual analog scale (VAS). Intra-articular electrical stimuli were applied to the left TMJ with an intensity around VAS = 5 (painful session). No electrical stimulation was applied in the control session. Pressure pain threshold (PPT) and pressure pain tolerance threshold (PPTol) were used as responses to pressure (test) stimuli and were assessed in the right masseter muscle and left forearm before and during TMJ stimulation in addition to the CS (during, immediately after, and 10 minutes after CS). PPT and PPTol were analyzed by multilevel analysis of variance.

Results: The parameters were not dependent on gender, assessment site, or session, but were dependent on time (PPT, PPTol: P < .001) with session-time interactions (PPT: P < .001, PPTol: P = .002). CS triggered increases in PPT and PPTol (hypoalgesia) in both sessions and without significant differences between sessions or assessment sites during CS (painful session: 49.2 ± 3.7%, control session: 46.0 ± 3.4% for PPT and painful session: 17.7 ± 3.2%, control session: 21.4 ± 3.5% for PPTol).

Conclusion: Acute noxious stimulation of the TMJ does not alter the magnitude of CPM effects on masseter muscle pain in either gender. It is suggested that deficiencies in CPM in persistent pain conditions are most likely more related to the duration of clinical pain than the pain per se.

Aims: To evaluate the concordance among different pain scales for evaluation of pain in toothache patients and to assess the influence of oral health on the quality of life of those patients.

Methods: Ninety-two patients seeking treatment for toothache were evaluated before and after treatment. At baseline and 1 week after the dental treatment, the patients were requested to fill out the Oral Health Impact Profile Inventory (OHIP-14) as well as the following pain scales: the visual analog scale (VAS), numeric scale (NS), verbal rating scale (VRS), and Faces Pain Scale-Revised (FPS-R). The data were analyzed by Pearson correlation, Student t test, and analysis of variance for repeated measurements, with a significance level of 5%.

Results: Patients were, on average, 34.4 years old. The sample was composed of 50 women and 42 men. Fifty-eight patients had dental pain of pulpal origin, and 34 had pain of periodontal origin. The mean OHIP score was 20.83 at baseline and 5.0 at 1 week after the completion of the dental treatment. The mean values of the scales at baseline were 50.7 mm, 56.7 mm, 52.2 mm, and 52.9 mm for the VAS, NS, VRS, and FPS-R, respectively. One week after the treatment, these values were 7.5 mm, 9.4 mm, 10.9 mm, and 8.7 mm. A positive correlation was detected between all four scales at baseline and also 1 week after the treatment (P < .05). At baseline, the NS was significantly different from the other scales. This difference, however, was not detected at the end of the trial.

Conclusion: All scales were able to detect differences in the pain reported after dental treatment and may be valid and reliable for use in clinical dental practice. The NS, however, returns higher scores at baseline when assessing the pain.

Aims: To investigate the relationship of headache frequency with patient-reported physical functioning and emotional functioning in temporomandibular disorder (TMD) subjects with concurrent temple headache.

Methods: The Research Diagnostic Criteria for TMD (RDC/TMD) Validation Project identified, as a subset of 614 TMD cases and 91 controls (n = 705), 309 subjects with concurrent TMD pain diagnoses (RDC/TMD) and temple headache. The temple headaches were subdivided into infrequent, frequent, and chronic headache according to the International Classification of Headache Disorders, second edition (ICHD-II). Study variables included self-report measures of physical functioning (Jaw Function Limitation Scale [JFLS], Graded Chronic Pain Scale [GCPS], Short Form-12 [SF-12]) and emotional functioning (depression and anxiety as measured by the Symptom Checklist-90R/SCL-90R). Differences among the three headache subgroups were characterized by increasing headache frequency. The relationship between ordered headache frequency and physical as well as emotional functioning was analyzed using linear regression and trend tests for proportions.

Results: Physical functioning, as assessed with the JFLS (P < .001), SF-12 (P < .001), and GCPS (P < .001), was significantly associated with increased headache frequency. Emotional functioning, reflected in depression and anxiety, was also associated with increased frequency of headache (both P < .001).

Conclusion: Headache frequency was substantially correlated with reduced physical functioning and emotional functioning in subjects with TMD and concurrent temple headaches. A secondary finding was that headache was precipitated by jaw activities more often in subjects with more frequent temple headaches.

Aims: To determine the available evidence in the literature for whether hypoxia-reperfusion injury plays a role in the pathogenesis of joint diseases in general and of osteoarthritis (OA) of the temporomandibular joint (TMJ) in particular.

Methods: The electronic databases CENTRAL, PubMed, and EMBASE were systematically searched. The search strategy combined thesaurus terms "reperfusion injury" and "joints" and excluded "tourniquet," which possibly induces iatrogenic reperfusion injury. Inclusion and exclusion criteria were applied, data were extracted, and quality was assessed.

Results: Four studies could be included, investigating four different aspects of the hypoxia-reperfusion mechanism in joints. All studies investigated several arthritides in the knee or shoulder joint and were observational studies, except for one section of one of the studies, which was a randomized controlled trial. These studies do not provide any evidence to support or reject the hypothesis that hypoxia reperfusion occurs in TMJ OA. Positive but weak evidence is provided to support the hypothesis that hypoxia-reperfusion injury occurs in OA of the knee joint. Furthermore, some results of the included studies suggest differences between OA and other types of arthritis in relation to the hypoxia-reperfusion mechanism.

Conclusion: There is no evidence to support or reject the hypothesis that hypoxia reperfusion occurs in TMJ OA, and limited evidence is provided to support that hypoxia-reperfusion injury occurs in OA of the knee joint. Since the studies suggest differences between OA and other types of arthritis in relation to hypoxia-reperfusion mechanisms, further research in this field needs to distinguish OA from other types of arthritis.

Aims: To test the hypothesis that estimates of time spent in tooth contact are significantly greater than estimates of time spent clenching, and to test the hypothesis that tooth contact is greater in pain patients, particularly those reporting facial or head pain, than those with pain elsewhere in the body.

Methods: An anonymous, voluntary, confidential questionnaire was administered to 235 patients seeking care at a general medical clinic. The questionnaire assessed demographic variables, presence and location of pain, and percentage of time spent in tooth contact and in clenching. Analysis of variance was used to examine differences among groups of patients; logistic regression was used to identify significant predictors of pain.

Results: All patients reported that the percentage of time spent in tooth contact was significantly greater than the time spent clenching. The same pattern of results emerged for those with and without head pain, and those with and without any chronic pain problem. Both tooth contact and clenching were significantly associated with head pain.

Conclusion: Results from the logistic regressions provide convergent validity on the importance of oral parafunctions, specifically tooth contact and clenching, to facial/head pain. For assessment of oral parafunctional behaviors, inquiries that utilize clear behavioral referents (tooth contact versus clenching) are likely to result in more accurate estimates than behaviors with unclear definitions.

Aims: To assess the biopsychosocial factors associated with acute temporomandibular disorders (TMD) based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD).

Methods: Participants were assessed in community-based dental clinics and evaluated by trained clinicians using physical and psychosocial measures. A total of 207 subjects were evaluated. Patients' high-risk versus low-risk status for potentially developing chronic TMD was also determined. Analyses of variance and chi square analyses were applied to these data.

Results: Participants' characteristic pain intensity differed among RDC/TMD Axis I diagnoses. They also significantly varied in their self-reported graded chronic pain, depression, somatization (pain inclusive), somatization (pain excluded), and physical well-being. In addition, participants with differing RDC/TMD Axis I diagnoses varied in self-reported pain during their chewing performance. Finally, there were also significant differences in chewing performance between high-risk versus low-risk (for developing chronic TMD) patients.

Conclusion: Participants with multiple diagnoses reported higher pain, as well as other symptoms, relative to participants without a TMD diagnosis. For chewing performance, participants with mutual diagnoses reported more pain compared to other participants. Finally, the risk-status of patients significantly affected chewing performance.

This article reports an unusual case of neuropathic orofacial pain secondary to leprosy. To the authors' knowledge, it is the first case of leprosy reported in the Western literature that was initially thought to be dental pain, then mistaken as a temporomandibular disorder before the correct diagnosis was made. The patient had migrated to Australia from India 24 years previously and was otherwise healthy without any overt features suggestive of infection. A review of the literature revealed that the trigeminal nerve is frequently involved in leprosy, usually associated with sensory loss rather than neuropathic pain. Even in Western countries, patients originally from countries where leprosy is endemic may develop symptoms of the disease many years later. The possibility of leprosy should be considered in the diagnosis of neuropathic orofacial pain in such patients.

Orofacial pain bridges an important gap between medicine and dentistry. This article presents the case of a man who reported preauricular pain, tinnitus, and vertigo that began after extraction of an impacted third molar and who was sent for evaluation of a possible temporomandibular joint disorder. However, he was subsequently found to have markers and imaging results consistent with recurrent and more centralized lupus and/or multiple sclerosis.

Aims: To determine whether a new palpometer and manual palpation can detect site-to-site differences in human craniofacial pain sensitivity in a similar pattern to that of an electronic pressure algometer and subsequently to compare between-session and within-session variability of palpometer and manual palpation.

Methods: Sixteen volunteers participated. Experiment 1 was carried out in two sessions. In session 1, pressure pain thresholds (PPT) were determined with a pressure algometer at nine craniofacial sites. Manual palpation and the palpometer were then applied to all sites, and subjects scored perceived pressure/pain on a 0 to 100 numerical rating scale (NRS). Mean scores were compared using analysis of variance (ANOVA). Ten of the volunteers were recalled for a second session and the same protocol was carried out except for assessment of PPTs to establish between-session variability. In experiment 2, three craniofacial sites were examined using the palpometer and manual palpation. Both techniques were repeated 10 times at each site and coefficient of variation (CV) was compared to determine within-session variability.

Results: There were no significant differences in NRS scores evoked by manual palpation or palpometer at any test site between repeated sessions. The CV varied between techniques, with lower within-session variability for the palpometer compared with manual palpation (P = .03).

Conclusion: The palpometer and manual palpation could detect differences in craniofacial sensitivity in healthy subjects, with no significant differences between repeated sessions. All techniques showed the highest sensitivity at the retromandibular site and the lowest at the temporalis muscle site. The palpometer had lower within-session variability compared with manual palpation.

Aims: To test the reliability and validity of a novel rat-holding device designed to be used in conjunction with the plantar test apparatus for studying nocifensive behavioral responses in an established model of temporomandibular joint (TMJ) pathology.

Methods: Thirty-five young adult male Sprague-Dawley rats were used. Withdrawal latencies in response to infrared 40 heat stimulation of the submandibular region in naïve animals (n = 4) and animals injected with saline or complete Freund's adjuvant (CFA) in the TMJ (n > 9) were measured over a 2-week time period. Nocifensive responses to mechanical stimulation of the cutaneous tissue directly over the TMJ with von Frey filaments were investigated in animals injected with CFA in the TMJ (n = 6). The effect on nocifensive responses to heat and mechanical stimulation of subcutaneous administration of buprenorphine (0.05 mg/kg) into the hindquarter was assessed in CFA and cotreated animals (n = 6). Statistical analysis was performed using a nonparametric Mann-Whitney U test.

Results: Under basal conditions, withdrawal latencies to heat stimulation of the orofacial region remained consistently around 15 seconds over 14 days. Unilateral CFA injection in the TMJ significantly decreased heat-withdrawal latencies on days 1, 2, 7, and 14 in the ipsilateral side (P < .05), but not contralateral side, when compared with basal values. CFA also significantly decreased the nocifensive threshold to mechanical stimulation on days 1, 2, and 7 postinjection (P < .05). CFA-mediated changes in heat withdrawal and mechanical thresholds in the orofacial region were significantly suppressed by subcutaneous administration of buprenorphine into the hindquarter (P < .05).

Conclusion: Findings from this study provide evidence to validate the use of this holding device for studying nocifensive behaviors in the orofacial region of rats in response to heat or mechanical orofacial stimulation.