Journal of Oral & Facial Pain and Headache最新文献

Aims: To examine if the existence of an association between self-reported awake oral behaviors and orofacial pain depends on the belief of patients that these behaviors are harmful to the jaw and to investigate if an additional variable (ie, somatic symptoms, depression, and/or anxiety) indirectly affects the association between the causal attribution belief and the report of awake oral behaviors.

Methods: Prior to the first clinical visit, patients referred to a specialized clinic for complaints of orofacial pain and dysfunction completed a digital questionnaire. Data of 329 patients diagnosed with myalgia according to the Diagnostic Criteria for Temporomandibular Disorders (82.4% women; mean ± SD age = 41.9 ± 14.7 years) were analyzed.

Results: Causal attribution belief moderated the association between awake oral behaviors and orofacial pain intensity. In addition, the relationship between causal attribution belief and self-reported oral behaviors was partially mediated by the presence of somatic symptoms (8%), depression (9%), and anxiety (16%).

Conclusion: Awake oral behaviors were positively associated with orofacial pain, but only under the condition of a strong belief of the patients in causal attribution of these behaviors to the jaw pain complaint. No such association was present in case of a low causal attribution belief. It appeared that, within this patient cohort, the relationship between causal attribution belief and self-reported oral behaviors was (in part) the result of shared psychologic risk factors.

Within the orofacial pain discipline, the most common group of afflictions is temporomandibular disorders (TMD). The pathologic and functional disorders included in this condition closely resemble those that are seen in the orthopedic medicine branch of the medical profession, so it would be expected that the same principles of orthopedic diagnosis and treatment are applied. Traditional orthopedic therapy relies on a "Two Pathway" approach involving conservative and/or surgical treatments. However, over the course of the 20th century, some members of the dental community have created another way of approaching these disorders- referred to in this paper as the "Third Pathway"-based on the assumption that signs and symptoms of TMD are due to a "bad" relationship between the mandible and skull, leading to a variety of irreversible occlusal or surgical corrective treatments. Since no other human joint is discussed in these terms within the orthopedic medicine communities, it has become progressively clear that the Third Pathway is a unique and artificial conceptual creation of the dental profession. However, many clinical studies have utilized the medically oriented conservative/surgical Two-Pathway model to diagnose and treat TMD within a biopsychosocial model of pain. These studies have shown that TMD comprise another domain of orthopedic illness that requires a medically oriented approach for good outcomes while avoiding the irreversible aspects of the Third Pathway. This review presents historical and current evidence that the Third Pathway is an example of unorthodox medicine that leads to unnecessary overtreatment and further proposes that it is time to abandon this approach as we move forward in the TMD field.

Entrustable professional activities (EPAs) are a curriculum development and learner assessment tool that ensure a trainee is able to safely translate the skills they have learned during residency into unsupervised clinical practice. Although EPAs are used extensively across various health professions worldwide, dentistry is just beginning to call for their development at both the predoctoral and postgraduate levels. Given the complex, multifactorial nature of orofacial pain disorders and the need for an interdisciplinary approach to management, the specialty of orofacial pain is well suited to embracing EPAs to ensure program graduates are prepared for practice. Therefore, 10 EPAs have been developed in a combined effort from program directors from every CODA-accredited postgraduate orofacial pain residency program.

Aims: To study the effect of platelet-rich plasma (PRP) injections on pain reduction in patients with temporomandibular joint osteoarthritis (TMJ OA).

Methods: The authors performed a comprehensive search of the MEDLINE, PubMed, and Web of Science databases to retrieve RCTs published up to July 2018. Pain outcomes (visual analog scale scores) were extracted to assess the effect of PRP injections on TMJ OA. All data analyses were conducted using RevMan 5.3.

Results: Six studies were included. According to the results of these trials, intra-articular injections of PRP were more effective than placebo for pain reduction (6 months postinjection: mean difference [MD] -2.82, 95% CI -3.39 to -2.25, P < .00001; 12 months postinjection: MD -3.29; 95% CI -4.07 to -2.52, P < .00001). Additionally, the comparison between PRP and hyaluronic acid injections showed a statistically significant difference in pain reduction in support of PRP (MD -0.81; 95% CI -1.22 to -0.40; P = .0001) at 12 months postinjection. All trials revealed a moderate risk of bias.

Conclusion: Based on current evidence, PRP injections may reduce pain more effectively than placebo injections in TMJ OA at 6 months (level of evidence: moderate) and 12 months (level of evidence: moderate) postinjection. This significant difference in pain reduction could also be seen when PRP was compared to hyaluronic acid at 12 months postinjection (level of evidence: low). It can be cautiously interpreted that PRP has a beneficial effect on the relief of TMJ OA pain. Large-scale, low-bias RCTs are needed to test whether PRP injection should be a routine treatment for patients with TMJ OA.

Aims: To identify the clinical characteristics of patients with primary and secondary burning mouth syndrome (BMS), to assess the effectiveness of pharmacotherapy in treating BMS, and to determine the clinical variables that may predict significant relief of clinical symptoms.

Methods: A retrospective chart review of patients who underwent clinical management for BMS in the Massachusetts General Hospital between January 2011 and December 2016 was carried out. Information regarding demographics, diagnostics, and therapeutic characteristics was extracted and analyzed.

Results: Of 112 BMS patients, 77 had primary BMS. Patients with primary and secondary BMS had similar clinical characteristics except when it came to the presence of at least one symptom of sensory discrepancy, which was more prevalent in primary BMS. Following pharmacologic intervention, 46.8% of the patients with primary BMS experienced significant relief in symptoms, and this therapy was associated with a lower level of pain, an onset of symptoms of less than 1 year, hyperlipidemia, absence of depression disorder, and nonconcurrent use of other neuropathic medications. In contrast, only 31.4% of patients with secondary BMS experienced significant relief in symptoms, and this was associated with the presence of anxiety disorder. Stepwise forward conditional logistic regression analysis suggested that nonconcurrent use of neuropathic medications was a predictor for significant relief of symptoms in patients with primary BMS. Likewise, the model suggested that presence of anxiety disorder was a predictor in patients with secondary BMS.

Conclusion: The prevalence of an associated sensory discrepancy was higher in primary BMS. Pharmacologic intervention provided significant relief for approximately half of the patients with primary BMS and nearly one-third of the patients with secondary BMS. Concurrent use of neuropathic medications was a negative predictor, and presence of anxiety disorder a positive predictor, of therapeutic response among patients with primary BMS and secondary BMS, respectively.

Aims: To evaluate the effectiveness of manual therapy in the treatment of myofascial pain related to temporomandibular disorders.

Methods: Randomized clinical trials were searched in the Cochrane Library, MEDLINE, Web of Science, Scopus, LILACS, and SciELO databases using the following keywords: temporomandibular joint disorders; craniomandibular disorders; myofascial pain syndromes; myofascial pain; exercise therapy; myofunctional therapy; physical therapy modalities; clinical trial; prospective studies; and longitudinal studies. Studies using the RDC/TMD and manual therapy for myofascial pain were included. All studies were evaluated using the Cochrane Risk of Bias tool.

Results: Five studies were included in the present review. Of 279 total patients, 156 were treated with manual therapy only or manual therapy with counseling. Manual therapy was efficient for pain relief in all studies evaluated; however, manual therapy was not better than counseling or botulinum toxin.

Conclusion: Manual therapy was better than no treatment in one study and better than counseling in another study; however, manual therapy combined with counseling was not statistically better than counseling alone, and manual therapy alone was not better than botulinum toxin. Manual therapy combined with home therapy was better than home therapy alone in one study. Further studies are required due to the inconclusive data and poor homogeneity found in this review.

Aims: To test for the possible antinociceptive effect of nifedipine in rodent models of acute and chronic neuropathic orofacial pain and the possible involvement of TRP- and NMDA-related processes in this effect.

Methods: Acute nociceptive behavior was induced by administering formalin, cinnamaldehyde, glutamate, capsaicin, or acidified saline to the upper lip or hypertonic saline to the cornea of Swiss mice. Acute nociceptive behavior was also induced by formalin injected into the TMJ or mustard oil injected into the masseter muscle of Wistar rats. The chronic pain model involved infraorbital nerve transection (IONX) in Wistar rats to induce mechanical hypersensitivity, which was assessed with von Frey hair stimulation of the upper lip. The effects of pretreatment with nifedipine or vehicle (control) were tested on the nociceptive behaviors. Docking experiments were also performed. Statistical analysis included one-way ANOVA followed by Tukey post hoc test and two-way ANOVA followed by Bonferroni post hoc test (statistical significance P < .05).

Results: Nifedipine produced significant antinociceptive effects in all of the acute nociceptive behaviors except that induced by capsaicin. The antinociceptive effects were attenuated by NMDA, TRPA1, or TRPM3 receptor antagonists. The IONX animals developed facial mechanical hypersensitivity, which was significantly reduced by nifedipine. The docking experiments suggested that nifedipine may interact with TRPM3 and NMDA receptors.

Conclusion: The present study has provided novel findings in a variety of acute and chronic orofacial pain models showing that nifedipine, a selective inhibitor of L-type Ca²⁺ channels, can suppress orofacial nociceptive behavior through NMDA, TRPA1, and TRPM3 receptor systems.