Journal of Oral & Facial Pain and Headache最新文献

Aims: To compare the clinical effectiveness of conventional double-puncture vs single-puncture type 2 arthrocentesis for management of temporomandibular joint (TMJ) disc displacement without reduction (DDWOR) after 3 years of follow-up.

Methods: A total of 26 patients with DDWOR were randomly and blindly allocated into two treatment groups (n = 13 each): group 1 = conventional double-puncture arthrocentesis; group 2 = single-puncture type 2 arthrocentesis. Data on gender, side of painful joint complaint, age (years), duration of joint pain (months), maximum interincisal distance (MID, mm), and pain intensity (self-reported with a 0-10 visual analog scale [VAS]) were collected. VAS scores and MID were measured before (baseline) and 3 years after (final) the arthrocentesis.

Results: Twenty-three patients completed the study (group 1, n = 11; group 2, n = 12). Both techniques resulted in significantly reduced VAS scores and increased MID (P = .001) after the 3 years of follow-up; however, there were no statistically significant differences between techniques (P > 0.05).

Conclusion: The two arthrocentesis methods tested were both effective in reducing VAS scores and increasing MID in patients with DDWOR.

Aims: (1) To summarize current knowledge on the prevalence, intensity, and descriptors of orofacial pain and snoring/obstructive sleep apnea (OSA) before and after head and neck cancer (HNC) treatment; and (2) to propose future directions for research.

Methods: The median prevalence for each condition was estimated from the most recent systematic reviews (SRs) and updated with new findings retrieved from the PubMed, Web of Science, Embase, and Cochrane databases up to December 2021.

Results: The prevalence of HNC pain seems relatively stable over time, with a median of 31% before treatment in three studies to a median of 39% at 1 month to 16 years after treatment in six studies. HNC pain intensity remains mild to moderate. There was a threefold increase in temporomandibular pain prevalence after surgery (median 7.25% before to 21.3% after). The data for snoring prevalence are unreliable. The OSA/HNC prevalence seems relatively stable over time, with a median of 72% before treatment in three studies to 77% after treatment in 14 studies.

Conclusion: With the exception of temporomandibular pain, the prevalence of HNC pain and OSA seems to be stable over time. Future studies should: (1) compare the trajectory of change over time according to each treatment; (2) compare individuals with HNC to healthy subjects; (3) use a standardized and comparable method of data collection; and (4) assess tolerance to oral or breathing devices, since HNC individuals may have mucosal sensitivity or pain.

Aims: To investigate the potential contributions of diastolic and systolic blood pressure (BP) and the circadian rhythm of BP to chronic migraine evolution.

Methods: This cross-sectional study included four groups of patients selected based on migraine frequency (high frequency ≥ 10 days per month and low frequency < 10) and on the presence of hypertension. Among-group and pairwise comparisons were carried out to investigate potential neurophysiologic differences in the cerebral vessel reactivity to a nitroglycerin test, in autonomic balance (tilting test), and BP circadian rhythm.

Results: A more marked decrease in cerebral blood flow velocity was observed in hypertensive high-frequency migraineurs compared to all other groups (P = .037). Moreover, a smaller decrease in vagal tone was recorded in the orthostatic position in hypertensive subjects, whether they were high- (P = .032) or low-frequency migraineurs (P = .014), with a consistently higher vagal to sympathetic tone ratio (P = .033). Finally, in nonhypertensive subjects, a higher but not significant prevalence of systolic nondippers was detected in high-frequency migraineurs (67%) compared to low-frequency subjects (25%; P = .099).

Conclusion: These findings suggest that hypertension may contribute to the chronic evolution of headache with mechanisms shared with migraine; ie, vascular tone alteration and autonomic dysregulation.

Aims: To systematically review the scientific literature for evidence concerning the clinical use of botulinum toxin (BTX) for the management of various temporomandibular disorders (TMDs).

Methods: A comprehensive literature search was conducted in the Medline, Web of Science, and Cochrane Library databases to find randomized clinical trials (RCT) published between 2000 and the end of April 2021 investigating the use of BTX to treat TMDs. The selected articles were reviewed and tabulated according to the PICO (patients/problem/population, intervention, comparison, outcome) format.

Results: A total of 24 RCTs were selected. Nine articles used BTX injections to treat myofascial pain, 4 to treat temporomandibular joint (TMJ) articular TMDs, 8 for the management of bruxism, and 3 to treat masseter hypertrophy. A total of 411 patients were treated by injection of BTX. Wide variability was found in the methods of injection and in the doses injected. Many trials concluded superiority of BTX injections over placebo for reducing TMD pain levels and improving maximum mouth opening; however, this was not universal.

Conclusion: There is good scientific evidence to support the use of BTX injections for treatment of masseter hypertrophy and equivocal evidence for myogenous TMDs, but very little for TMJ articular disorders. Studies with improved methodologic design are needed to gain better insight into the utility and effectiveness of BTX injections for treating both myogenous and TMJ articular TMDs and to establish suitable protocols for treating different TMDs.

Aims: To evaluate the efficacy and safety of melatonin for migraine prophylaxis in adults.

Methods: After a comprehensive literature search in the MEDLINE, Cochrane Database, and International Clinical Trial Registry Platform databases, reviewers extracted data from three relevant articles. PRISMA guidelines were followed in the selection, analysis, and reporting of the findings. Quality assessment was performed using the Cochrane risk of bias assessment tool. A random-effects model was used to estimate the effect size, and meta-regression was performed for variables with a likely influence on effect size. Subgroup analysis was performed based on the comparison used in the included studies.

Results: Melatonin therapy in migraine was associated with a significantly higher responder rate when compared to both placebo and standard therapy (OR = 1.84; 95% CI: 1.08 to 3.14; P = .03). The results of the meta-analyses indicated that melatonin can achieve a significant reduction in frequency of migraine attacks (MD = 1.00; 95% CI: 0.02 to 1.98; P = .04), migraine attack duration (MD = 5.02; 95% CI: 0. 91 to 9.13; P = .02), use of analgesics (MD = 1.43; 95% CI: 0.38 to 2.48; P = .008), and migraine severity (MD = 1.93; 95% CI: 1.23 to 2.63; P < .0001) over placebo, but had no significant effects in comparison to amitriptyline or valproate. There was no significant difference in the occurrence of common adverse drug reactions, such as drowsiness and fatigue, between the melatonin group and the comparison groups.

Conclusions: Melatonin showed a beneficial prophylactic role in migraine, with a better responder rate in comparison to placebo in reducing migraine severity, mean attack duration, mean attack frequency, and analgesic use, but did not show significant effects in comparison to amitriptyline or valproate.

Aims: To understand, from the patient perspective, the meaning of living with trigeminal neuralgia (TN) and what the patient-desired outcomes of treatment are.

Methods: A qualitative study involving focus group work with 14 participants with a diagnosis of TN was conducted. The discussions were recorded and transcribed verbatim and analyzed using framework analysis.

Results: Four themes and 14 subthemes were identified. Theme 1 reflects the uncertainty about TN etiology and prognosis; theme 2 includes descriptions of the mental, social, and physical impacts of TN that contrast with coping mechanisms developed over time; theme 3 reflects participants' views of what a successful treatment means and the specific outcomes they expect following treatment, as well as patient willingness to self-manage their conditions while supported; and theme 4 highlights the importance of appropriate and timely access to health care and the importance of peer support.

Conclusion: This study confirms the need to move beyond the biologic models of disease to patient-centered care and research approaches.

Aims: (1) To determine the dose-response relationship of therapeutic ultrasound for TMD-related pain in the masseter muscle among four doses comprised of two intensities (0.4 W/cm² and 0.8 W/cm²) and two duty cycles (50% and 100%); and (2) to determine if therapeutic ultrasound applied to the masseter muscle would elicit a segmental effect on the ipsilateral temporalis muscle.

Methods: A total of 28 adult women with bilateral myalgia were randomly allocated to one of the four intervention doses. Therapeutic ultrasound was applied on each side of the masseter sequentially for 5 minutes. The following outcomes were measured before and immediately after each intervention: self-reported pain score, pressure pain thresholds for the masseter and temporalis muscles, and intraoral temperature adjacent to the treated masseter.

Results: Self-reported pain scores showed neither significant main effects nor significant interaction among the intensity or duty cycle doses (all P > .05). The change in the pressure pain threshold of the masseter showed a significant interaction (P = .02) attributed to the 0.4 W/cm² and 100% duty cycle dose. Intraoral temperature was significantly increased and associated with the duty cycle (P = .01). A significant segmental effect of the pressure pain threshold of the temporalis was found for intensity (P = .01).

Conclusion: There was an increase in the pressure pain threshold of the painful masticatory muscles and an increase in intraoral temperature adjacent to the treated area immediately after the use of ultrasound at 0.4 W/cm² with a 100% duty cycle.

Aims: To determine whether there is an association between gene polymorphisms and patients with painful temporomandibular joint (TMJ) clicking when compared to patients with painless TMJ clicking and a healthy control group.

Methods: In this pilot study, the genotypic and allelic frequencies of candidate single-nucleotide polymorphisms (SNP) were compared among 60 individuals divided equally into three groups: patients with painful TMJ clicking (n = 20); patients with painless TMJ clicking (n = 20); and healthy controls (n = 20). Participants were genotyped for the following SNPs using real-time polymerase chain reaction: MMP1 -16071G/2G, COMT Val158Met, TNFα -308, IL1β +3954, IL6 -174, and IL10 -1082. The pressure pain threshold (PPT) of the TMJ was also assessed. All variables were compared among groups.

Results: Patients with painful TMJ clicking had a significant association and a higher frequency of MMP1 -16071G/2G (P = .042), COMT Val158Met (P = .030), and TNFα -308 (P = .016) when compared to the other groups, as well as a lower frequency of IL10 -1082. Considering PPT values, a progressively lower mean was found in individuals with painful TMJ clicking, followed sequentially by the painless TMJ clicking and the control groups.

Conclusion: This pilot study showed that patients with painful TMJ clicking had a significant association with mutant genotypes related to degradation of extracellular matrix components, pain, proinflammation, and anti-inflammation. Furthermore, these patients also had significantly lower TMJ PPT values in all comparisons.

Aims: To compare the efficacy of platelet-rich plasma (PRP) injection vs dry needling (DN) for management of trigger points in the masseter muscle in myofascial pain syndrome (MPS) patients.

Methods: This randomized controlled trial included 30 clinically confirmed cases of myofascial trigger points (MTrPs) in the masseter muscle who were randomly and equally (1:1) assigned to the test (PRP) and control (DN) groups. Both groups were evaluated for pain (visual analog scale [VAS]), range of functional movements, need for pain medication, patient satisfaction (Likert scale), and sleep (VAS) at baseline and 2-week, 1-month, and 3-month follow-ups. VAS pain and Likert score were also obtained at 6-month intervals.

Results: The use of PRP solution in MTrPs in MPS patients had a better effect on pain and patient satisfaction compared to DN.

Conclusion: PRP appears to be a more effective treatment modality compared to DN in the management of MTrPs in MPS patients.

Aims: To investigate expectations and experiences of internet-based therapy (IBT) in adolescents with temporomandibular disorder (TMD) pain.

Methods: Seven adolescents were strategically selected for this study. All patients had received IBT for their TMD pain in a previous randomized controlled trial. One-on-one interviews were conducted in a nonclinical setting. The interviews were semi-structured, following an interview guide with six domains. The recorded interviews were transcribed, and a qualitative inductive content analysis was then performed.

Results: Content analysis indicated that the expectations of the adolescents and their experiences of IBT as a treatment for TMD pain can be understood in light of three main categories: (1) To become better; (2) An ambivalent experience; and (3) A personal challenge. The adolescents expressed expectations of less TMD pain after treatment, but also of improvement in general well-being and everyday life. Although their experiences of IBT varied, adolescents described having mixed feelings about treatment and feeling that it was personally challenging.

Conclusion: Gained understanding of expectations and experiences is a necessary basis for revising the IBT program to meet the demands of adolescents and to improve treatment adherence. Furthermore, the content of the three categories clarifies the values of adolescents, and this understanding can in turn contribute to the development of new patient-centered treatment programs.