Journal of Oral & Facial Pain and Headache最新文献

Background: Temporomandibular joint osteoarthritis (TMJOA) is a pathological condition marked by subchondral bone remodeling. Osteoarthritis can lead to TMJ pain, nevertheless, the relationship between nociceptive mechanisms and subchondral bone in TMJOA still unclear.

Methods: In the present investigation, a rat TMJOA model was established via intra-articular administration of monosodium iodoacetate (MIA). Following the induction of MIA-triggered TMJOA, tissue samples were collected from the TMJ condyle, trigeminal system components including ganglion (TG) and nucleus caudalis (TNC), and hippocampal formation. Micro-computed tomography (Micro-CT) was employed to evaluate subchondral bone degeneration in the TMJ, while tartrate-resistant acid phosphatase (TRAP) staining was conducted to measure the activity of osteoclasts in the subchondral bone. Furthermore, immunofluorescence (IF) staining was performed to detect the expression of calcitonin gene related peptide (CGRP) in the TMJ subchondral bone. Afterwards, immunohistochemistry (IHC) was used to detect the expression of CGRP in the TG, TNC and hippocampus tissues. The experimental results were expressed as mean ± Standard Error of the Mean (SEM) values and two-way Analysis of Variance (ANOVA) with Student-Newman-Keuls post hoc testing was employed for statistical comparisons, adopting a significance threshold of p < 0.05.

Results: Compared with the control group, Micro-CT results revealed progressive condylar degeneration over time. Consistently, MIA-induced TMJOA rats demonstrated a pronounced accumulation of TRAP-positive osteoclasts in the subchondral bone. The expression of CGRP in the TMJ subchondral bone, TG, TNC and hippocampus tissues was also obviously increased in MIA-induced TMJOA rats.

Conclusions: MIA-induced rat TMJOA pain could be attributed to the augmented exprssion of CGRP in the TMJ subchondral bone, TG, TNC and hippocampus tissues. An elevated level of CGRP stimulated nociception which was implicated in the development of peripheral and central sensitization in TMJOA pain.

Burning Mouth Syndrome (BMS) is a complex, chronic neuropathic orofacial pain disorder characterized by a persistent burning or dysesthetic sensation in the oral cavity without an identifiable organic cause. Accurate diagnosis and effective management of BMS pose significant challenges to clinicians, necessitating a comprehensive and multidisciplinary approach. This review delves into BMS's pathogenesis and diagnostic algorithms, highlighting the latest advancements in understanding the underlying mechanisms and diagnostic strategies. Utilizing specific diagnostic algorithms assists clinicians in assessing and selecting appropriate treatment strategies, thereby minimizing diagnostic delays. These algorithms are crucial for excluding other causes of oral burning by focusing on symptomatology, patient history, and clinical examination. They involve ruling out oral infections, nutritional deficiencies, hormonal imbalances, autoimmune disorders, and medication side effects as potential causative factors. Supporting the diagnostic process, additional tests such as blood tests (including a thrombophilic panel and Neuron-Specific Enolase), neurosensory assessments, neuroradiological examinations, and evaluations of psychological profiles and cognitive function may be employed. Neurosensory assessments and neuroradiological examinations can provide insights into possible neuropathic causes, while psychological and cognitive assessments can identify any psychological factors and the extent to which cognitive decline may contribute to the condition. A comprehensive diagnostic approach not only aids in the accurate identification of BMS but also helps differentiate it from other oral conditions with similar presentations. This thorough evaluation is essential for developing a tailored treatment plan that addresses each patient's specific needs, ultimately improving clinical outcomes and enhancing the quality of life for individuals suffering from BMS.

Background: Polypharmacy is common in headache medicine. This project uses DrugBank and Food and Drug Administration's (FDA) Adverse Event Reporting System (FAERS) to determine the likelihood of a theoretical and empirically reported interaction between a given number of headache abortive and preventive medications.

Methods: All headache medications referenced in "The American Headache Society Position Statement on Integrating New Migraine Treatments into Clinical Practice" and Szperka's "Migraine care in the era of COVID-19: clinical pearls and plea to insurers" were included. All possible combinations of up to three abortives and preventatives were screened for drug-drug interactions through searches in DrugBank and FAERS. If at least one drug-drug interaction was listed, then it was included in our analysis. The percentage of combinations containing an interaction was then compared across the two databases.

Results: Of the 38 abortives and 23 preventives included, once more than 3 drugs are used in any combination, a drug-drug interaction was >99% likely, per DrugBank. However, per FAERS, the reported interaction was 39% to 60% likely once 3 or 4 drugs are used in any combination. In FAERS, the likelihood of interaction rised most dramatically once 3 or more drugs are used.

Conclusions: Theoretical interactions, based on DrugBank, maybe overstated when compared to actual observed interactions in FAERS. Future direction is needed delving into the types of interactions recorded in each database.

Background: The temporomandibular joints (TMJs) are essential for daily function and must operate in synergy to ensure optimal jaw movement. Real-time magnetic resonance imaging (RT-MRI) enables direct visualization of mandibular condyle motion; however, its application for symmetry assessment remains insufficiently studied. This exploratory study focuses on the consistency of condylar motion symmetry assessments, including visual evaluation of raw image series and 3D trajectories calculated from RT-MRI, as well as automatically extracted quantitative parameters. Given that well-correlated parameters are more likely to be reliable, this work aims to identify optimal methods for assessing symmetry of the condylar pathway using RT-MRI.

Methods: The study includes 18 volunteers. A 2D real-time fast low angle shot (FLASH) sequence was used to acquire two sagittal and one axial planes. For quantitative analysis, mandibular condyles were segmented using a neural network. The extracted symmetry parameters were maximum displacement difference and maximum difference of amplitudes for spatial assessments, and latency and velocity peak delay for temporal evaluations. 3D trajectories were automatically generated using a previously validated method. Qualitative scoring of raw image series was conducted by two experts, and the 3D trajectories were evaluated by a dental surgeon. The agreement between qualitative scores was assessed using Cohen's kappa test, while correlations among quantitative parameters were analyzed using Spearman's test.

Results: Results showed higher agreement in the axial plane (intra-observer κ = 0.68; inter-observer κ = 0.44) than in the sagittal plane (κ = 0.51 and 0.20, respectively). Inter-planar correlations were weak to moderate (ρ = 0.21-0.48), with latency showing the strongest correlation.

Conclusions: For our dataset, latency emerged as the most robust temporal parameter. Additionally, motion analysis in the axial plane demonstrated greater consistency in both quantitative measurements and visual scoring. These findings suggest that the axial plane may be preferable for assessing motion symmetry in RT-MRI.

Clinical trial registration: "METHODO" ClinicalTrials.gov Identifier: NCT02887053, approval: CPP EST-III, 08.10.01; "EDEN" ClinicalTrials.gov Identifier: NCT05218460, approval: CPP SUD-EST IV, 26.07.21.

Background: Temporomandibular disorders (TMDs) and bruxism are the most common disorders affecting the oral and maxillofacial system. Patients with TMDs or bruxism frequently suffer from chronic head and neck pains (HNPs); however, the etiology between TMDs/bruxism and HNPs remains unclear.

Methods: We explore the association between TMDs/bruxism and HNPs with a bidirectional Mendelian randomization (MR) method with public online genome-wide association study (GWAS) data from the Integrative Epidemiology Unit (IEU) open GWAS project, FinnGen consortium and GWAS Catalog website. Inverse variance weighted (IVW) and other four statistical approaches were employed to investigate the associations. Furthermore, Cochran's Q, Mendelian randomization (MR)-Egger intercept test, MR pleiotropy residual sum and outlier test, and leave-one-out tests were conducted as sensitivity analyses to ensure the robustness of results. Multivariable MR (MVMR) analyses were adopted to validate the significant effects observed in the two-sample MR analyses while adjusting for potential confounders.

Results: Overall, our analysis revealed a reciprocal significant association between TMDs and neck/shoulder pain (NSP) in both forward (p = 0.023) and reverse (p = 0.004) analyses, which were corroborated by subsequent MVMR analyses adjusted for anxiety, body mass index (BMI) and sleeplessness. All results were confirmed robust under current sensitivity analysis.

Conclusions: These findings suggest a potential causal association between TMDs and HNPs. The bidirectional relationship highlight the importance of preventing TMDs and HNPs as a health strategy for mitigating each other's risks.

Background: Chronic orofacial pain (COFP) is a complex condition that requires multidisciplinary management grounded in the biopsychosocial model. This study examined the associations between temporomandibular disorders (TMD) and headache symptoms and psychological factors within a university-based multidisciplinary care setting, providing insight into the integration of mental health in COFP management.

Methods: A retrospective review of 162 patient records from the University of Alberta Multidisciplinary Orofacial Pain Clinic (2020-2023) was conducted. Psychological assessments included the Adverse Childhood Experiences (ACE) scale, Pain Catastrophizing Scale (PCS) and Injustice Experience Questionnaire (IEQ). Logistic regression was used to evaluate associations between psychological factors and pain severity.

Results: The cohort (aged 13-93) was predominantly female (84.0%). Fifteen percent declined psychological measures. Significant associations were observed between PCS (p = 0.036) and IEQ (p = 0.005) scores and reported pain severity. Moderate-to-high PCS scores were associated with a 3.67-fold increase in the odds of moderate to severe TMD symptoms (Odds Ratio (OR): 3.67, 95% Confidence Interval (CI): 1.09-12.35), while high PCS scores predicted severe headaches (OR: 3.91, 95% CI: 1.50-10.17, p = 0.005). Elevated IEQ scores were similarly associated with increased odds of severe headaches (OR: 2.76, 95% CI: 1.08-7.05, p = 0.034).

Conclusions: Psychological factors such as pain catastrophizing and perceived injustice are strongly associated with symptom severity of TMD and headache symptoms in COFP. These findings underscore the importance of integrating targeted psychological assessments into multidisciplinary care. Further research should explore barriers to implementation and advance biopsychosocial approaches to improve outcomes for patients with COFP.

Neuropathic orofacial pain (NOP), which includes conditions such as trigeminal neuralgia, burning mouth syndrome, and temporomandibular disorders, poses a significant clinical challenge. This difficulty arises primarily from its diverse pathophysiological mechanisms and the limited efficacy of conventional treatments. This review highlights recent progress in understanding the mechanisms underlying NOP while also evaluating the potential of Traditional Chinese Medicine (TCM), with a particular focus on acupuncture, as an integrative therapeutic approach. Emerging clinical studies suggest that acupuncture holds significant potential in alleviating NOP symptoms. Acupuncture effectively manages NOP by combining local (e.g., TE21 (Erheliao), ST7 (Xiaguan), SI18 (Quanliao)) and distal (e.g., LI4 (Hegu), PC6 (Neiguan)) acupoints. Local points relieve pain and improve circulation, while distal points enhance systemic neuromodulation. This integrative approach optimizes pain regulation and neuroinflammatory control, making acupuncture a promising NOP treatment. Various acupuncture techniques and point stimulation methods, whether used independently or as complementary therapies, have demonstrated both safety and efficacy, ranging from traditional practices to more modern innovations. However, the precise mechanisms by which acupuncture exerts its effects in managing NOP remain unclear and warrant further exploration. While interest in TCM and acupuncture for musculoskeletal pain has grown considerably, the evidence specifically addressing NOP remains limited and fragmented. Currently, there are no established protocols or clear clinical guidelines for the use of acupuncture in the treatment of NOP. To bridge this gap, future research should adopt a multidisciplinary approach and implement rigorous experimental designs to deepen our understanding of acupuncture's underlying mechanisms. Such efforts could provide the foundation for developing standardized protocols, ultimately enhancing acupuncture's utility as an effective therapeutic option for individuals coping with NOP.

Background: Temporomandibular disorders (TMD) are common, particularly in females of reproductive age, but it remains unclear if TMD and female reproductive traits directly influence each other. Previous studies have suggested links between reproductive factors, such as the menstrual cycle and menopause, and TMD, yet any causal link is unconfirmed. This study seeks to delineate the reciprocal causal interplay between female reproductive traits and TMD.

Methods: A bidirectional Mendelian randomization (MR) approach was applied to assess five reproductive traits-age at menarche, first sexual intercourse, first birth, last birth, and menopause-considering TMD as the outcome in one analysis and the exposure in the reverse. Statistical methods, including the inverse variance-weighted method, MR Egger, MR Pleiotropy Residual Sum and Outlier (MR-PRESSO), Cochran's Q test, and leave-one-out analyses, were used to examine pleiotropy and heterogeneity.

Results: Later age at first sexual intercourse (odds ratio (OR) = 0.51, 95% confidence intervals (CI) 0.37-0.71, p = 6.46 × 10^-5), first birth (OR = 0.86, 95% CI 0.78-0.95, p = 0.003), and last birth (OR = 0.37, 95% CI 0.17-0.78, p = 0.009) were identified to be protective against TMD. No significant associations emerged for age at menarche or menopause. However, TMD onset may contribute to delayed menarche (Beta = 0.04, 95% CI 0.01-0.06, p = 0.035) without affecting other reproductive traits.

Conclusions: Genetically determined later timing of first sexual intercourse, first birth, and last birth may protect against TMD, while TMD onset may delay menarche, suggesting a bidirectional relationship between reproductive timing and TMD.

Background: This study aimed to evaluate and compare the effects of connective tissue massage (CTM) and manual lymphatic drainage (MLD) on neck pain, disability, quality of life, and pain thresholds in patients with migraine.

Methods: A total of 40 migraine patients were randomly assigned to either the CTM or MLD group. Quality of life was assessed using the Short Form-36 (SF-36); pain sensitivity and perception were measured using an algometer, and neck pain was evaluated using the Neck Pain and Disability Scale (NPAD). Patients tracked their headaches in a pain diary for 15 days before and after the intervention. Both groups received 45 min of treatment twice a week for six weeks.

Results: After treatment, the pain threshold increased significantly, whereas total medication use and the number of pain days decreased in both groups. However, while CTM led to a greater reduction in NPAD scores (p < 0.001), MLD was more effective in improving overall pain management and enhancing quality of life (p = 0.017).

Conclusions: These findings suggest that CTM and MLD can help migraine patients, with MLD showing a stronger effect on pain relief and well-being, whereas CTM being more effective in reducing neck pain and disability.

Clinical trial registration: ClinicalTrials.gov/NCT05976399.

Background: In everyday clinical practice, the screening of specific genes for awake bruxism (AB) is not a sustainable and feasible practice; most of the time, the only information that clinicians can rely on is investigating the family history of bruxism. Nevertheless, little is known about the relationship between the reported history and AB frequency. The aim of the present paper is to assess the existence of any differences in the frequency of self-reported AB behaviors between healthy young individuals with and without a positive report of family history of bruxism.

Methods: Participants were recruited within the community of the University of Siena by advertising the possibility of taking part in the investigation through the academic website and mail. All the participants performed a seven-day monitoring of the frequency of self-reported AB via the ecological momentary assessment (EMA). Moreover, for the assessment of bruxism family history, participants were asked to fill out a short questionnaire taken from the Standardized Tool for the Assessment of Bruxism (STAB).

Results: The final sample was composed of 117 individuals (32 males and 85 females, mean age 22.3 ± 2.3). Of the total amount of participants, 48.7% reported a positive family history of bruxism. The Mann-Whitney U test showed a statistically significant difference in the reported frequency of all AB behaviors (i.e., teeth contact, mandible bracing, teeth clenching, teeth grinding) between the two groups (p < 0.05). Conversely, no significant difference in the frequency of AB behaviors was present between individuals with a positive report of family history in first-degree relatives compared to second-degree relatives (p > 0.05).

Conclusions: Based on these findings, clinicians are recommended to not underestimate a positive family history of bruxism, as it can be an indicator of an ongoing AB.