Journal of Oral & Facial Pain and Headache最新文献

The occipital nerve block involves the injection of a local anesthetic and possibly a corticosteroid near the occipital nerves at the base of the skull and aims at providing relief from chronic headaches by temporarily numbing or reducing inflammation around the occipital nerves. It has proven to be efficacious in treating chronic headaches, especially those that are refractory to medication; it is both diagnostic and therapeutic with symptom abatement from weeks to months. Occipital nerve blocks can be utilized alone or with standard-of-care therapy for various other headache conditions, such as cluster headaches, episodic headaches or chronic migraines. This review aims to provide an analysis of the world literature on the role of occipital nerve block (ONBs) in the treatment of headaches, including the procedure, efficacy and safety of ONB, and to elucidate the current understanding of ONBs. ONBs demonstrate diagnostic and therapeutic benefits with symptom abatement for weeks to months. Outcomes are generally well tolerated, with minimal side effects associated mainly with the injection process, including numbness, tingling and local discomfort. Greater occipital nerve blocks are an efficacious procedure to treat chronic headache symptoms, and future research should include additional longitudinal follow-up results and interactions of ONBs with other headache treatments.

Osteoma is a rare benign tumor primarily affecting the craniofacial skeleton. Coronary osteomas in the coronoid process are uncommon and asymptomatic until they affect mandibular function. This report presents a case of coronoid osteoma with its diagnosis, treatment and surgical approach. Osteoma is a benign tumor composed of well-differentiated bone tissue, with different origins: central, peripheral and extraskeletal. Mandibular coronoid osteomas are rare but important to consider in symptomatic patients. Mandibular osteoma frequency ranges from 22.8% to 81.3%, with a reported frequency of 15.28% in the maxilla. A 63-year-old female presented with facial deformation, limited mouth opening, and associated symptoms, such as intermittent dizziness and nasal congestion. Imaging revealed a well-defined radiopaque lesion in the coronoid process, displacing surrounding structures. Diagnosis confirmed coronoid osteoma. Surgical removal resulted in satisfactory recovery and improved mouth opening. Coronoid osteomas are rare, with limited reported cases. Osteomas are more prevalent in the mandible body than in other locations. Radiographic imaging and histopathological examination are crucial for diagnosis. Radiographic and histological features distinguish osteomas from other lesions. Etiology remains uncertain, with trauma, temporal muscle hyperactivity, or post-traumatic fibrosis as potential causes. Differential diagnosis involves distinguishing osteoma from osteochondroma, osteoblastoma, exostoses and osteosarcoma. Continued research and reporting are necessary to enhance understanding and management of this rare condition.

In orofacial pain patients, pain-related temporomandibular disorders (TMD) and neuropathic pain (NP) can both be present. The aim of this cross-sectional study was to examine whether in patients with orofacial pain, associations can be found between (subdiagnoses of) pain-related TMD and NP. Participants were asked to fill in the questionnaires of the Diagnostic Criteria for TMD (DC/TMD) and a screening questionnaire for NP, the Douleur Neuropathique 4 (DN4). Complete data sets were collected from 355 participants with an orofacial pain complaint. First, univariate analyses were used to pre-screen the independent variables. Subsequently, multivariate binary logistic regression analysis was used to further assess the association between the independent variables, which were significant in the univariate analyses, and the dependent variable NP. From all 355 participants, 274 (77.2%) had pain-related TMD. 72 participants (20.3%) had a DN4 score ≥4, suggesting the presence of NP. A DN4 score ≥4 occurred in 62 (22.6%) of the 274 cases with pain-related TMD. In the univariate analyses, NP was found to be significantly associated with the presence of pain-related TMD (χ² = 4.088, p = 0.043), myalgia (χ² = 6.916, p = 0.009), and headache attributed to TMD (χ² = 13.366, p < 0.001). In the multivariate analysis, NP was only significantly associated with headache attributed to TMD (Odds Ratio = 2.37, 95% Confidence Interval: 1.30 to 4.34, p = 0.005). NP characteristics are associated with headache attributed to TMD. The results stress the need for including a NP assessment in diagnostic protocols for pain-related TMD.

There is a lack of objective indicators to evaluate the treatment effect of burning mouth syndrome, a neuropathic pain of unknown causes. Therefore, this study aimed to evaluate potential salivary biomarkers by analyzing saliva before and after clonazepam treatment in patients with burning mouth syndrome. Saliva was collected from 23 patients with burning mouth syndrome before and 4 weeks after the topical administration of clonazepam. Patients were classified as responders (pain relief of 50% or more, n = 10) or non-responders (n = 13) based on pain relief after treatment. Clinical examination data of responders and non-responders were compared using Mann-Whitney U test and Fisher's exact test. Changes in the level of salivary biomarkers (salivary α-amylase, cortisol, calmodulin, α-enolase and interleukin-18) were evaluated before and after treatment using Wilcoxon signed-rank sum test, and their association with treatment response was examined using Fisher's exact test. The salivary biomarker levels showed no significant differences between the responders and non-responders. However, the change in salivary α-amylase activity after treatment revealed a significant difference between the two groups (p = 0.039). Although not all patients showed the same pattern, there was a difference in the alteration of salivary α-amylase activity before and after treatment between responders and non-responders. Further study is required to clarify whether there is a causal relationship between salivary α-amylase activity and treatment response. However, considering that salivary α-amylase activity is related to orofacial pain and psychological stress, this suggests the potential use of salivary α-amylase as a biomarker for burning mouth syndrome.

To compare the effects of home-based rehabilitation and occlusal splints or centre-based rehabilitation in patients with temporomandibular joint disorders (TMD). A systematic review and meta-analysis. PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov electronic databases were consulted from inception to August 2023, searching for randomized controlled trials (RCTs) that compared home-based rehabilitation for TMD with splints or centre-based rehabilitation. The risk of bias was assessed using the Cochrane risk of bias tool. 23 RCTs (1402 participants, three comparator interventions) were identified. Very low-certainty evidence suggested there are no clinically difference between home-based rehabilitation and splints in pain intensity (mean difference (MD) 7.75, 95% confidence interval (CI): 2.17 to 13.32), maximal mouth opening (MMO) (MD 1.83, 95% CI: -0.27 to 3.93) at short and long-term follow-up, in sleep quality (MD: 1.67, 95% CI: -2.04 to 3.56) and quality of life (psychological: MD 0.94, 95% CI: -4.43 to 6.31; general: MD -1.18, 95% CI: -5.72 to 5.37) at short-term follow-up. Low-certainty evidence suggested that home-based rehabilitation plus manual therapy is more effective for TMD treatment compared to home-based rehabilitation at short-term follow-up (pain intensity: MD: 14.93, 95% CI: 7.72 to 21.93; MMO: MD -2.93, 95% CI: -5.3 to -0.54; sleep quality: MD 1.4, 95% CI: 0.09 to 2.71). Compared with home-based rehabilitation, Transcutaneous Electrical Nerve Stimulation (TENS) and Low-Level Laser Therapy (LLLT) was superior in pain relief at short-term follow-up. Low and very low-certainty evidence suggests home-based rehabilitation could be considered a low-cost, beneficial therapy alternative for TMD patients to relieve symptoms.

The aim was to describe the comorbidity and impact of fibromyalgia and/or migraine on patients with cluster headache. Comorbid diseases can exacerbate the physical and psychological burden experienced by patients. The comorbidities of cluster headache have been scarcely investigated, with the exception of migraine, which is well-known to coexist with cluster headache. In contrast, the comorbidity of migraine and fibromyalgia has been well investigated and firmly established. An internet survey was uploaded to the webpage of a cluster headache patient association. The survey collected sociodemographic and clinical data, and patients completed questionnaires that assessed depression, sleep quality, health-related quality of life, and health care resource utilization (HCRU) over the preceding six months. Differences in total depression, sleep quality, and health-related quality of life scores among the groups were analyzed with the Kruskal-Wallis test, and differences in HCRU were analyzed with the chi-square test. Ninety-one patients with cluster headache participated in the survey; 39 (42.9%) experienced only cluster headache, 15 (16.5%) experienced cluster headache and migraine, 10 (11%) experienced cluster headache and fibromyalgia, and 27 (29.7%) experienced cluster headache with comorbid fibromyalgia and migraine. Moderate depression scores and positive suicidal ideation were found across all subgroups. Sleep quality and health-related quality of life were consistently poor across the different subgroups, with the cluster headache with comorbid fibromyalgia and migraine subgroup showing significantly lower scores. Heavy use of health care resources was observed across all subgroups, with no notable differences among them. The comorbidity of cluster headache with fibromyalgia and/or migraine does not seem to be infrequent. This comorbidity substantially increases the psychosocial burden experienced by patients and decreases their overall quality of life.

The objective of this study was to perform a systematic review of the literature to determine the overall efficacy of low-level laser therapy (LLLT) in managing burning mouth syndrome (BMS). A literature search was conducted through PubMed, Scopus, Web of Sciences, and Cochrane Central Register of Controlled Trials from their inception up to 28 March 2023. The search terms were defined by combining (Mesh Terms OR Key Words) from "Burning mouth syndrome" AND (Mesh Terms OR Key Words) from "Laser therapy". Methodological quality assessment was performed using the Joanna Briggs Institute Critical appraisal tool, attributing scores from 1 to 13 to the selected studies. Literature search, study selection, and data extraction were carried out by two authors. Differences on issues were resolved by a third author, if required. The primary investigated outcome was reducing BMS pain. A total of 21 articles met the inclusion criteria. After assessing full-text articles for eligibility, 12 articles were excluded. Consequently, 9 articles were retained. A low score of bias was calculated in 66% of the included studies. Compared to placebo, a significant reduction in pain or burning sensation was reported in 5 studies. This significant reduction was still observed in the laser group at the two- and four-month follow-ups in 2 studies. LLLT could be beneficial for patients suffering from BMS. In order to get strong evidence for placebo use, future studies with standardized methodology and outcomes are required.

This case series aimed to assess the treatment outcomes of onabotulinum toxin A (BTX-A) in patients with refractory posttraumatic trigeminal neuropathic pain (PTNP) and to conduct a narrative review of the evidence for BTX-A in PTNP. Thirteen patients were treated with BTX-A infiltrations. Patient demographic and pain characteristics, BTX-A administration, and treatment outcomes were retrospectively analyzed. Papers retrieved after a literature search of articles on PTNP treatment using BTX-A were reviewed. Six patients reported an improvement in pain 3 months after the initial BTX-A injection, with 4 patients reporting a 50% reduction. Two patients achieved an 80% reduction in pain score over 3 years of BTX-A therapy. Three patients reported temporary ipsilateral facial muscle weakness. The literature review revealed five case reports on the use of BTX-A in PTNP patients that reported similar effectiveness to the present cohort study. BTX-A may be a potential treatment modality for refractory PTNP, thus reducing the need for polypharmacy. Multiple intraoral BTX-A injections administered over the painful sites are well tolerated, safe and easily practiced. High-quality studies are required to evaluate the long-term therapeutic efficacy and side effects of BTX-A therapy.

Pain assessment in trigeminal neuralgia (TN) mouse models is essential for exploring its pathophysiology and developing effective analgesics. However, pain assessment methods for TN mouse models have not been widely studied, resulting in a critical gap in our understanding of TN. With the rapid advancement of deep learning, numerous pain assessment methods based on deep learning have emerged. Nonetheless, these methods have some limitations: (1) insufficiently objective supervision signals for training, (2) failure to account for the dynamic behavioral characteristics of mouse models in the constructed models and (3) inadequate generalization ability of the models. In this study, we initially constructed an objective pain grading dataset as the ground truth for model training, which remedy the limitations of prior studies that relied on subjective evaluation as supervisory signals. Then we proposed a novel deep neural network, named trigeminal neuralgia pain assessment network (TNPAN), which fuses the static texture characteristics and dynamic behavioral characteristics of mouse facial expressions. The promising experimental results demonstrate that TNPAN exhibits exceptional accuracy and generalization capability in pain assessment.

To compare pain characteristics, impact of pain and characteristics of patients with painful root-filled teeth with and without signs of inflammatory dental disease. This cross-sectional study was performed in the Public Dental Health services, Region Örebro County, Sweden. Adult patients with ≥1 root-filled tooth identified at their regular check-up were included and assigned to one of two groups; those with ≥1 sign of inflammatory dental disease (DD+) and those without any such sign (DD-). Patients/teeth were compared regarding pain characteristics (intensity, frequency, duration, quality and provoking factors), impact of pain (medication intake, impact on life) and patient characteristics as background factors (general health, other bodily and orofacial pain). Statistics included descriptive data (frequency tables) and group comparisons (Chi-square, Fisher's Exact and Mann-Whitney U-tests). The DD+ group included 27 participants (30 teeth) and the DD- group 22 participants (23 teeth). On average, pain intensity was mild, the frequency most often recurrent, and the impact was low. Average pain duration since onset exceeded 2 years in both groups. The only observed between-group differences were average pain intensity; 3.1 (0-10 Numerical Rating Scale (NRS)) in DD- group compared to 1.6 for DD+ (p = 0.030), and tenderness to apical palpation; only reported in the DD+ group. The similarities in clinical presentation between the two groups underscore the difficulties in correctly distinguishing between pain of odontogenic and non-odontogenic origin in root-filled teeth with a standard clinical investigation. Additional diagnostic methods need to be investigated for their ability to differentiate between tooth pain or discomfort of different origins.