Journal of Oral & Facial Pain and Headache最新文献

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 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.

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 clarify the mechanisms of hypersensitivity and spontaneous pain in intraoral structures in rats with diabetes mellitus (DM) accompanied by reduced saliva.

Methods: Adult male Sprague-Dawley rats received a single injection of streptozocin (50 mg/kg) to induce DM. Saliva volume, intraoral hypersensitivity to menthol and capsaicin solutions, and head-withdrawal thresholds (HWTs) to noxious heat and mechanical stimulation of the tongue and whisker pad were measured.

Results: On day 7 after streptozocin injection, rats with DM had a significantly reduced spontaneous saliva volume, polydipsia, capsaicin aversion of the intraoral mucosa, and a reduced HWT to noxious mechanical stimulation of the whisker pad skin. The HWT to noxious mechanical stimulation of the tongue reduced further on day 14 after streptozocin injection. These symptoms are similar to the orofacial and intraoral complaints of patients with DM. Meanwhile, reduction of HWT to noxious heat stimulation of the tongue and whisker pad were not observed. These results indicate that spontaneous intraoral mucosal pain and mechanical facial hypersensitivity are antecedent symptoms before mechanical hypersensitivity of the tongue.

Conclusion: The mechanisms of saliva reduction, spontaneous intraoral mucosa pain, and mechanical hypersensitivity of intraoral and facial structures induced by DM involve both peripheral and autonomic neuropathies. Tongue hypersensitivity to noxious mechanical stimulation might be aggravated by xerostomia.

Aims: To test the feasibility and acceptability of a customized six-session cognitive behavioral therapy (CBT) group intervention for adults with recurrent trigeminal neuralgia (TN).

Methods: Fifteen participants with TN were recruited from a specialist facial pain unit in London, United Kingdom. The effects of the group intervention were evaluated using validated self-report measures, which the participants completed before and after the intervention and at 1-month and 9-month follow-ups. A semi-structured interview was also used at the 1-year follow-up to gather qualitative feedback of the group intervention.

Results: Participants reported an increase in confidence in managing everyday tasks in the presence of TN symptoms, a reduction in negative beliefs about pain, and an increase in engagement in meaningful activity. All patients completed the group intervention (100% retention rate). Qualitative feedback highlighted that the group CBT intervention was helpful, and no participants reported a worsening of mood or experience as a result of the intervention.

Conclusion: The trends for improvement in several domains, plus the positive experiences of the participants, suggest that a CBT management program is acceptable and feasible for this population and should be further developed and implemented on a larger scale to determine its clinical efficacy.

Aims: To evaluate the diagnostic value of non-nerve-selective MRI sequences in posttraumatic trigeminal neuropathic pain (PTNP).

Methods: This study retrospectively analyzed all MRI protocols performed between February 2, 2012 and June 20, 2018 commissioned by the Department of Oral and Maxillofacial Surgery, University Hospitals Leuven. Demographic, clinical, and radiologic data were extracted from the records of patients with an MRI in the context of PTNP. A contingency table was constructed based on the opinions of the treating physician and the radiologist who initially evaluated the MRI. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated.

Results: The sample consisted of 27 women (65.9%) and 14 men (34.1%). The sensitivity and negative predictive value of MRI in PTNP were 0.18 and 0.77, respectively. Artifacts interfered with visualization of a possible cause of the trigeminal pain in 24.4% of MRIs. Almost all artifacts (90%) were caused by metal debris originating from the causal procedure or posttraumatic surgeries. MRI resulted in changed management for PTNP patients only once.

Conclusion: The diagnostic value of non-nerve-selective MRI sequences for PTNP is low and has little impact on clinical management. Therefore, there is a need for dedicated sequences with high resolution and low artifact susceptibility for visualizing the posttraumatic injuries of the trigeminal branches.

Aims: To review randomized clinical trials on arthrocentesis for managing temporomandibular disorders (TMD) and to discuss the clinical implications.

Methods: On March 10, 2019, a systematic search of relevant articles published over the last 20 years was performed in PubMed, as well as in Scopus, the authors' personal libraries, and the reference lists of included articles. The focus question was: In patients with TMD (P), does TMJ arthrocentesis (I), compared to any control treatment (C), provide positive outcomes (O)?

Results/conclusion: Thirty papers were included comparing TMJ arthrocentesis to other treatment protocols in patients with disc displacement without reduction and/or closed lock (n = 11), TMJ arthralgia and/or unspecific internal derangements (n = 8), or TMJ osteoarthritis (n = 11). In general, the consistency of the findings was poor because of the heterogenous study designs, and so caution is required when interpreting the meta-analyses. In summary, it can be suggested that TMJ arthrocentesis improves jaw function and reduces pain levels, and the execution of multiple sessions (three to five) is superior to a single session (effect size = 1.82). Comparison studies offer inconsistent findings, with the possible exception of the finding that splints are superior in managing TMJ pain (effect size = 1.36) compared to arthrocentesis, although this conclusion is drawn from very heterogenous studies (I² = 94%). The additional use of cortisone is not effective for improving outcomes, while hyaluronic acid or platelet-rich plasma positioning may have additional value according to some studies. The type of intervention, the baseline presence of MRI effusion, and the specific Axis I diagnosis do not seem to be important predictors of effectiveness, suggesting that, as in many pain medicine fields, efforts to identify predictors of treatment outcome should focus more on the patient (eg, age, psychosocial impairment) than the disease.

Aims: To investigate the associations between temporomandibular disorders (TMDs) and sleep disorders in adult subjects.

Methods: The PubMed, Embase, Evidence-Based Medicine Reviews, and ProQuest Dissertations & Theses databases were searched for studies published in English up to September 2019. Unpublished/gray literature and reference lists of identified articles were also examined. Inclusion criteria were male and female adults, presence or absence of a TMD based on the RDC/TMD or DC/TMD criteria, presence or absence of a sleep disorder according to the International Classification of Sleep Disorders, and any of the following study designs: cross-sectional, case-control, or longitudinal. Methodologic quality assessment was conducted using the National Heart, Lung, and Blood Institute quality assessment tools.

Results: Twenty-two studies (11 cross-sectional, 9 case-control, 1 prospective cohort, and 1 mixed design) met the inclusion criteria. TMDs were assessed independently in relation to sleep bruxism (SB), obstructive sleep apnea (OSA), and sleep quality (SQ). All studies but one assessed TMDs using the RDC/TMD criteria. The relation between the TMD and the different sleep disorders was conflicting for SB and positive for OSA and SQ. Five studies were of good quality, and 17 were of fair quality.

Conclusions: The evidence is inconclusive regarding the relationship between TMDs and SB and insufficient regarding the relationship with OSA. There is consistently fair evidence to support an association between TMD and SQ. This study highlights the need for higher-quality longitudinal studies to clarify the association between TMDs and sleep disorders.