Pain
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Comparative Study
Contributing factors to chronic myofascial pain: a case-control study.
This case-control study was designed to investigate the contributing factors for chronic masticatory myofascial pain (MFP). Eighty-three patients with MFP, selected from the dental clinics of the Jewish General and Montreal General Hospitals, Montreal, Canada, and 100 concurrent controls selected only at the first clinic, participated in this study. The association with MFP was evaluated for bruxism, head-neck trauma, psychological factors (symptom check list 90 revised questionnaire, SCL-90R) and sociodemographic characteristics by using unconditional logistic regression. ⋯ In addition, female gender had almost three times the risk of chronic MFP than males when the model was also adjusted for psychological symptoms. Grinding-only, age, household income and education were not related with chronic MFP. Tooth clenching, trauma and female gender may contribute to MFP even when other psychological symptoms are similar between subjects.
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Comparative Study
Facial arthralgia and myalgia: can they be differentiated by trigeminal sensory assessment?
Heat and electrical detection thresholds were assessed in 72 patients suffering from painful temporomandibular disorder. Employing widely accepted criteria, 44 patients were classified as suffering from temporomandibular joint (TMJ) arthralgia (i.e. pain originating from the TMJ) and 28 from myalgia (i.e. pain originating from the muscles of mastication). Electrical stimulation was employed to assess thresholds in large myelinated nerve fibers (Abeta) and heat application to assess thresholds in unmyelinated nerve fibers (C). ⋯ Following arthrocentesis, mean electrical detection threshold ratios in the AUT territory were significantly elevated from 0.64+/-0.06 to 0.99+/-0.04 indicating resolution of the hypersensitivity (paired t-test, P=0.001). In conclusion, large myelinated fiber hypersensitivity is found in the skin overlying TMJs with clinical pain and pathology but is not found in controls. In patients with muscle-related facial pain there was significant elevation of the electrical detection threshold in the AUT region.
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Catastrophizing about pain has emerged as a critical variable in how we understand adjustment to pain in both adults and children. In children, however, current methods of measuring catastrophizing about pain rely on brief subscales of larger coping inventories. Therefore, we adapted the Pain Catastrophizing Scale (Sullivan et al., 1995) for use in children, and investigated its construct and predictive validity in two studies. ⋯ This three factor structure is invariant across age groups and gender. Study 2 revealed in a clinical sample of children with chronic or recurrent pain (23 girls, 20 boys; age range between 8 years 3 months and 16 years 6 months) that catastrophizing about pain had a unique contribution in predicting pain intensity beyond gender and age, and in predicting disability, beyond gender, age and pain intensity. The function of pain catastrophizing is discussed in terms of the facilitation of escape from pain, and of the communication of distress to significant others.
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Case Reports
Pulsed radiofrequency treatment of the Gasserian ganglion in patients with idiopathic trigeminal neuralgia.
Pulsed radiofrequency treatment has been described as a minimal invasive alternative to radiofrequency thermocoagulation for the management of chronic pain syndromes. We present here our first five high-risk patients with idiopathic trigeminal neuralgia who were treated with pulsed radiofrequency after multidisciplinary assessment; with a mean follow-up of 19.2 months (range 10-26). ⋯ An excellent long-term effect was achieved in three of the five patients, a partial effect in one patient and a short-term effect in one patient. No neurological side effects or complications were reported.
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Comparative Study
Unilateral carrageenan injection into muscle or joint induces chronic bilateral hyperalgesia in rats.
Chronic musculoskeletal pain is a major clinical problem and there is a general lack of animal models to study this condition. Carrageenan is commonly used to produce short-lasting acute inflammation and hyperalgesia in animal models. However, the potential of carrageenan to produce chronic, long-lasting hyperalgesia has not been evaluated. ⋯ At 1 week, the inflammation converted to primarily a macrophage response with scattered mast cells. The data suggest that animals injected with 1 or 3% carrageenan in the knee joint or gastrocnemius muscle could be used as models of acute inflammation through 24 h and chronic inflammation after 1 week. Furthermore, 3% carrageenan injected into deep tissues produces hyperalgesia that spreads to the contralateral side, at the same time period as the inflammation transforms from acute to chronic.