The Clinical journal of pain
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Review Comparative Study
Comparison of clinical characteristics in myogenic, TMJ internal derangement and atypical facial pain patients.
Temporomandibular joint (TMJ) disorders have been collectively grouped as myofascial pain-dysfunction syndrome (MPDS) or temporomandibular joint dysfunction syndrome (TMJDS). In the past, these terms have been used synonomously to describe a set of clinical signs and symptoms that include pain in the TMJ and muscles of mastication, limited or deviant opening of the mandible, and/or joint sounds. The present study segregated two major subgroups subsumed within this diagnostic classification and assigned them to a myogenic facial pain (MFP) group and a TMJ internal derangement (TMJID) group. ⋯ Minnesota Multiphasic Personality Inventory (MMPI) scores from 95 subjects were compared with self-report measures of depression and anxiety. It was concluded that subcategorization of myofascial pain dysfunction patients into a MFP and TMJID group is justified on the basis of psychometric differences, clenching habits, masseter EMG levels, and male:female ratio. Furthermore, psychopathological factors are more significant among MFP and AFP subjects than TMJID patients.
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Randomized Controlled Trial Clinical Trial
Effectiveness of alprazolam in the treatment of chronic pain: results of a preliminary study.
One hundred chronic pain patients were begun on alprazolam, 1.5 mg/day. No other medication changes or therapeutic interventions were made. ⋯ The average score of all patients had decreased from 3.6 to 2.2 on a verbal analog scale that rated pain severity from 0 to 5. There was no difference in response among the various diagnostic groups represented in the study population.
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In a postal survey, 1,009 randomly chosen individuals, aged 18-84, were asked about their pain problems. The pain prevalence depended on the kind of questions and definitions used, but prevalence was high overall. ⋯ At least 12% of the population was calculated as having sufficient pain problems to need some kind of care. This high figure indicates that the establishment of special treatment facilities can never be sufficient to meet the total demand for care due to pain.
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This study examined the effect of significant weight gain on physical, demographic, behavioral, and psychosocial factors in a representative sample of chronic pain patients. One hundred fifty-five chronic pain patients who reported gaining more than 15 pounds since the onset of their pain were compared with 341 pain patients who stated that their weight had remained the same since the onset of their pain. ⋯ Results showed that a significant relationship exists between weight gain and decreased physical activity, increased emotional distress, and accident liability. This study suggests that the inclusion of weight management training in multidisciplinary pain centers may play an important part in the rehabilitation of chronic pain patients.
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Reflex sympathetic dystrophy (RSD) usually occurs in an individual who has been experiencing significant personal stress, a state associated with increased discharge of norepinephrine (NE) from perivascular postganglionic sympathetic neurons. RSD is often precipitated by this sequence: traumatic arterial spasm, regional ischemia, neurogenic inflammation, and ischemic/edematous damage to membranes of preterminal perivascular nociceptive neurons. In the natural repair of these membranes, it is suggested that adrenoceptors appear and are ordinarily transitory; but in RSD, they are retained by the increased adjacent NE. This process delays further healing, produces pain, and releases inflammatory substances, resulting in interacting pathophysiologic vicious cycles.