J Orofac Pain
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Pain-pressure thresholds of the head and neck region of 31 female patients (aged 13 to 50 years; mean, 28.4 +/- 9.6 years) suffering from episodic tension-type headache and 32 female control subjects (aged 15 to 46 years; mean, 26.6 +/- 8.6 years) were recorded with an electronic algometer by the same blinded observer. The multivariate analysis of variance revealed that the algometer values obtained from different age groups of patients and control subjects were statistically different, but the values for the right-side muscles were not statistically different from the corresponding values for the left-side muscles. ⋯ The results may indicate that pain-pressure thresholds of the head and neck region should be considered in the diagnosis of episodic tension-type headache. The results may also propose that the increased pain sensitivity of the head and, especially, the neck region, may be included in the pathogenetic mechanism in episodic tension-type headache.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized clinical trial of intraoral soft splints and palliative treatment for masticatory muscle pain.
Thirty subjects seeking treatment for masticatory muscle pain at a university-based TMJ clinic were randomly assigned to soft-splint, palliative-treatment, and no-treatment groups. After 4 to 11 weeks of treatment, subjects were evaluated for changes from their baseline levels of symptoms, maximum pain-free opening, pain thresholds measured by a pressure algometer, and occlusal contacts. ⋯ The soft-splint group had fewer occlusal contact changes assessed with shimstock compared to the palliative-treatment and no-treatment groups. The findings of this study suggest that the soft splint is an effective short-term treatment for reducing the signs and symptoms of masticatory muscle pain in patients, and the soft splint does not cause occlusal changes.
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Comparative Study Clinical Trial Controlled Clinical Trial
Thermographic assessment of neuropathic facial pain.
Ongoing pain, intermittent sharp pain, or intermittent dull aching pain around the teeth can evoke the suspicion of tooth pathology. However, when no dental cause can be found clinically or radiographically, the differential diagnosis involving neuropathic pain and pulpal pathology is still a challenge. Neuropathic facial pains are still too often misdiagnosed as tooth pain of dental origin, resulting in unnecessary dental extraction or endodontic therapy. ⋯ The other half of the patients with sympathetically independent traumatic trigeminal neuralgia displayed "cold" thermograms in the area of their pain complaints. Electronic thermography was the least selective test for the group showing "cold" thermogram patterns (80% agreement with the thermographic characterization criteria). These data suggest that electronic thermography may be helpful in differentiating neuropathic pains from pulpal pathology.
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Pain-pressure thresholds (PPTs) and stimulus-response (S-R) curves in masseter muscles and index fingers of 11 female patients with chronic jaw-muscle pain were compared with that of 11 matched control subjects. Experimental hyperalgesic and hypoalgesic conditions in the masseter muscles of control subjects were induced by intramuscular injection of 5% saline and of local anesthetic, respectively. The PPTs were found to be significantly lower in the masseter muscles of pain patients than in those of control subjects. ⋯ The PPTs in masseter muscles of control subjects were not significantly affected by injection of 5% saline; however, the slopes of the S-R curves for the masseter muscles were significantly steeper for saline-injection values compared to baseline values (21.7% +/- 29.6%, P < .037). Injection of local anesthetic into masseter muscles of control subjects increased the PPTs significantly and reduced the slopes of the S-R curves significantly as compared to baseline values (-22.9% +/- 34.6%, P < .0155). The present results suggest that PPTs and S-R curves are valuable tools for quantitative description of chronic and experimental jaw muscle pain.
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Comparative Study
Pain-related limitation in activities of daily living in patients with chronic orofacial pain: psychometric properties of a disability index.
Pain-related limitations in activities of daily living are presented for 272 patients reporting orofacial pain of the temporomandibular region using the seven-item Pain Disability Index. Results showed that the factor structure for orofacial pain patients differed little from the factor structure for outpatients visiting chronic pain clinic settings. ⋯ The factor analytical findings indicated that these patients share common pain-related limitations in activities of daily living. These findings are also consistent with previous results indicating greater pain in orofacial pain patients diagnosed with pain complaints primarily myogenous in origin than in pain patients having discal disorders.