J Orofac Pain
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Randomized Controlled Trial Clinical Trial
Trazodone in burning mouth pain: a placebo-controlled, double-blind study.
An 8-week parallel, placebo-controlled, double-blind trial evaluated the efficacy of the antidepressant trazodone in the treatment of chronic burning mouth pain. ⋯ In this controlled trial, trazodone failed to relieve burning mouth pain.
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The aim of this study was to determine the prevalence of pain that is related to temporomandibular disorders (TMD), gender differences, and perceived treatment need in children and adolescents at a public dental clinic in Linköping, Sweden. ⋯ Overall, TMD-related pain was more common in girls than in boys. A majority of children and adolescents who experienced pain once a week or more perceived a need for treatment. Seven percent of the examined subjects were diagnosed with TMD pain.
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Nerve signals arising from sites of tissue or nerve injury lead to long-term changes in the central nervous system and contribute to hyperalgesia and the amplification and persistence of pain. These nociceptor activity-induced changes are referred to as central sensitization. Central sensitization involves an increase in the excitability of medullary and spinal dorsal horn neurons brought about by a cascade of events, including neuronal depolarization, removal of the voltage-dependent magnesium block of the N-methyl-D-aspartate (NMDA) receptor, calcium entry into neurons, phosphorylation of the NMDA receptor, a change in the cell's excitability, and an increase in synaptic strength. ⋯ The latter exhibits changes very similar to those in the spinal dorsal horn, but the Vi/Vc zone likely is involved in autonomic nervous system processing and activation of the pituitary-adrenal axis. Descending systems are also an important component of the central sensitization process and provide the neural networks by which cognitive, attentional, and motivational aspects of the pain experience modulate pain transmission. These findings of nociceptor activity-induced neuronal plasticity have important clinical implications in the development of new approaches to the management of persistent pain.
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A case of episodic, spontaneous odontalgia, aggravated by ingestion of cold food, with no apparent dental pathology is presented. Attempts at alleviating the pain by means of root canal treatment had failed in previous, similar episodes, and pain and pulpal hyperalgesia had shifted to other locations. ⋯ A prophylactic attempt with nifedipine, a calcium channel blocker, failed to alleviate the pain. This diagnostic entity and possible therapeutic approaches are discussed.