J Orofac Pain
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Comparative Study
Electromyographic data from TMD patients with myofascial pain and from matched control subjects: evidence for statistical, not clinical, significance.
This study tested the hypotheses that electromyographic (EMG) activity at rest would be significantly greater for temporomandibular disorder (TMD) patients with myofascial pain than for nonpain control subjects, and that a cutoff score based on EMG values could be established to accurately separate the two groups. Fifty-four TMD patients diagnosed with myofascial pain and 54 nonpain control subjects who were matched for age and gender were examined. ⋯ The application of a cutoff value that produced the smallest classification error nonetheless resulted in misclassification of about one third of the TMD and nonpain individuals. These data provide little support for the use of resting EMG data obtained via a scanning procedure in accurately distinguishing facial pain patients from nonpain control subjects.
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Randomized Controlled Trial Clinical Trial
The efficacy of dry needling and procaine in the treatment of myofascial pain in the jaw muscles.
In patients with myofascial pain, painful trigger points are often treated using dry needling and local anesthetic injections. However, the therapeutic effect of these treatments has been poorly quantified, and the mechanism underlying the effect is poorly understood. In a randomized, double-blind, double-placebo clinical trial, a pressure algometer was used to measure pain-pressure thresholds in the masseter and temporalis muscles of 30 subjects aged 23 to 53 years with myofascial pain in the jaws, before and after a series of dry needling treatments, local anesthetic injections, and simulated dry needling and local anesthetic treatments (treatment group A: Procaine + simulated dry needling; treatment group B: dry needling + simulated local anesthetic; control group C: simulated local anesthetic + simulated dry needling). ⋯ There were no statistically significant between-group differences in pain pressure thresholds and visual analogue scale scores at the end of treatment. The findings suggest that the general improvement in pain symptoms was the result of nonspecific, placebo-related factors rather than a true treatment effect. Thus, the therapeutic value of dry needling and Procaine in the management of myofascial pain in the jaw muscles is questionable.
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Randomized Controlled Trial Comparative Study Clinical Trial
A controlled evaluation of ibuprofen and diazepam for chronic orofacial muscle pain.
The clinical efficacy, side effect liability, and hormonal effects of two prototypic pharmacologic agents were evaluated for the management of chronic myogenous facial pain in a double-blind, randomized, controlled clinical trial. Thirty-nine subjects (35 women,. 4 men) with daily or near-daily orofacial pain of at least 3 months' duration and tenderness to palpation of masticatory muscles participated. Patients were randomly allocated to one of four treatments: placebo, diazepam, ibuprofen, or the combination of diazepam and ibuprofen. ⋯ No significant changes were noted in muscle tenderness, interincisal opening, or plasma beta-endorphin level. This study supports the efficacy of diazepam in the short-term management of chronic orofacial muscle pain. The lack of effect following administration of an anti-inflammatory analgesic suggests that inflammation is not the basis for chronic muscle pain in the orofacial region, and that the analgesic effect of such medications is not sufficient for pain relief in this condition.
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The objective of this study was to assist clinicians in the diagnosis of the occipital neuralgia syndrome by describing its clinical characteristics. Bibliographies and clinical descriptions of occipital neuralgia syndrome were identified through a review of literature published between 1966 and 1993. A prospective case series was performed by the authors in a university emergency department during a 1-year period. ⋯ Occipital neuralgia is a benign extracranial cause of headache, and it may be confused with other more serious headache syndromes. Recognition depends on an understanding of the symptoms along with a careful history and physical examination. Local anesthetic injections produce significant relief of the headaches and can aid in the diagnosis of the syndrome.
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Recent evidence suggests that a past history of physical and/or sexual abuse is more frequently reported among chronic pain populations; however, the prevalence of reported abuse has not been examined in patients with chronic orofacial pain caused by temporomandibular disorders (TMD). This study compares reported physical/sexual abuse among female TMD subjects recruited from the general population with that of age-matched female control subjects. The association of reported abuse with clinical pain, experimental pain responses, and psychologic variables was examined in the TMD group. ⋯ Reported abuse among TMD subjects was not related to clinical pain or psychologic variables. Regarding experimental pain responses, TMD subjects reporting a history of abuse exhibited longer ischemic pain tolerances compared to those not reporting abuse; however, the groups did not differ on other experimental pain measures. Results indicate that the reported prevalence of physical/sexual abuse is similar among TMD subjects compared to other chronic pain populations; however, the relationship of abuse to clinical and psychosocial variables remains unclear.