J Orofac Pain
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Practice Guideline Guideline
The scope of TMD/orofacial pain (head and neck pain management) in contemporary dental practice. Dental Practice Act Committee of the American Academy of Orofacial Pain.
The Dental Practice Act Committee of the American Academy of Orofacial Pain was convened in 1995 for the purpose of studying the scope of temporomandibular disorders (TMD)/orofacial pain and dental practice acts. The committee concluded that the scope of clinical practice of TMD/orofacial pain is expanding beyond the teeth and oral cavity to include the diagnosis and treatment of disorders affecting the entire head and neck. The expansion of clinical practice is consistent with historical precedent in dentistry and within the scope of current dental practice acts. The present report represents the position of the American Academy of Orofacial Pain.
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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.
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This study compared myofascial pain of the masticatory muscles to fibromyalgia. Study data show that, in both myofascial pain and fibromyalgia patients, facial pain intensity and its daily pattern and effect on quality of life are very similar. This indicates that fibromyalgia should be included in the differential diagnosis for myofascial pain of the masticatory muscles. ⋯ On the other hand, while body pain is episodic in most myofascial pain patients, it is constant and more severe in the majority of fibromyalgia patients. This difference in the pain patterns suggests that body pain in fibromyalgia and myofascial pain could have different etiologies. The lack of correlation between the intensity of pain and the length of time since onset also supports the concept that myofascial pain of the masticatory muscles and fibromyalgia are unlikely to be progressive disorders.
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An open-label trial of clonidine, an alpha 2-adrenergic agonist, was prescribed for patients with a clinical diagnosis of oral neuropathic pain or neuralgia involving the oral cavity. Clonidine (0.2 mg/g) was prepared in a cream base and applied four times daily to the site of pain. Seventeen patients were assessed: 10 were diagnosed with neuropathic pain, and 7 with neuralgia. ⋯ This open-label clinical trial suggests that topical clonidine may be effective in the management of some patients with oral neuralgia-like pain, but may have a more limited effect in those patients with oral neuropathic pain. Besides type of pain, no other variables predicted which of the patients would achieve pain reduction with topical clonidine. Although confirmation of clinical efficacy requires double-blind clinical studies, this initial trial suggests that further study is warranted.
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The McGill Pain Questionnaire is an instrument that is widely used to assess the multidimensional experience of pain. Although it was introduced more than 20 years ago, limited information is available about its use in patients suffering from persistent facial pain. The aim of this study was to investigate the response patterns of persistent facial pain patients to the McGill Pain Questionnaire, to correlate these patterns with patients' beliefs about the seriousness of the condition, and to compare the findings with data reported from other painful conditions. ⋯ Differences were also found in the choice of specific pain descriptors. More than 20% of the facial pain patients selected "radiating" and "pressing"; this was not the case for those suffering from other pain conditions. Facial pain patients who felt that their condition was more serious or different from what the treatment providers had told them had a greater likelihood of choosing specific word categories of the McGill Pain Questionnaire.