J Orofac Pain
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This study examined the effects of the intensity, quality, and duration of odotogenic pain on the incidence, pattern, and clinical characteristics of pain referral in the orofacial region. Four hundred consecutive patients reporting with posterior toothache to the dental emergency clinic were included. Patients completed a standardized clinical questionnaire consisting of a numerical rating scale for pain intensity and chose verbal descriptors from a list of adjectives describing the quality of their pain. ⋯ However, neither duration nor quality of pain influenced the incidence of referred pain. Finally, pain referral occurred in vertical laminations as indicated on mannequin drawings, but these were not found to be diagnostic because of extensive horizontal overlap. The association of intensity and referral is attributed to central nervous system hyperexitability causing expansion of receptive fields and spread and referral of pain.
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Seventeen patients with neuropathic orofacial pain are presented with reference to precipitating events, pain descriptions, response to treatment, and other aspects of their histories and clinical presentation. Stellate ganglion blocks were done on 14 patients. Ten of 14 patients reported temporary relief of pain with stellate ganglion blocks. ⋯ It is argued that sympathetically maintained pain involving orofacial locations does occur and that stellate ganglion blocks may benefit a subgroup of these patients. It is noted that current diagnostic categories are inadequate to describe a subgroup of these patients. New categories are suggested, and further study is recommended.
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This study explored psychologic and physiologic factors differentiating patients with temporomandibular disorders (n = 23) from sex-, age-, and weight-matched asymptomatic control subjects. Each subject completed several standard psychologic questionnaires and then underwent two laboratory stressors (mental arithmetic and pressure-pain stimulation). Results indicated that patients with temporomandibular disorders had greater resting respiration rates and reported greater anxiety, sadness, and guilt relative to control subjects. ⋯ There were no differences between patients with temporomandibular disorders and control subjects on pain measures or any other measured variable for the pressure-pain stimulation trial. In addition, there were no differences in electromyography levels between patients with temporomandibular disorders and control subjects. The results are discussed in terms of their implications for the etiology and treatment of this common and debilitating set of disorders.
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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.