J Orofac Pain
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A self-administered questionnaire consisting of 21 questions, diagrams for chief pain location, and a digital pain scale was used prospectively to sort 92 patients with orofacial pain into three categories: (1) musculoligamentous (ie, temporomandibular disorders); (2) neurologically based (ie, migraine, trigeminal neuralgia, tension-type headache, cluster headache, and atypical facial pain); and (3) dentoalveolar pain. Sensitivity, specificity, as well as negative and positive predictive values suggest that this questionnaire may be used reliably to identify patients with orofacial pain that fits the above-described pain categories without prior knowledge of the clinical diagnosis. ⋯ Patients with musculoligamentous or dentoalveolar pain selected the lowest digital pain scale values up to 15 times more frequently than those with neurologically based pain. Although this questionnaire may be used for initial categorization of pain, there is still no substitute for a thorough history and clinical examination.
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This study examined masseter and temporalis pain-pressure thresholds in 29 patients with chronic bilateral myogenous temporomandibular disorder and in 11 controls. Patients with evidence of temporomandibular joint pathosis were omitted. The influence of time, facial side, muscle site, and side of greatest spontaneous pain on pain-pressure thresholds was measured. ⋯ Mean pain-pressure thresholds in patients differed over the four sessions, which is consistent with recent reports of fluctuating levels of pain in patients with temporomandibular disorders. Additional findings included significant pain-pressure threshold differences among muscle sites in patients and controls, and lower patient pain-pressure thresholds relative to controls. Within- and between-session reliability was adequate for patients (r = .85 and r = .75, respectively) and controls (r = .90 and r = .75, respectively).
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Comparative Study
Comparison of pain and quality of life in bruxers and patients with myofascial pain of the masticatory muscles.
Although it has been suggested that bruxism is a cause or a risk factor in myofascial pain of the masticatory muscles, the prevalence of pain in bruxers and its characteristics have not been assessed or compared to those of myofascial pain patients in general. In this study, self-reports of pain and quality of life were recorded on 100-mm visual analogue and five-point category scales from two research populations: (1) 19 nocturnal bruxers who participated in a polysomnographic study and (2) 61 patients with myofascial pain of the masticatory muscles with no evidence of bruxism who participated in a controlled clinical trial on the efficacy of oral splints. ⋯ The fact that pain from bruxism was worst in the morning suggests that it is possibly a form of postexercise muscle soreness. Myofascial pain, which was worst late in the day, is likely to have a different etiology.
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Research efforts have been directed to determine whether temporomandibular disorder (TMD) patients have psychological problems and whether these factors influence treatment outcome. Because there is no consensus about the best way to quickly assess psychological problems in TMD patients, this study was designed to evaluate a simple method for identifying psychological factors that may need to be addressed as part of a comprehensive treatment program. ⋯ Sensitivity, specificity, and ordinal rank-based association model analyses showed moderate to strong associations between patients' ratings and the corresponding psychometric measures. These results provide evidence that the brief self-ratings of psychological factors utilized in this study may be a useful first step to screening for psychological difficulties in TMD patients.