J Orofac Pain
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The aim of this study was to investigate whether the treatment effect of intramuscular glucocorticoid injection differs between patients with fibromyalgia and those with localized myalgia of the masseter muscle concerning pain, tenderness to digital palpation, pressure pain threshold, pressure pain tolerance level, maximum voluntary occlusal force, or intramuscular temperature. Twenty-five patients with fibromyalgia and 25 patients with localized myalgia of the masseter muscle were first asked to assess their pain on a visual analogue scale; afterward, a routine clinical examination, including tenderness to digital palpation, was performed. For each patient, the pressure pain threshold, pressure pain tolerance level, and maximum voluntary occlusal force, as well as the intramuscular temperature, were recorded. ⋯ In the fibromyalgia group, there was a reduced tenderness to digital palpation in response to the treatment. The localized myalgia group responded with a general improvement of symptoms as well as a significant reduction of pain intensity and tenderness to digital palpation. The results of this study indicate that patients with fibromyalgia and localized myalgia in many respects show a similar response to local glucocorticoid treatment.
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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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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.
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Randomized Controlled Trial Clinical Trial
Effect of systemic versus topical nonsteroidal anti-inflammatory drugs on postexercise jaw-muscle soreness: a placebo-controlled study.
Certain types of jaw-muscle pain may be managed with pharmacologic treatment. This study evaluated the effect of topical and systemic nonsteroidal anti-inflammatory drugs on acute postexercise jaw-muscle soreness. Ten men without temporomandibular disorders performed six 5-minute bouts of submaximal eccentric jaw exercise. ⋯ Treatment effects on pain tolerance thresholds and on maximum voluntary occlusal force were nonsignificant. The results demonstrated that repeated eccentric jaw exercise caused muscle fatigue and low levels of postexercise pain and soreness. Topical nonsteroidal anti-inflammatory drugs seem to have some advantages over systemic nonsteroidal anti-inflammatory drugs for management of exercise-induced jaw-muscle pain.