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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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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A literature review concerning the relationships between motor vehicle accidents and temporomandibular disorders, whiplash, headache, neck pain, and litigation was undertaken. The review shows that many patients recover or resume work prior to settlement, but most unsuccessfully treated patients do not generally recover following the settlement of legal claims; the postinjury problems are not strictly psychologic. Litigating patients and nonlitigating patients are often not dramatically different in most important regards (including pain and return to work), with litigating patients deserving the same treatment as other patients with chronic pain. ⋯ Patients with postinjury temporomandibular disorders tend to respond less well to treatment than do noninjury patients with temporomandibular disorders, as do litigating compared to nonlitigating temporomandibular disorders patients, but a cause and effect relationship is not known. The incidence of temporomandibular disorders following motor vehicle accidents may not be as high as has been claimed in whiplash cases. More research is required in the area of temporomandibular disorders, motor vehicle accidents, and litigation.
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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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Comparative Study Clinical Trial Controlled Clinical Trial
Thermographic assessment of neuropathic facial pain.
Ongoing pain, intermittent sharp pain, or intermittent dull aching pain around the teeth can evoke the suspicion of tooth pathology. However, when no dental cause can be found clinically or radiographically, the differential diagnosis involving neuropathic pain and pulpal pathology is still a challenge. Neuropathic facial pains are still too often misdiagnosed as tooth pain of dental origin, resulting in unnecessary dental extraction or endodontic therapy. ⋯ The other half of the patients with sympathetically independent traumatic trigeminal neuralgia displayed "cold" thermograms in the area of their pain complaints. Electronic thermography was the least selective test for the group showing "cold" thermogram patterns (80% agreement with the thermographic characterization criteria). These data suggest that electronic thermography may be helpful in differentiating neuropathic pains from pulpal pathology.