Clinical features of chronic primary pain in individuals presenting painful temporomandibular disorder and comorbidities.

BACKGROUND: The diagnosis of chronic primary pain (CPP), according to the recently released International Classification of Disease (ICD-11) criteria, refers to conditions with complex aetiologies. CPP is characterized by specific clinical features such as generalized sensory hypersensitivity and widespread pain, and is associated with functional disability and emotional distress. OBJECTIVE: This study investigated clinical features of CPP in individuals with painful temporomandibular disorders (TMD) and comorbidities (fibromyalgia, migraine and/or tension-type headache). METHODS: This cross-sectional study was conducted with a sample of 129 individuals. Painful TMD, fibromyalgia and primary headaches were evaluated based on well-established international criteria. Generalized sensory hypersensitivity was assessed using psychophysical tests. Symptoms of anxiety and depression were assessed by the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. The Central Sensitization Inventory was applied to assess central sensitization-related symptoms and the Pittsburg Sleep Quality Index to evaluate the quality of sleep. The presence of widespread pain was assessed using a body map. The sample was stratified into three groups: control (n = 25), TMD-painful TMD only (n = 35) and TMD + Cm-painful TMD and comorbidities (n = 69). Statistical analysis was performed using one-way ANOVA, chi-squared test and ANCOVA, considering gender as a covariate (α = .05). RESULTS: Compared to controls, individuals presenting painful TMD and comorbidities showed lower pressure pain thresholds in all evaluated areas (p ≤ .012) and a higher number of painful areas in the body (p = .001). They presented more symptoms of anxiety (p = .040) and depression (p = .018), and a higher score in the Central Sensitization Inventory (p ≤ .006) than the other groups. CONCLUSION: Individuals with painful TMD and comorbidities presented more clinical features of CPP compared to those affected by TMD only.

Widespread Pain and Central Sensitization in Adolescents with Signs of Painful Temporomandibular Disorders.

AIMS: To investigate the associations between signs of painful temporomandibular disorders (TMD) and number of tender points (TPs) and fibromyalgia in adolescents, as well as the relationship between TPs and pressure-pain threshold (PPT) in individuals presenting with local, regional, or widespread pain as a way to investigate the presence of central sensitization (CS). METHODS: The sample consisted of 690 Brazilian adolescents with and without signs of painful TMD, aged 12 to 14 years old. Painful TMD was classified according to the Research Diagnostic Criteria for TMD (RDC/TMD) Axis I. The criteria established by Yunus were applied to assess juvenile fibromyalgia and TPs. Mann-Whitney and chi-square tests were applied to test the associations between signs of painful TMD and demographic variables. Regression models were used to estimate the association between signs of painful TMD and number of TPs and to determine which additional predictive variables were associated with TPs. Regression analyses were performed to test the associations between PPT values and number of TPs. Fisher test was used to estimate the association between signs of painful TMD and FM. RESULTS: Significant associations between signs of painful TMD and the number of TPs (P < .001), as well as between TPs and the PPT values for local, regional, and widespread pain (P < .001), were found. No association between signs of painful TMD and fibromyalgia was found (P = .158). CONCLUSION: Individuals with signs of painful TMD presented with more TPs compared to pain-free adolescents. Moreover, the higher the number of TPs, the lower the PPT. This finding suggests that adolescents with signs of painful TMD are at increased risk of presenting with CS.

Toxicity of therapeutic contact lenses based on bacterial cellulose with coatings to provide transparency.

Therapeutic contact lenses were developed from bacterial cellulose (BC) by the Institute of Chemistry at Brazil's São Paulo State University (UNESP). In a previous study, cyclodextrins (CD) and medications such as ciprofloxacin (CP) and diclofenac sodium (DS) were incorporated into the lenses to provide therapeutic properties and control drug release. However, significant opacity was seen in the material inherent to cellulose. In order to achieve full material transparency, the lenses were coated with an organic-inorganic hybrid compound containing aluminum alkoxide and glycidoxypropyltrimethoxysilane (GPTS)(H), or chitosan (Q) nanoparticles. This study evaluated the toxicity of these contact lenses to ensure the safety of these materials for future availability to the medical device industry. Lenses composed of BC and coated with either GPTS (H) or chitosan (Q), incorporating ciclodextrin (CD) to release diclofenac sodium (DS) or ciprofloxacin (CP), were submitted to cytotoxicity assays (XTT and Clonogenic Survival), genotoxicity (Comet Assay) and mutagenicity (Cytokinesis-blocked micronucleus assay) directly in cell culture. Statistical analyses were performed using the Tukey and Dunnett or Kruskal-Wallis and Dunn tests. All of the nanoparticles used in the lense coatings did not show cytotoxic effects by the XTT test (p > 0.05; Dunnett). Only materials associated with diclofenac sodium (BC-H-CD-DS and BC-Q-CD-DS) presented significantly different survival fractions compared to negative control (p < 0.001; Dunnett). Genotoxicity evaluation revealed a genotoxic effect in BC-H-CD-DS (p < 0.05; Dunn). All tested lenses did not present any mutagenic effect. These results indicate that improvements in DS incorporation are needed to eliminate toxicity. We demonstrated promising results in the safety of employing BC lenses functionalized with a drug delivery system permitting the bioavailability of ophthalmic drugs. Further studies utilizing other specific tests, such as corneal lineage are required before safe and efficient ophthalmologic use.