CHANGES IN PELVIC TILT DURING THREE DIFFERENT RECIPROCAL STANCE POSITIONS IN PATIENTS WITH SACROILIAC JOINT REGIONAL PAIN.

PURPOSE: Essential to the successful management of patients with sacroiliac joint pain (SIJP) is understanding how these joints move. The innominates tilt together in the same direction with symmetrical activities (i.e. forward-bending) but move opposite of one another when performing asymmetrical activities (i.e. walking). How they move in patients with SIJP is unknown. The purpose of this study was to examine inter-innominate movement (tilt) when assuming three different stance positions to describe how the innominate bones move in those with and without SIJP. STUDY TYPE: Observational Cohort Study. METHODS: Twenty-eight participants were classified into two groups; SIJP with low back pain (LBP), and no SIJP or LBP. SIJP participants were further classified into groups with left or right pelvic tilt. Pelvic tilt was measured during neutral standing and in both left-sided and right-sided reciprocal stance, with a full-stride (one hip fully flexed the other fully extended) and in a half-stride position, which mimic the double-stance phase of gait. A repeated measure ANOVA assessed for differences between Groups (Level, Left or Right Pelvic Tilt), stance side position (left/right), and stride length (full/half). RESULTS: The was a significant Group main effect (F [2, 25] = 130.2, p < 0.0001), and a significant Side main effect (F [1, 25] = 429.7, p < 0.0001), qualified by a significant Side x Group interaction (F [2, 25] = 19.9 p < .0001). Follow-up comparisons showed that pelvic tilts for right and left stance were significantly different (p < 0.05) for each group (Level, left and right pelvic tilt). For the right stance condition, all groups were significantly different from each other (p < 0.05). For the left stance position, the right pelvic tilt and level pelvic tilt means were not different from each other (p > 0.05), but each was different from the mean for the left pelvic tilt group (p < 0.05). CONCLUSIONS: When assuming an asymmetrical stance position, the innominates tilt opposite of each other in those without SIJP. In patients with SIJP they behave in the normal fashion in one asymmetrical stance position but not the other. Instead of tilting opposite, as expected, the innominates remain symmetrical, dependent on the side of the presenting pelvic tilt. LEVEL OF EVIDENCE: 2b.

The Minnesota Prescription Monitoring Program.

We must keep in mind that health care professionals practice in an environment of legal and regulatory influences, where some patients with pain also have an addictive disease. As dentists routinely manage acute oral and dental pain by pharmacological means, people who abuse prescription medications see dentists as easy targets to "score" prescription opioids and controlled substances. This potential for deception must be balanced with our professional responsibility to prescribe and dispense controlled substances appropriately, guarding against abuse while ensuring that patients have medication available when appropriate and necessary. However, dentists also have a personal responsibility to protect themselves and their practices from becoming easy targets for drug abuse and diversion. Becoming aware of the potential signs and symptoms of drug seeking behavior and recognizing the signs of controlled substance misuse will safeguard patients, practices, and practitioners. Utilizing the services of the Minnesota Prescription Monitoring Program may help to not only improve patient care, but to facilitate appropriate pain management and help identify patients having drug seeking behaviors

The effectiveness of adding pharmacologic treatment with clonazepam or cyclobenzaprine to patient education and self-care for the treatment of jaw pain upon awakening: a randomized clinical trial.

AIMS: To compare the relative effectiveness of a benzodiazepine (clonazepam), a muscle relaxant (cyclobenzaprine), and a placebo for the treatment of jaw pain upon awakening, when each is combined with the recommended nonpharmacological components of initial medical management. METHODS: Forty-one subjects were recruited with a diagnosis of myofascial pain based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). All subjects were given education about TMD and a self-care program. Subjects were randomized into 1 of 3 groups: clonazepam (0.5 mg/night), cyclobenzaprine (10 mg/night), or placebo. The primary outcome measure was the subjects' average intensity of jaw pain upon awakening over the prior week. This was recorded with a visual analog scale at pretreatment and at the completion of the 3-week trial. A secondary outcome measure was sleep quality based on the Pittsburg Sleep Quality Index. RESULTS: Within-group changes showed a statistically significant (P < .001) decrease in jaw pain upon awakening for all 3 groups. Between-group differences demonstrated a statistically significant difference (P < .016) between cyclobenzaprine and placebo, and between cyclobenzaprine and clonazepam. There was no significant effect on sleep quality in any group. CONCLUSION: This study suggests that cyclobenzaprine is statistically superior to either placebo or clonazepam when added to self-care and education for the management of jaw pain upon awakening. Based on the subjects' report of sleep quality, these medications failed to significantly improve sleep in the short term.