[Technical specification of epidural blood patch for treatment of spinal cerebrospinal fluid leakage].

Spinal cerebrospinal fluid leakage is a common cause of spontaneous intracranial hypotension. Traditional treatment methods include conservative treatment and surgical treatment, but conservative treatment is ineffective for some patients, while surgical treatment is rarely used in clinical practice due to severe trauma. Minimally invasive surgery at appropriate time is an important method to handlecerebrospinal fluid leakage. Therefore, the Group of Headache and Facial Pain, Pain Branch of Chinese Medical Association formulated this technical specification of epidural blood patch for treatment of normal dural sac tension spinal cerebrospinal fluid leakage. This paper mainly discusses the concept and mechanism, indications and contraindications, operation methods, complications and treatment methods of epidural blood patch in order to improve clinical efficacy, reduce neuralsystem complications and reduce the incidence of adverse events.

Endoscopic microvascular decompression versus microscopic microvascular decompression for trigeminal neuralgia: A systematic review and meta-analysis.

BACKGROUND: To compare the efficacy and safety of full endoscopic or endoscope-assisted microvascular decompression (E-MVD) and microscopic microvascular decompression (M-MVD) for primary trigeminal neuralgia (TN). METHODS: We systematically searched the online database, including PubMed, Embase and Cochrane Library. The search terms used included, but were not limited to, "Trigeminal Neuralgia", "Microvascular Decompression Surgery" and "Endoscope". Postoperative facial pain relief and postoperative complications were considered for meta-analysis. All the outcomes were calculated as odds ratios (ORs) with 95% confidence intervals using R language. RESULTS: A total of three studies involving 442 (E-MVD [218] versus M-MVD [224]) patients were included for analysis in our study. Postoperative facial pain relief (very much improved or much improved) was no difference between the two groups (OR, 0.95;95% CI, 0.57-1.58; I2 = 0%; p = 0.83). In addition, the occurrence of some postoperative complications was not statistically different between the two groups, including CSFleak (OR, 1.35;95% CI, 0.16-11.13; I2 = 0%; p = 0.94), facial paralysis (OR, 0.26;95% CI, 0.03-2.54; I2 = 0%; p = 0.67), hearing loss (OR, 0.87;95% CI, 0.30-2.55; I2 = 32%; p = 0.22), facial numbness (OR, 1.03;95% CI, 0.56-1.87; I2 = 62%; p = 0.10). CONCLUSIONS: Both endoscopic microvascular decompression and microscopic microvascular decompression for trigeminal neuralgia appear to provide patients with equivalent facial pain relief outcomes. Complication rates were also similar between the groups.

Age-related Changes in Trigeminal Ganglion Macrophages Enhance Orofacial Ectopic Pain After Inferior Alveolar Nerve Injury.

BACKGROUND/AIM: The ectopic pain associated with inferior alveolar nerve (IAN) injury has been reported to involve macrophage expression in the trigeminal ganglion (TG). However, the effect of age-related changes on this abnormal pain conditions are still unknown. This study sought to clarify the involvement of age-related changes in macrophage expression and phenotypic conversion in the TG and how these changes enhance ectopic mechanical allodynia after IAN transection (IANX). MATERIALS AND METHODS: We used senescence-accelerated mouse (SAM)-prone 8 (SAMP8) and SAM-resistance 1 (SAMR1) mice, which are commonly used to study ageing-related changes. Mechanical stimulation was applied to the whisker pad skin under light anaesthesia; the mechanical head withdrawal threshold (MHWT) was measured for 21 d post-IANX. We subsequently counted the numbers of Iba1 (macrophage marker)-immunoreactive (IR) cells, Iba1/CD11c (M1-like inflammatory macrophage marker)-co-IR cells, and Iba1/CD206 (M2-like anti-inflammatory macrophage marker)-co-IR cells in the TG innervating the whisker pad skin. After continuous intra-TG administration of liposomal clodronate Clophosome®-A (LCCA) to IANX-treated SAMP8-mice, the MHWT values of the whisker pad skin were examined. RESULTS: Five days post-IANX, the MHWT had significantly decreased in SAMP8 mice compared to SAMR1-mice. Iba1-IR and Iba1/CD11c-co-IR cell counts were significantly increased in SAMP8 mice compared to SAMR1 mice 5 d post-IANX. LCCA administration significantly restored MHWT compared to control-LCCA administration. CONCLUSION: Ectopic mechanical allodynia of whisker pad skin after IANX is exacerbated by ageing, which involves increases in M1-like inflammatory macrophages in the TG.

Diagnosis and treatment of intractable idiopathic orofacial pain with attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) has been reported to be associated with primary chronic pain syndromes, such as fibromyalgia, migraine, and chronic low back pain. Although idiopathic orofacial pain (IOP) is classified as burning mouth syndrome or persistent idiopathic facial or dentoalveolar pain and as a primary chronic pain, the association between IOP and ADHD has not been investigated. This retrospective cohort study investigated the severity of ADHD symptoms measured using the ADHD scale and the effects of treatment using ADHD drugs and the dopamine system stabilizer aripiprazole. The participants were 25 consecutive patients with refractory IOP referred to a psychiatrist and diagnosed with coexisting ADHD according to the Diagnostic and Statistical Manual of Mental Disorders-5. The ADHD scale scores were higher in patients with intractable IOP than those in the general population. Pharmacotherapy used in this study led to clinically significant improvements in pain, anxiety/depression, and pain catastrophizing. Intractable IOP and ADHD were shown to be associated. In the future, screening and pharmacotherapy for ADHD should be considered in the treatment of intractable IOP.

Granulomatosis with polyangiitis mistaken as a temporomandibular joint disorder: A case report.

INTRODUCTION: Granulomatosis with polyangiitis (GPA), is a rare systemic disease that if left untreated, it may lead to death within 6-12 months. This case report describes a 15-year-old female with a 14-month history of epiphora, nasal breathing difficulties, headaches, and jaw pain. The patient reported having various medical procedures attempted to address her symptoms. The classical presentation of strawberry gingivitis led to the diagnosis of GPA. Based on a multi-language search, this is the first reported case, that GPA is mistaken as Temporomandibular Joint Disorders (TMD). CASE PRESENTATION: A 15-year-old female with nearly 14 months of numerous complaints, including headaches and jaw pain, was referred for an orofacial pain (OFP) consultation. The patient had completed a dental examination and was prescribed chlorhexidine for gingivitis control. The OFP examination was not consistent with signs and symptoms of TMD. However, the gingival appearance of strawberry gingivitis was suggestive of GPA. A rheumatologist confirmed the diagnosis of GPA based on the clinical interview, serology testing, and dental findings. A course of rituximab and corticosteroids, and regular dental cleanings were recommended. A 4-month follow-up visit demonstrated complete resolution of her jaw pain and headaches. Gingival tissue appeared normal. CONCLUSION: This case emphasizes the need for familiarity with systemic diseases that can present oral manifestations. It also stresses the importance for dental professionals to be knowledgeable of differential diagnoses for TMD, headaches, and autoimmune disorders. Why is this case new information? This is believed to be the first published case mistaking GPA as TMD. This is a case in which a multidisciplinary approach and management were keys for a successful treatment outcome. What are the keys to successful management of this case? Obtain a thorough clinical history. Know the oral manifestation of systemic diseases. Know differential diagnosis of TMD and headaches. What are the primary limitations to success in this case? Having no access to the medical records during the OFP consultation. Having no awareness of differential diagnosis for gingivitis: strawberry, plaque-induced.

Assessment of epidermoid cyst with trigeminal neuralgia before neuroendoscopy: A high-resolution MR study based on 3D-FIESTA and MR angiography.

PURPOSE: To assess the value of preoperative 3D-FIESTA and MR angiography (MRA) in endoscopic resection of epidermoid cysts presenting with trigeminal neuralgia (TN). METHODS: 3D-FIESTA and MRA were performed before neuroendoscopy in 32 cases of epidermoid cysts with TN, and the tumors were grouped into types A, B, C, and D according to the relationship between the tumor and adjacent nerves and arteries (Hitoshi Kobata's classification). Evaluation of the neuroendoscopic resectability of different types of tumors, included gross total tumor removal (GTR), subtotal tumor removal (STR), and partial tumor removal (PTR). During the 5-year follow-up, symptoms were assessed based on facial pain relief using the Barrow Neurological Institute (BNI) score. RESULTS: The coincidence rate between MRI classification of the tumor and the operation was 100%. Type B tumors were the most common (18/32, 56.3%). Type A tumors showed the highest resectability (9/9, 100%), followed by type B tumors (14/18, 77.8%). Moreover, microvascular decompression was performed in all 4 cases of type C and 1 case of type D tumors. During follow-up, 23 patients showed marked improvement in symptoms (15, 8 of BNI I or II), 8 cases showed partial improvement (BNI III), and only 1 case of type C tumor was associated with poor facial pain relief, which recurred 5 years later (BNI IV). CONCLUSIONS: Preoperative high-resolution MR can accurately analyze the relationship between epidermoid cysts and adjacent nerves and arteries. It could act as a powerful tool in the evaluation of tumor resectability and the prognosis of surgery.

[My tongue is burning!-Glossodynia/orofacial pain disorder]. / Meine Zunge brennt! ­ Glossodynie/orofaziales Schmerzsyndrom.

Glossodynia or orofacial pain disorder is known as burning mouth syndrome. It is a therapeutic challenge. Its etiology is not well defined. Recent studies show not only a correlation with neuropathic changes, but there are also indications of comorbidities such as depression, anxiety, and carcinophobia. These can also manifest as a reaction to the disease and are not necessarily considered causative. Burning mouth syndrome poses a diagnostic challenge since its differential diagnosis is broad. With regard to dermatological aspects, lichen planus mucosae, oral leucoplakia, pemphigus vulgaris, and aphthous mouth ulcers should be considered. Diabetes, anemia, vitamin deficiency, and endocrinological influences should be considered regarding the predominance of elderly and female patients. Meta-analyses of treatment studies usually show a low level of evidence of the randomized, controlled trials. According to the literature mainly psychotherapy and antidepressants are proposed for therapy. Alpha lipoic acid as a dietary supplement shows short-term improvement and low-level laser therapy might have some benefit.

The association between myofascial orofacial pain with and without referral and widespread pain.

OBJECTIVES: Pain referral on palpation has been suggested to be a clinical sign of central sensitization potentially associated with widespread pain conditions. Our aim was to evaluate if myofascial pain with referral is a better predictor for widespread pain when compared to no pain or local myofascial pain. MATERIALS AND METHODS: Individuals at the Public Dental services in Västerbotten, Sweden, were randomly invited based on their answers to three screening questions for temporomandibular disorders (TMD). In total, 300 individuals (202 women, 20-69 yrs) were recruited, and examined according to the Diagnostic Criteria for TMD (DC/TMD) after completion of a body pain drawing. Widespread pain was considered present when seven or more pain sites were reported on the widespread pain index. A binary logistic regression model, adjusted for the effect of age and gender were used to evaluate the association between myofascial orofacial pain and widespread pain. RESULTS: Widespread pain was reported by 31.3% of the study sample. There was a 57.3% overlap with myofascial pain. Widespread pain was associated to myofascial orofacial pain with and myofascial orofacial pain (OR 4.83 95% CI 2.62-9.05 and OR 11.62 95% CI 5.18-27.88, respectively). CONCLUSION: These findings reinforce the existing knowledge on the overlap between painful TMD and other chronic pain conditions.

Olfactory dysfunction in COVID-19, new insights from a cohort of 353 patients: The ANOSVID study.

Olfactory disorders (OD) pathogenesis, underlying conditions, and prognostic in coronavirus disease 2019 (COVID-19) remain partially described. ANOSVID is a retrospective study in Nord Franche-Comté Hospital (France) that included COVID-19 patients from March 1 2020 to May 31 2020. The aim was to compare COVID-19 patients with OD (OD group) and patients without OD (no-OD group). A second analysis compared patients with anosmia (high OD group) and patients with hyposmia or no OD (low or no-OD group). The OD group presented less cardiovascular and other respiratory diseases compared to the no-OD group (odds ratio [OR] = 0.536 [0.293-0.981], p = 0.041 and OR = 0.222 [0.056-0.874], p = 0.037 respectively). Moreover, history of malignancy was less present in the high OD group compared with the low or no-OD group (OR = 0.170 [0.064-0.455], p < 0.001). The main associated symptoms (OR > 5) with OD were loss of taste (OR = 24.059 [13.474-42.959], p = 0.000) and cacosmia (OR = 5.821 [2.246-15.085], p < 0.001). Most of all ORs decreased in the second analysis, especially for general, digestive, and ENT symptoms. Only two ORs increased: headache (OR = 2.697 [1.746-4.167], p < 0.001) and facial pain (OR = 2.901 [1.441-5.842], p = 0.002). The high OD group had a higher creatinine clearance CKD than the low or no-OD group (89.0 ± 21.1 vs. 81.0 ± 20.5, p = 0.040). No significant difference was found concerning the virological, radiological, and severity criteria. OD patients seem to have less comorbidity, especially better cardiovascular and renal function. Associated symptoms with OD were mostly neurological symptoms. We did not find a significant relationship between OD and less severity in COVID-19 possibly due to methodological bias.

Craniofacial neuralgias.

While non-headache, non-oral craniofacial neuralgia is relatively rare in incidence and prevalence, it can result in debilitating pain. Understanding the relevant anatomy of peripheral branches of nerves, natural history, clinical presentation, and management strategies will help the clinician better diagnose and treat craniofacial neuralgias. This article will review the nerves responsible for neuropathic pain in periorbital, periauricular, and occipital regions, distinct from idiopathic trigeminal neuralgia. The infratrochlear, supratrochlear, supraorbital, lacrimal, and infraorbital nerves mediate periorbital neuralgia. Periauricular neuralgia may involve the auriculotemporal nerve, the great auricular nerve, and the nervus intermedius. The greater occipital nerve, lesser occipital nerve, and third occipital nerve transmit occipital neuralgias. A wide range of treatment options exist, from modalities to surgery, and the evidence behind each is reviewed.

A new biofeedback approach for the control of awake bruxism and chronic migraine headache: utilization of an awake posterior interocclusal device / Uma nova abordagem via biofeedback para o controle do bruxismo de vigília e de enxaqueca crônica: utilização de um dispositivo interoclusal posterior em vigília

ABSTRACT Background: The relationship of bidirectional comorbidity between chronic migraine and pain in the cephalic segment led us to evaluate the improvement in reducing the pain in patients diagnosed with chronic migraine headache and awake bruxism, when undergoing treatment with a partial posterior interocclusal device designed for the management and control of awake bruxism through biofeedback. Methods: Seventy-four patients were evaluated during the following periods: pretreatment, seven, thirty, ninety, one hundred and eighty days, and one year. The evaluation was carried out by measuring the pain in the pretreatment period and pain reduction after awake bruxism treatment, using clinical evaluation and numerical scales for pain. Results: Most of the patients who complained of headache migraine pain, masticatory myofascial pain, temporomandibular joint and neck pain experienced a significant reduction in overall pain, including headaches, between t0 and t30 (p<0.0001). After 30 days of using the device, it was observed that the improvement remained at the same level without any recurrence of pain up to t90. At t180 and t360, it was observed that even with the device withdrawal (at t90) the improvement remained at the same level. Conclusion: The utilization of a posterior interocclusal device designed for the management and control of awake bruxism through biofeedback seems to contribute to the reduction of pain (including migraine headache) in the majority of patients, and, even with the device withdrawal (at t90), the improvement remained at the same level, suggesting the patients succeeded in controlling their awake bruxism and consequently the pains.

RESUMO Introdução: A relação de comorbidade bidirecional entre enxaqueca crônica e dor no segmento cefálico nos levou a avaliar a melhora na redução da dor em pacientes diagnosticados com cefaleia crônica de enxaqueca e bruxismo de vigília, quando submetidos a tratamento com dispositivo interoclusal posterior parcial projetado para o manejo e o controle do bruxismo acordado através de biorretroalimentação (biofeedback). Métodos: Setenta e quatro pacientes foram avaliados durante os seguintes períodos: pré-tratamento, sete, trinta, noventa e cento e oitenta dias, e um ano. A avaliação foi realizada por meio da avaliação da dor no período pré-tratamento e redução da dor após o tratamento do bruxismo de vigília, através de avaliação clínica e escalas numéricas de dor. Resultados: A maioria dos pacientes que se queixou de dor de cabeça com enxaqueca, dor miofascial mastigatória, articulação temporomandibular e dor no pescoço sofreu uma redução significativa na dor geral, incluindo dores de cabeça, entre t0 e t30 (p<0,0001). Após 30 dias de uso do dispositivo, observou-se que a melhora permaneceu no mesmo nível, sem recorrência da dor até t90. Em t180 e t360, observou-se que, mesmo com a retirada do dispositivo (em t90), a melhoria permaneceu no mesmo nível. Conclusão: A utilização de um dispositivo interoclusal posterior projetado para o controle do bruxismo de vigília através de biofeedback parece contribuir para a redução da dor (incluindo enxaqueca) na maioria dos pacientes, e, mesmo com a retirada do dispositivo (t90), a melhora manteve-se no mesmo nível, sugerindo que os pacientes conseguiram controlar o seu bruxismo de vigília e a dor associada a esse hábito.

Peripheral mechanisms contribute to comorbid visceral hypersensitivity induced by preexisting orofacial pain and stress in female rats.

BACKGROUND: Stress exacerbates many chronic pain syndromes including irritable bowel syndrome (IBS). Among these patient populations, many suffer from comorbid or chronic overlapping pain conditions and are predominantly female. Nevertheless, basic studies investigating chronic psychological stress-induced changes in pain sensitivity have been mostly carried out in male rodents. Our laboratory developed a model of comorbid pain hypersensitivity (CPH) (stress in the presence of preexisting orofacial pain inducing chronic visceral pain hypersensitivity that significantly outlasts transient stress-induced pain hypersensitivity (SIH)) facilitating the study of pain associated with IBS. Since CPH and SIH are phenotypically similar until SIH resolves and CPH persists, it is unclear if underlying mechanisms are similar. METHODS: In the present study, the visceromotor response (VMR) to colorectal distention was recorded in the SIH and CPH models in intact females and ovariectomized rats plus estradiol replacement (OVx + E2). Over several months, rats were determined to be susceptible or resilient to stress and the role of peripheral corticotrophin-releasing factor (CRF) underlying in the pain hypersensitivity was examined. KEY RESULTS: Stress alone induced transient (3-4 weeks) visceral hypersensitivity, though some rats were resilient. Comorbid conditions increased susceptibility to stress prolonging hypersensitivity beyond 13 weeks. Both models had robust peripheral components; hypersensitivity was attenuated by the CRF receptor antagonist astressin and the mast cell stabilizer disodium cromoglycate (DSCG). However, DSCG was less effective in the CPH model compared to the SIH model. CONCLUSIONS AND INFERENCES: The data indicate many similarities but some differences in mechanisms contributing to comorbid pain conditions compared to transient stress-induced pain.

Myofascial pain, widespread pressure hypersensitivity, and hyperalgesia in the face, neck, and shoulder regions, in survivors of head and neck cancer.

PURPOSE: Medical treatment for head and neck cancer may induce the presence of inflammation, pain, and dysfunction. The purpose of the current study was to assess the presence of myofascial trigger points (TrPs) and their relationship with widespread pressure hypersensitivity and hyperalgesia in survivors of head and neck cancer (sHNC). METHODS: TrPs and pressure-pain thresholds (PPTs) were quantified in different muscles/joints in the head and neck of 30 sHNC (59.45 ± 13.13 years) and 28 age- and sex-matched controls (58.11 ± 12.67 years). RESULTS: The sHNC had more TrPs in all muscles on the affected side (p < 0.05) than did the healthy controls, and in the temporalis, masseter, and suboccipitalis muscles on the unaffected side (p < 0.05). They also had lower PPTs in all places (p < 0.05) except for the temporalis muscle (p = 0.114) and C5-C6 joint (p = 0.977). The intensity of cervical pain correlated positively with the presence of upper trapezius TrPs. CONCLUSIONS: sHNC suffering cervical and/or temporomandibular joint pain have multiple active TrPs and experience widespread pressure hypersensitivity and hyperalgesia, suggestive of peripheral and central sensitization.

Histone deacetylase inhibitors prevent persistent hypersensitivity in an orofacial neuropathic pain model.

Chronic orofacial pain is a significant health problem requiring identification of regulating processes. Involvement of epigenetic modifications that is reported for hindlimb neuropathic pain experimental models, however, is less well studied in cranial nerve pain models. Three independent observations reported here are the (1) epigenetic profile in mouse trigeminal ganglia (TG) after trigeminal inflammatory compression (TIC) nerve injury mouse model determined by gene expression microarray, (2) H3K9 acetylation pattern in TG by immunohistochemistry, and (3) efficacy of histone deacetylase (HDAC) inhibitors to attenuate development of hypersensitivity. After TIC injury, ipsilateral whisker pad mechanical sensitization develops by day 3 and persists well beyond day 21 in contrast to sham surgery. Global acetylation of H3K9 decreases at day 21 in ipsilateral TG . Thirty-four genes are significantly ( p < 0.05) overexpressed in the ipsilateral TG by at least two-fold at either 3 or 21 days post-trigeminal inflammatory compression injury. The three genes most overexpressed three days post-trigeminal inflammatory compression nerve injury are nerve regeneration-associated gene ATF3, up 6.8-fold, and two of its regeneration-associated gene effector genes, Sprr1a and Gal, up 174- and 25-fold, respectively. Although transcription levels of 25 of 32 genes significantly overexpressed three days post-trigeminal inflammatory compression return to constitutive levels by day 21, these three regeneration-associated genes remain significantly overexpressed at the later time point. On day 21, when tissues are healed, other differentially expressed genes include 39 of the top 50 upregulated and downregulated genes. Remarkably, preemptive manipulation of gene expression with two HDAC inhibitors (HDACi's), suberanilohydroxamic acid (SAHA) and MS-275, reduces the magnitude and duration of whisker pad mechanical hypersensitivity and prevents the development of a persistent pain state. These findings suggest that trigeminal nerve injury leads to epigenetic modifications favoring overexpression of genes involved in nerve regeneration and that maintaining transcriptional homeostasis with epigenetic modifying drugs could help prevent the development of persistent pain.

The therapeutic potential of cystathionine gamma-lyase in temporomandibular inflammation-induced orofacial hypernociception.

Hydrogen sulfide (H2S) is an endogenous neuromodulator produced mainly by the enzyme cystathionine gamma-lyase (CSE) in peripheral tissues. A pronociceptive role of endogenously produced H2S has been previously reported by our group in a model of orofacial inflammatory pain. Using the established persistent orofacial pain rat model induced by complete Freund's adjuvant (CFA) injection into temporomandibular joint (TMJ), we have now investigated the putative role of endogenous H2S modulating hypernociceptive responses. Additionally, plasmatic extravasation on TMJ was measured following different treatments by Evans blue dye quantification. Thus, rats were submitted to Von Frey and Formalin tests in orofacial region before and after pharmacological inhibition of the CSE-H2S system combined or not with CFA-induced TMJ inflammation. Pretreatment with CSE inhibitor, propargylglycine (PAG; 88.4 µmol/kg) reduced temporomandibular inflammatory pain when injected locally as well as systemically. In particular, local PAG injection seems to be more effective for hypernociceptive responses in orofacial persistent inflammation since its action is evidenced in the majority analyzed periods of the inflammatory process compared to its systemic use. Moreover, local injection seems to act on temporomandibular vascular permeability, evidenced by decreased plasmatic extravasation induced by local PAG administration. Our data are consistent with the notion that the endogenous synthetized gas H2S modulates persistent orofacial pain responses revealing the pharmacological importance of the CSE inhibitor as a possible therapeutic target for their control.

A systematic review of the comorbidity between Temporomandibular Disorders and Chronic Fatigue Syndrome.

UNLABELLED: The most common cause of chronic oro-facial pain is a group of disorders collectively termed temporomandibular disorders (TMDs). Chronic painful TMD is thought to be a 'central sensitivity syndrome' related to hypersensitivity of the nervous system, but the cause is unknown. A similar understanding is proposed for other unexplained conditions, including chronic fatigue syndrome (CFS). Exploring the comorbidity of the two conditions is a valuable first step in identifying potential common aetiological mechanisms or treatment targets. METHOD: Systematic literature review. Studies were included if they recruited community or control samples and identified how many reported having both TMD and CFS, or if they recruited a sample of patients with either TMD or CFS and measured the presence of the other condition. RESULTS: Six papers met inclusion criteria. In studies of patients with CFS (n = 3), 21-32% reported having TMD. In a sample of people with CFS and fibromyalgia, 50% reported having TMD. Studies in people with TMD (n = 3) reported 0-43% having CFS. Studies in samples recruited from oro-facial pain clinics (n = 2) reported a lower comorbidity with CFS (0-10%) than a study that recruited individuals from a TMD self-help organisation (43%). CONCLUSION: The review highlights the limited standard of evidence addressing the comorbidity between oro-facial pain and CFS. There is a valuable signal that the potential overlap in these two conditions could be high; however, studies employing more rigorous methodology including standardised clinical assessments rather than self-report of prior diagnosis are needed.

The role of Nav1.9 channel in the development of neuropathic orofacial pain associated with trigeminal neuralgia.

BACKGROUND: Trigeminal neuralgia is accompanied by severe mechanical, thermal and chemical hypersensitivity of the orofacial area innervated by neurons of trigeminal ganglion (TG). We examined the role of the voltage-gated sodium channel subtype Nav1.9 in the development of trigeminal neuralgia. RESULTS: We found that Nav1.9 is required for the development of both thermal and mechanical hypersensitivity induced by constriction of the infraorbital nerve (CION). The CION model does not induce change on Nav1.9 mRNA expression in the ipsilateral TG neurons when evaluated 9 days after surgery. CONCLUSIONS: These results demonstrate that Nav1.9 channels play a critical role in the development of orofacial neuropathic pain. New routes for the treatment of orofacial neuropathic pain focussing on regulation of the voltage-gated Nav1.9 sodium channel activity should be investigated.

Central and peripheral pain generators in women with chronic pelvic pain: patient centered assessment and treatment.

Women with chronic pelvic pain (CPP) often present without obvious cause on imaging studies, laboratory values or physical exam. Dysfunctional sensory processing in the central nervous system (CNS) may explain pain of unclear origin. Central sensitization (CS), a mechanism of centrally mediated pain, describes this abnormal processing of sensory information. Women with CPP often present with several seemingly unrelated symptoms. This can be explained by co-existing chronic pain syndromes occurring in the same patient. Central sensitization occurs in all of these pain syndromes, also described as dysfunctional pain syndromes, and thus may explain why several often occur in the same patient. Six of the most common pain disorders that co-exist in CPP include endometriosis, painful bladder syndrome/interstitial cysitis, vulvodynia, myofascial pain/ pelvic floor hypertonus, irritable bowel syndrome, and primary dysmenorrhea. Central pain generators, (pain originating from CS) and peripheral pain generators, (pain from local tissue damage), can both occur in each of these six conditions. These pain generators will be described. Chronic pain, specifically dysfunctional sensory processing, is recognized as a systemic disease process like diabetes to be managed as opposed to a local problem to be "fixed" or cured. A multi-disciplinary approach to assessment and treatment with a focus on improving emotional, physical and social functioning instead of focusing strictly on pain reduction is more effective in decreasing disability. This is best achieved by determining the patient's needs and perspective through a patient-centered approach. Algorithms for such an approach to assessment and treatment are outlined.

Trigeminal Inflammatory Compression (TIC) injury induces chronic facial pain and susceptibility to anxiety-related behaviors.

Our laboratory previously developed a novel neuropathic and inflammatory facial pain model for mice referred to as the Trigeminal Inflammatory Compression (TIC) model. Rather than inducing whole nerve ischemia and neuronal loss, this injury induces only slight peripheral nerve demyelination triggering long-term mechanical allodynia and cold hypersensitivity on the ipsilateral whisker pad. The aim of the present study is to further characterize the phenotype of the TIC injury model using specific behavioral assays (i.e. light-dark box, open field exploratory activity, and elevated plus maze) to explore pain- and anxiety-like behaviors associated with this model. Our findings determined that the TIC injury produces hypersensitivity 100% of the time after surgery that persists at least 21 weeks post injury (until the animals are euthanized). Three receptive field sensitivity pattern variations in mice with TIC injury are specified. Animals with TIC injury begin displaying anxiety-like behavior in the light-dark box preference and open field exploratory tests at week eight post injury as compared to sham and naïve animals. Panic anxiety-like behavior was shown in the elevated plus maze in mice with TIC injury if the test was preceded with acoustic startle. Thus, in addition to mechanical and cold hypersensitivity, the present study identified significant anxiety-like behaviors in mice with TIC injury resembling the clinical symptomatology and psychosocial impairments of patients with chronic facial pain. Overall, the TIC injury model's chronicity, reproducibility, and reliability in producing pain- and anxiety-like behaviors demonstrate its usefulness as a chronic neuropathic facial pain model.