The effect of the twin block compared with trigger point injections in patients with masticatory myofascial pain: a pilot study.

OBJECTIVE: The twin block, a novel nerve block that blocks the deep temporal and masseteric branches of the trigeminal nerve, has been shown to be effective in the short-term management of masticatory myofascial pain. However, little is known about its effectiveness in long-term management. The objective of this study was to assess the efficacy of the twin block in comparison with trigger point injections for the treatment of masticatory myofascial pain. STUDY DESIGN: Forty-eight patients age 18 to 89 years were randomly assigned to the twin block group (n = 23) or the trigger point injection group (n = 25). The final analysis was based on a total number of 40 patients. RESULTS: Mean numerical pain intensity at baseline was 6.54 ± 1.90 for the trigger point injection group and 6.47 ± 2.23 for the twin block group. At the 6th month visit, it was 1.85 ± 1.85 for the trigger point injection group and 1.85 ± 1.94 for the twin block group. There were no statistically significant differences in pain intensity between the 2 groups at baseline (P = .64) and at the 6th month follow-up (P = .45). CONCLUSIONS: The twin block is effective in the long-term management of masticatory myofascial pain compared with trigger point injections. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03870191.

What should we tell patients with painful temporomandibular disorders about what to eat?

BACKGROUND AND OVERVIEW: Patients with painful temporomandibular disorders (TMD) commonly report problems eating, owing to limited mandibular opening and pain and discomfort with biting and chewing. Consequently, painful TMD may affect dietary intake and nutritional status. CONCLUSIONS: Treatment of painful TMD is multifaceted and involves pharmacologic, physical, and cognitive behavior and dietary therapies. Painful TMD may influence the quality of dietary intake and eating behaviors. There is a dearth of established guidelines and validated measures that clinicians can use to assess and manage diet and nutritional well-being in patients with this disorder. The authors present recommendations in an effort to guide clinicians on how to help patients with painful TMD improve the quality of their diets and avoid or minimize eating-related pain. PRACTICAL IMPLICATIONS: Providing comprehensive care for patients with painful TMD should include diet evaluation and recommendations for eating comfortably and supporting nutrition. An interprofessional approach may help improve treatment outcomes. Research is needed to develop evidence-based guidelines for diet and nutrition that clinicians can use in the care of patients with painful TMD.

Acupuncture modulates facial warm sensory thresholds.

AIMS: To assess the effects of four- and six-point acupuncture on facial sensory detection thresholds to thermal and electrical stimuli. METHODS: Ten healthy volunteers underwent four-point acupuncture at ST6 and LI4 bilaterally for 15 minutes. A further 10 subjects underwent six-point acupuncture by adding needling at ST2 bilaterally. Sensory testing to thermal and electrical stimuli applied to mental and infraorbital nerve dermatomes was performed at baseline, 10 minutes, 1 hour, and 1 day after needling. RESULTS: In the mental and infraorbital nerve dermatomes, six-point acupuncture significantly increased warm threshold by a peak mean of 1.1°C to 1.4°C (repeated measures ANOVA P = .001) and this effect was significant at all time points relative to baseline (P < .05). No significant effects were observed by the four-point acupuncture on warm thresholds, and neither four- nor six-point acupuncture significantly altered electrical detection thresholds. CONCLUSION: A dose effect, related to the number of points employed, may be present when employing acupuncture.

Prolonged gingival cold allodynia: a novel finding in patients with atypical odontalgia.

OBJECTIVE: The aim of this study was to examine atypical odontalgia (AO) patients with extraoral quantitative sensory testing (EQST) and an intraoral mucosal cold test. STUDY DESIGN: Twenty-one subjects with AO and 18 control subjects underwent EQST for electrical and thermal pain and detection thresholds. Cold was applied to painful mucosal areas in AO patients and randomly in control subjects. RESULTS: Electrical pain thresholds were higher in AO patients than in control subjects in the same dermatome affected by the pain (P = .03), but no significant differences were observed in electrical detection thresholds and heat pain and detection thresholds at other sites. Cold application was painful in control and AO subjects, but duration of pain sensation was significantly longer in AO patients (P = .019 in contralateral side; P = .029 in affected side). CONCLUSIONS: The finding of extended painful aftersensation following cold application in AO patients supports the involvement of central mechanisms. The cold test is clinically easy to apply and of clinically significant value.

Management of neuropathic orofacial pain.

Current management of painful trigeminal neuropathies relies on pharmacological (topical and systemic), surgical, and complementary modalities. There is, however, a lack of quality research relating to the effectiveness of these modalities. In this review we analyze the available data that relates to the therapy of trigeminal neuralgia, postherpetic neuralgia, and posttraumatic neuropathies and provide clinical guidelines. The review focuses on medical management, as well as surgical and other interventions for painful neuropathies.