Characteristics and prevalence of orofacial pain as an initial symptom of oral and oropharyngeal cancer and its impact on the patient's functionality and quality of life.

OBJECTIVE: To evaluate the prevalence and characteristics of orofacial pain in oral and oropharyngeal cancer (OOC), at diagnosis. MATERIAL AND METHODS: a) Study group (SG; n = 74) patients with cancer were divided into 2 subgroups: oral cancer (OC) and oropharyngeal cancer (OPC); b) control group (CG; n = 74) patients within dental care. STUDY DESIGN: An Orofacial Pain Assessment, verbal descriptive scale, Helkimo dysfunction index, Quality of Life questionnaire, and Karnofsky performance status (KPS) was used for evaluation. RESULTS: The mean age was 58.46 years (79.7% male) in SG, 58.61 years (20.3% male) in CG. The pain within the SG was indicated by the following: prevalence = 91.9% (21.6% in stages 0, I, or II; 70.3% in III or IV); reason for seeking care = 50.1%; main complaint = 55.4%; most important issue in the past 7 days = 74.3%; breakthrough-like pain = 64.9%; main features: chewing or swallowing as triggering factors, wake up patient, variable duration, independent of daytime, multiple descriptors, and earache. The following indexes were worse within the SG: clinical dysfunction, quality of life, and KPS. In addition, the OC subgroup reported toothache-like pain and burning; whereas the OPC subgroup reported heavy swallowing as triggering factor, throat as location, and a bilateral earache. CONCLUSION: At diagnosis, orofacial pain, including breakthrough-like pain, was prevalent in patients with OOC, and the pattern was heterogeneous. Predominantly, the pain was moderate to severe, related to stage of cancer, and already compromising the patients' quality of life and functionality.

Effectiveness of Laser Therapy and Laser Acupuncture on Treating Paraesthesia After Extraction of Lower Third Molars.

Objective: This randomized clinical trial evaluated the sensitive return of the lower alveolar nerve (LAN) using two photobiomodulation therapy (PBMT) techniques, after the extraction of lower third molars or implant surgery. Materials and methods: Sixty participants with sensory impairment of LAN were randomly divided into three groups (n = 20): group C-systemic medication (control-ETNA®, 01 capsule, 8/8 h, 30 days); group laser therapy (LT) (808 nm, 100 mW, 40 sec/point, 4 J/point, intra/extraoral, irradiation following nerve path); group laser acupuncture (LA) (same parameters as the LT group, applied at six acupuncture points on the affected side (ST 4 [Dicang], M-HN-18 [Jiachengjiang], CV 24 [Chengjiang], ST 5 [Daying], ST 6 [Jiache], and point A1 [YNSA]). The following evaluations were performed, at predetermined times: general perception of paresthesia, thermal perception, vibratory mechanical perception, two-point discrimination, pain perception, and tactile perception. Data were analyzed by two-way analysis of variance (ANOVA), followed by the Tukey, except for the two-point discrimination, which was analyzed using the chi-square test. Results: In general and thermal perception, both PBMTs had better results than control; regarding cold perception, only the LT group was statistically superior to control. LA presented inferior results of neural regeneration for tests of perception of pain and tactile at the lip, and of tactile perception at the chin. In the other tests, there was no statistical difference among the groups. Conclusions: LT and the conventional drug treatment had the same effectiveness and both were superior to LA for the treatment of paresthesia of the LAN after oral surgeries.

Chronic facial pain: different comorbidities and characteristics between neuropathic and nonneuropathic conditions.

OBJECTIVE: The aim of this study was to investigate the association between comorbidities and chronic diseases and neuropathic and nonneuropathic orofacial pain diagnoses to suggest subclassifications of disease. STUDY DESIGN: This was a cross-sectional, retrospective, case-control study. We evaluated 174 patients with orofacial pain and 132 controls by using a systematic protocol that consisted of medical history and demographic, pain, and orofacial characteristics. Patients were grouped according to their diagnosis-neuropathic or non-neuropathic pain; medical comorbidities; and exclusion criteria. Analyses included Z-score normalization, χ2 test, Fisher's exact test, 1-way analysis of variance (ANOVA), Student t test, Pearson's correlation coefficient, 2-step clustering, and logistic regression at 95% confidence level. RESULTS: Functional chronic diseases were prevalent and correlated with pain and orofacial features. Three groups were identified in the cluster analysis: neuropathic facial pain, other orofacial pain syndromes, and fibromyalgia/temporomandibular disorders (TMDs). Logistic regression showed that hypothyroidism and gastritis were predictors for nonneuropathic orofacial conditions. Psychiatric diseases and gastritis were more prevalent among patients with generalized pain syndromes and TMDs and less prevalent among patients with neuropathic pain. CONCLUSIONS: Functional comorbidities were associated with orofacial and dental features and may correspond to multimorbidity states in patients with chronic orofacial pain. The findings support the hypothesis that nonneuropathic orofacial pain syndromes could be functional disorders.

Increased Anxiety-Like Behavior in the Acute Phase of a Preclinical Model of Periodontal Disease.

Periodontal disease (PD) is an infectious-inflammatory oral disease that is highly prevalent among adolescence and adulthood and can lead to chronic orofacial pain and be associated with anxiety, stress and depression. This study aimed to identify anxiety-like behaviors in the ligature-induced murine preclinical model of PD in different phases of the disease (i.e., acute vs. chronic). Also, we investigated orofacial mechanical allodynia thresholds and superficial cortical plasticity along the orofacial motor cortex in both disease phases. To this aim, 25 male Wistar rats were randomly allocated in acute (14 days) or chronic (28 days) ligature-induced-PD groups and further divided into active-PD or sham-PD. Anxiety-like behavior was evaluated using the elevated plus maze, mechanical allodynia assessed using the von Frey filaments test and superficial motor cortex mapping was performed with electrical transdural stimulation. We observed increased anxiety-like behavior in active-PD animals in the acute phase, characterized by decreased number of entries into the open arm extremities [t (1,7) = 2.42, p = 0.04], and reduced time spent in the open arms [t (1,7) = 3.56, p = 0.01] and in the open arm extremities [t (1,7) = 2.75, p = 0.03]. There was also a reduction in the mechanical allodynia threshold in all active-PD animals [Acute: t (1,7) = 8.81, p < 0.001; Chronic: t (1,6) = 60.0, p < 0.001], that was positively correlated with anxiety-like behaviors in the acute group. No differences were observed in motor cortex mapping. Thus, our findings show the presence of anxiety-like behaviors in the acute phase of PD making this a suitable model to study the impact of anxiety in treatment response and treatment efficacy.

Existential Meaning of Patients with Chronic Facial Pain.

Coping strategies are necessary to deal with pain, one of the most disabling conditions. Treatments are often refractory, and the elaboration of existential meaning is necessary to live with residual pain. The objective of this study was to discuss the relevance of the meaning of life in coping with refractory chronic neuropathic facial pain according to singular cases. Each patient is unique and needs a singular approach to understand and treat the pain phenomenon. Self-transcendence, existential issues and philosophical values are central concepts to assess chronic conditions and should be highlighted in medical practice these days.

Post-operative orofacial pain, temporomandibular dysfunction and trigeminal sensitivity after recent pterional craniotomy: preliminary study.

BACKGROUND: Surgical trauma at the temporalis muscle is a potential cause of post-craniotomy headache and temporomandibular disorders (TMD). The aim of this study was to evaluate the prevalence of pain, masticatory dysfunction and trigeminal somatosensory abnormalities in patients who acquired aneurysms following pterional craniotomy. METHODS: Fifteen patients were evaluated before and after the surgical procedure by a trained dentist. The evaluation consisted of the (1) research diagnostic criteria for TMD, (2) a standardized orofacial pain questionnaire and (3) a systematic protocol for quantitative sensory testing (QST) for the trigeminal nerve. RESULTS: After pterional craniotomy, 80% of the subjects, 12 patients, developed orofacial pain triggered by mandibular function. The pain intensity was measured by using the visual analog scale (VAS), and the mean pain intensity was 3.7. The prevalence of masticatory dysfunction was 86.7%, and there was a significant reduction of the maximum mouth opening. The sensory evaluation showed tactile and thermal hypoesthesia in the area of pterional access in all patients. CONCLUSIONS: There was a high frequency of temporomandibular dysfunction, postoperative orofacial pain and trigeminal sensory abnormalities. These findings can help to understand several abnormalities that can contribute to postoperative headache or orofacial pain complaints after pterional surgeries.

Effects of localized versus widespread TMD pain on sleep parameters in patients with bruxism: A single-night polysomnographic study.

OBJECTIVE: The purpose of this study was to investigate whether the presence of concomitant widespread pain could influence the polysomnographic characteristics of patients with Sleep Bruxism(SB) and chronic masticatory muscle pain(TMD). METHODS: 20 SB/TMD patients (17 women and 3 men) were evaluated according to the RDC/TMD questionnaire; and were divided into two groups according to the absence (Group A) or presence (Group B) of widespread pain. They were evaluated in a one night polysomnography paradigm. RESULTS: Group B had lower sleep efficiency (p=0.034) and higher mean age (p=0.000) than Group A. Self-reported orofacial pain complaints, clinical and emotional aspects (RDC/TMD Axis I and II), and SB PSG parameters were similar in both groups; all patients had masticatory myofascial pain and the pain characteristics were bilateral location (95.0%) and tightness/pressure quality (70.0%). CONCLUSIONS: At a single-night PSG, SB/TMD patients with widespread pain presented lower PSG sleep efficiency and higher mean age.

Influence of Sexual Hormones on Neural Orofacial Perception.

OBJECTIVE: To investigate the trigeminal somatosensory (thermal, pain, tactile, vibratory, and electric), gustative (salty, bitter, sweet, sour), and olfactory thresholds in healthy women during the menstrual cycle and investigate any association with estradiol and progesterone levels in saliva. METHODS: We examined/tested 39 women between age 19 and 47 years and with regular menstrual cycles and no comorbidities. All women were informed about the purposes of the study, and only those who signed the informed consent were included. The tests were performed at three stages within the cycle: menstrual phase, follicular phase, and luteal phase. The procedure consisted of saliva collection at the beginning of each session to measure hormone levels, salivary flow, somatosensory evaluation with quantitative sensory testing applied to the right trigeminal maxillary branch and right forearm, gustative (sweet [glucose], salt [sodium chloride], sour [citric acid], and bitter [urea]) and olfactory (isopropanol at different concentrations) thresholds. RESULTS: During the menstrual cycle, thresholds for sweet, salty, sour, cold, vibration, and deep pain decreased, but warmth, electrical, and superficial pain thresholds increased. The bitter threshold was high, and the olfactory threshold was low in the follicular phase. Low estrogen levels were correlated to high deep pain thresholds in the forearm ( P = 0.008) and face ( P = 0.041), high tactile thresholds ( P = 0.001), and high superficial pain ( P = 0.006) thresholds in the face. High levels of progesterone were associated with a high deep pain threshold in the face and a high salty threshold ( P < 0.001). CONCLUSION: Estrogen and progesterone seem to be involved in sensory neuromodulation in women during the menstrual cycle.

Quantitative sensory testing in fibromyalgia and hemisensory syndrome: comparison with controls.

Fibromyalgia syndrome (FS) is a chronic painful condition with sensory, motor and affective dysfunctions. Few studies had investigated the trigeminal area, and little is known about its association with hemisensory syndrome, which is characterized by chronic pain restricted to hemibody. Our objective was to investigate sensorial abnormalities with quantitative sensory testing of patients with FS and patients with hemisensory syndrome, compared to controls. Thirteen patients diagnosed with FS according to the American College of Rheumatology, and 12 patients with hemisensory syndrome were evaluated and compared to 25 age-gender-matched controls. They were investigated with a quantitative sensory testing protocol including gustative, olfactory, cold, warm, touch, vibration, electric, deep and superficial pain thresholds and the corneal reflex evaluation. The patients had higher gustative thresholds for salty and bitter. In general, patients with FS had somatosensory thresholds higher than the controls; however, patients with hemisensory syndrome had only superficial pain thresholds increased, in both body sides and not only in the area affected by pain. Patients with hemisensory syndrome can be a subgroup of FS, different from nondermatomal somatosensory deficits which are characterized by chronic pain with hypoesthesia in hemibody. The bilateral hypoalgesia supports that pain pathways play a key role in this condition, with no compromise of other sensorial modalities.

Facial sensibility of patients with trigeminal neuralgias.

OBJECTIVES: Idiopathic trigeminal neuralgia (ITN) is an excruciating shock-like paroxysmal pain restricted to the trigeminal area of innervation, with discrete loss of sensibility (thermal, tactile and painful). Trigeminal postherpetic neuralgia (PHN) is a neuropathic pain at the trigeminal territory that persists after Herpes zoster infection, which also is associated to sensorial compromise. The objective of this study was to evaluate the somesthetic facial sensibility (pain, thermal and tactile) and to compare the findings between PHN and ITN. METHODS: 18 patients with PHN and 26 patients with ITN were diagnosed by the IASP criteria. They were evaluated with a systematic approach, which included mechanical, thermal (cold and warm) and painful stimuli. RESULTS: We found statistical significance at the ophthalmic branch of PHN in pain (p=0.001), tactile (p=0.002), cold (p=0.016) and warm (p=0.013); in ITN, the maxillary branch had higher threshold with pinpricks (p=0.016) and the mandibular branch had higher tactile threshold. CONCLUSIONS: The trigeminal area affected by the disease had the higher sensorial losses (ophthalmic branch in PHN and maxillary/mandibular branches in ITN). PHN patients had losses in large and small fibers; therefore, ITN patients had the losses mostly in large fibers, which support different peripheral neural mechanisms for these neuropathic diseases.

Temporomandibular Disorder in Brazilian patients: a preliminary study.

The objective of the current study was to evaluate disease-related beliefs, adherence to treatment, quality of life, coping strategies and cognitive status in a group of Brazilian patients with Temporomandibular Disorder (TMD). Thirty patients were evaluated with a semi-directed interview, the Coping Strategies Inventory, and a Mini-Mental State Examination. Although half (50%) of the patients had known their diagnosis long term, 40% of the sample were not correctly following proposed treatment. All patients had a similar pattern of pain behavior related to TMD, while disease-related beliefs, quality of life and coping strategies were variable. Expectations about treatment also had significant association with treatment adherence. The findings of this study suggest that a more thorough understanding of individual differences in TMD is warranted.

Evaluation of the sensation in patients with trigeminal post-herpetic neuralgia.

BACKGROUND: Post-herpetic neuralgia (PHN) is one complication after herpes zoster infection, which may affect the facial superficial sensitivity. METHODS: Eighteen patients with PHN were interviewed and evaluated according to a systematized sensitivity approach, including mechanical, thermal and pain. RESULTS: The pain location was V1 in 15 patients. All trigeminal branches from both facial sides were evaluated; we compared the affected with the opposite side. There was a significant difference at V1 with cold (P=0.038), vonFrey (P=0.008) and pinpricks (P=0.022); at V2, the statistical difference occurred with cold (P=0.034), heat (P=0.019) and pinpricks (P=0.037); at V3, differences occurred with cold (P=0.042) and heat (P=0.036). Only V1 and oral mucosa (V2-3) presented pain threshold differences between both sides (P=0.001, P=0.021). CONCLUSION: Age, predominance of trigeminal PHN in V1 and continuous burning pain was common and similar to literature. Sensation was hampered with evident deficits of all sensory modalities in the affected trigeminal areas, especially V1.

Frequency of postoperative complications after balloon compression for idiopathic trigeminal neuralgia: prospective study.

BACKGROUND: Idiopathic trigeminal neuralgia (ITN) is often treated with balloon compression, considered in the literature to be a safer and more efficient procedure than other surgeries, with a high success rate. METHODS: This study evaluated 105 patients with idiopathic trigeminal neuralgia who underwent balloon compression of the trigeminal ganglion, with a follow-up of 210 days, and clinical questionnaires and a systematic physical evaluation used as instruments. RESULTS: There was a significant decrease in the shock-like complaint (P < .001), although 66.3% still experienced pain after 7 days of surgery from other causes; 50.5% presented limitation during jaw activities. Other complaints were hearing, taste and/or smelling loss, and visual difficulties. One patient had a TMJ ankylosis and needed surgical TMJ treatment. CONCLUSIONS: Although neurosurgery in the treatment of severe ITN pain is known to provide relief and its importance is recognized, there may also be severe complications that could compromise habitual tasks to various degrees. Therefore, the patient needs to be alerted about all complaints that he or she might present after the procedure. The professional has a duty to correctly inform and alert every patient under his or her care.

Idiopathic trigeminal neuralgia: clinical aspects and dental procedures.

OBJECTIVE: Evaluation of the characteristics and dental treatments in a Brazilian series of idiopathic trigeminal neuralgia (ITN) patients. STUDY DESIGN: Forty-eight subjects with ITN were interviewed and evaluated according to a systematized approach. FINDINGS: (a) location of the trigger zone, intraoral in 64.58%; (b) comorbidities, 18 patients (hypertension in 9); (c) treatment with dental procedures for ITN according to duration of pain (31), 44.44% (during the first year), 50.00% (1-5 years), 80.00% (5-10 years), and 100.00% (>10 years). There was no correlation between trigger zone location and the frequency of previous dental procedures (P=.667). There was significant statistical correlation between the number of patients who underwent dental treatments and the duration of ITN (P=.004). CONCLUSION: (a) Demographic characteristics of this sample are similar to those described in the literature, (b) the dental procedures were not correlated with location of trigger zone, and (c) patients with long-lasting ITN had more number of previous dental procedures.