Injuries, dislocations, and poor health perceived by older adults to result from vigorous physical activity: implications for active living, health promotion, and gerontology.

This study examines older adults' perceptions about their participation in vigorous physical activity (VPA) and the association between VPA and self-related health. A total of 686 older adults responded to self-reported questionnaires, and Pearson's ꭓ2 test and binary logistic regression were used to present findings. About 74% of older adults reported experiencing dislocations, fractures, or/and other forms of injury in intense physical activities lasting 30 minutes or more a day. After controlling for relevant socio-demographic factors, older adults who participated in VPA for 30 or more minutes a day were less likely (OR=0,129; p=0,000) to report good health compared with those who participated in VPA for less than 30 minutes. It is concluded that VPA in older populations can result in casualties that may compel older adults to underrate their health, which can discourage active living habits in older populations and discredit PA/health promotion programs.

Evaluation of the psychoemotional status of young adults with symptoms of temporomandibular disorders.

BACKGROUND AND PURPOSE: Temporomandibular disorders (TMD) are among the most frequent pathologies of the stomatognathic system. One problem often associated with TMD is the psychoemotional status. The aim of study was to evaluate the psychoemotional status of young adults with pain symptoms associated with TMD. MATERIAL AND METHODS: We analyzed the data of 260 volunteers. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) form was used to diagnose TMD. The relationships between TMD/RDC clinical diagnoses and psychoemotional status, as described by the Beck's Depression Inventory (BDI) and Perceived Stress Scale (PSS-10), were analyzed. We divide the group into four on the basis of RDC/TMD Axis I diagnosis. Group 0 included 30 students lacking TMD symptoms. Group I consisted of 30 people with myofascial pain (group IA in RDC/TMD). Group II contained 23 people with disk displacement with reduction (group IIA in RDC/TMD). Group III contained ten people (Group III diagnosis, often associated with pain). RESULTS: We did not find statistically significant differences between the study groups. In subjects with pain (Groups I and III), we found the mean value on the BDI and PSS-10 scales to be higher than among the pain-free subjects (Groups 0 and II). CONCLUSION: In young adults with TMD accompanied by pain, psychoemotional status should also be evaluated.

Validation of the WHOQOL-BREF and Shorter Versions Using Rasch Analysis in Traumatic Brain Injury and Orthopedic Populations.

OBJECTIVE: To use Rasch analysis to validate the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and existing short versions in individuals with traumatic brain injury and orthopedic injuries, with comparisons to a general population group. DESIGN: The Partial Credit Rasch model was applied to evaluate the WHOQOL-BREF as well as shortened versions using a cross-sectional study design. SETTING: Regional hospital, and national electoral sample in New Zealand. PARTICIPANTS: Individuals with traumatic brain injury (n=74), individuals with orthopedic injuries (n=114), general population (n=140). INTERVENTIONS: None. MAIN OUTCOME MEASURE: WHOQOL-BREF. RESULTS: The WHOQOL-BREF met expectations of the unidimensional Rasch model and demonstrated good reliability (person separation index [PSI] =0.82) when domain items were combined into physical-psychological, social, and environmental superitems. Analysis of shorter versions, the EUROHIS-QOL-8 and World Health Organization Quality of Life-5 (WHOQOL-5), indicated overall acceptable fit to the Rasch model and evidence of unidimensionality. The EUROHIS-QOL-8 showed good reliability (PSI=0.81); however, reliability of the WHOQOL-5 (PSI=0.68) was below acceptable standards for group comparisons, in addition to demonstrating poor person-item targeting. CONCLUSIONS: The WHOQOL-BREF and the 8-item EUROHIS-QOL-8 version are both reliable and valid in the assessment of quality of life in both injury and general populations. Ordinal-interval conversion tables published for these validated scales as well as for the WHOQOL-5 can be used to improve precision of assessment. The transformation of ordinal scale scores into an interval measure of health-related quality of life also permits the calculation of a single summary score for the WHOQOL-BREF, which will be useful in a wide range of clinical and research contexts. Further validation work of the WHOQOL-5 is needed to ascertain its psychometric properties.

Outcomes and patient satisfaction following individualized physical therapy treatment for patients diagnosed with temporomandibular disc displacement without reduction with limited opening: A cross-sectional study.

OBJECTIVE: To investigate physical therapy treatment outcomes and patient satisfaction in patients with a diagnosis of disc displacement without reduction with limited opening (DDWoR wLO). METHODS: Records of 97 patients with DDWoR wLO who received physical therapy in one outpatient clinic were used in this cross-sectional study. Outcomes included number of visits, maximum active interincisal opening, self-reported pain, and patient satisfaction. RESULTS: The average number of physical therapy visits per patient was 5.5, and there were significant improvements in pain rating and interincisal opening following physical therapy. Effect sizes for these comparisons were large (>1.0). Mean patient satisfaction responses across all symptom areas was consistent with patients being more than less satisfied following treatment. DISCUSSION: Individualized physical therapy treatment is an effective conservative intervention to improve mouth opening, reduce pain, and provide patient satisfaction in patients with one specific sub-type of temporomandibular disorder (TMD), DDWoR wLO.

Clinical factors that affect perceived quality of life in arthroscopic reconstruction for acromioclavicular joint dislocation. / Factores clínicos que afectan a la calidad de vida percibida en la reconstrucción artroscópica de las luxaciones acromioclaviculares.

OBJECTIVE: To analyse the results of arthroscopic repair of acromioclavicular dislocation in terms of health-related quality of life. MATERIAL AND METHOD: Prospective study of patients with acromioclavicular dislocation Rockwood grade iii-v, treated arthroscopically with a mean follow up of 25.4 months. The demographics of the series were recorded and evaluations were performed preoperatively, at 3 months and 2 years with validated questionnaires as Short Form-36 Health Survey (SF-36), visual analogue scale (VAS), The Disabilities of the Arm, Shoulder and Hand (DASH), Constant-Murley Shoulder Outcome Score (Constant) and Walch-Duplay Score (WD). RESULTS: Twenty patients, 17 men and 3 women with a mean age of 36.1 years, were analysed. According to the classification of Rockwood, 3 patients were grade iii, 3 grade iv and 14 grade v. Functional and clinical improvement was detected in all clinical tests (SF-36, VAS and DASH) at 3 months and 2 years follow up (P<.001). The final Constant score was 95.3±2.4 and the WD was 1.8±0.62. It was not found that the health-related quality of life was affected by any variable studied except the evolution of DASH. CONCLUSIONS: The health-related quality of life (assessed by SF-36) in patients undergoing arthroscopic repair of acromioclavicular joint dislocation grades iii-v was not influenced by gender, age, grade, displacement, handedness, evolution of the VAS, scoring of the Constant or by the WD. However, it is correlated with the evolution in the DASH score.

Satisfaction with Life in Orofacial Pain Disorders: Associations and Theoretical Implications.

AIMS: To test if patients with masticatory myofascial pain, local myalgia, centrally mediated myalgia, disc displacement, capsulitis/synovitis, or continuous neuropathic pain differed in self-reported satisfaction with life. The study also tested if satisfaction with life was similarly predicted by measures of physical, emotional, and social functioning across disorders. METHODS: Satisfaction with life, fatigue, affective distress, social support, and pain data were extracted from the medical records of 343 patients seeking treatment for chronic orofacial pain. Patients were grouped by primary diagnosis assigned following their initial appointment. Satisfaction with life was compared between disorders, with and without pain intensity entered as a covariate. Disorder-specific linear regression models using physical, emotional, and social predictors of satisfaction with life were computed. RESULTS: Patients with centrally mediated myalgia reported significantly lower satisfaction with life than did patients with any of the other five disorders. Inclusion of pain intensity as a covariate weakened but did not eliminate the effect. Satisfaction with life was predicted by measures of physical, emotional, and social functioning, but these associations were not consistent across disorders. CONCLUSIONS: Results suggest that reduced satisfaction with life in patients with centrally mediated myalgia is not due only to pain intensity. There may be other factors that predispose people to both reduced satisfaction with life and centrally mediated myalgia. Furthermore, the results suggest that satisfaction with life is differentially influenced by physical, emotional, and social functioning in different orofacial pain disorders.

Treatment Seeking and Self-Constructed Explanations of Pain and Pain Management Strategies Among Adolescents with Temporomandibular Disorder Pain.

AIMS: To explore adolescents' explanations of their temporomandibular disorder (TMD) pain, their pain management strategies for TMD pain, and their treatment-seeking behavior. METHODS: One-on-one interviews were conducted with 21 adolescents aged 15 to 19 years who had TMD pain and followed a semistructured interview guide. Subjects were strategically selected from patients referred to an orofacial pain clinic. All participants had been examined and received a pain diagnosis based on the Research Diagnostic Criteria for TMD. The interviews focused on the adolescents' experiences of TMD pain, their strategies for handling pain, and how they seek care. The interviews were recorded, transcribed verbatim, and analyzed using qualitative manifest content analysis. RESULTS: Qualitative manifest content analysis revealed two categories: (1) self-constructed explanations, with three subcategories (situation-based explanatory model, physical/biologic model, and psychological explanatory model); and (2) pain management strategies, with four subcategories (social support, treatment, relaxation/rest, and psychological strategies). Adolescents used physical activities and psychological and pharmacologic treatment to manage pain. Reasons for seeking treatment were to be cured, to obtain an explanation for their pain, and because their symptoms bother others. CONCLUSION: Adolescents living with TMD pain develop self-constructed explanations and pain management strategies. With access to these descriptions, dentists can be better prepared to have a dialogue with their adolescent patients about their own explanations of pain, the nature of pain, and in which situations the pain appears. Dentists can also explore adolescent patients' pain management strategies and perhaps also suggest new treatment strategies at an earlier stage.

Impact of Age on Pain Perception for Typical Painful Diagnoses in the Emergency Department.

BACKGROUND: Age-related differences in pain perception have been demonstrated in experimental settings but have been investigated scarcely and without valid scale in the clinical framework. OBJECTIVES: To examine the effect of age on pain perception for recognized painful diagnoses encountered in the emergency department (ED). METHODS: A post-hoc analysis of real-time archived data was performed in a tertiary urban and a secondary regional ED. We included all consecutive adult patients (≥18 years) with the following diagnosis at discharge: renal colic, pancreatitis, appendicitis, headache/migraine, dislocation and extremities fractures, and a pain evaluation of ≥1 (0-10, verbal numerical scale) at triage. The primary outcome was to compare for each of these diagnoses the level of pain intensity between four age groups (18-44; 45-64; 65-74; 75+ years). RESULTS: A total of 15,670 patients (48% women) were triaged with a mean pain intensity of 7.7 (SD=2.0). Women exhibited greater pain scores than men for pancreatitis, headache/migraine, and extremity fracture. Renal colic, pancreatitis, appendicitis, and headache/migraine showed a linear decrease in pain scores with age whereas dislocation and extremity fractures did not present age differences. Mean differences in pain intensity scores between young adults (18-44 years) and patients aged ≥75 years were 0.79 (95% confidence interval [95% CI] 0.5-1.1) for renal colic, 1.1 (95% CI 0.7-1.4) for pancreatitis, 0.70 (95% CI 0.2-1.2) for appendicitis, and 0.86 (95% CI 0.6-1.1) for headache/migraine. CONCLUSION: Older patients perceive similar pain for dislocation and extremity fractures and less for visceral and headache/migraine pain; however, these age differences may not be clinically important.

Temporomandibular disorder pain is related to the general disposition to be anxious.

AIMS: To assess whether trait anxiety as a person's general disposition to be anxious is a risk factor for temporomandibular disorder (TMD) pain. METHODS: A total of 320 adult TMD patients with at least one pain-related TMD diagnosis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were included in the study. Subjects from the general population without pain-related TMD were used as controls (n = 888). All study participants completed the State-Trait Anxiety Inventory (STAI). The association between the level of trait anxiety (STAI-Trait scores) and case-control status (patients diagnosed with pain-related TMD and controls) was analyzed using logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (CI) were computed. RESULTS: The level of trait anxiety was associated with the subject status (case vs control). A one-point increase in STAI-Trait sum scores (range: 20 to 80) was related to an increase of the odds for pain-related TMD by the factor 1.04 (CI: 1.02-1.05; P < .001). Severe trait anxiety (above the 90th percentile of general-population subjects) doubled the odds (OR: 2.05; CI: 1.42-2.98; P < .001). Analyses adjusted for age, gender, and level of education did not change the results. CONCLUSION: Trait anxiety is significantly associated with diagnoses of TMD pain.

Another angry adolescent: another boxer's fracture?

Hand injuries are a common chief complaint in the pediatric population presenting for emergency care. Adolescents, in particular, often present with trauma to their hands after punching objects. The most frequent result of this action is a fracture to one or more of their metacarpals, also known as a boxer's fracture. However, we present a case with this common mechanism that resulted in an uncommon injury, carpometacarpal joint dislocations.

Temporomandibular joint and psychosocial evaluation of patients after orthognathic surgery: a preliminary study.

PURPOSE: The purpose of this study was to evaluate the psychological and psychosocial status of patients prior to and after orthognathic surgery. MATERIALS AND METHODS: Twenty-two patients (13 males and 9 females) who underwent orthognathic surgery were examined in this study. The bilateral sagittal split ramus osteotomy (BSSRO) group included 10 patients, and the Le Fort I osteotomy and BSSRO group included 12 patients. We continued RDC/TMD Axis II research for 12 patients who had preoperative temporomandibular joint disorder (TMD). The RDC/TMD Axis II charts were recorded preoperatively and 6 months after surgery. The Wilcoxon signed rank test was used for statistical analysis. RESULTS: Overall, there was no significant difference between the preoperative and 6-month postoperative depression indices. The non-specific physical symptoms score (NPS) with pain score decreased significantly (p < 0.05), but the NPS without pain score decreased insignificantly. In terms of the graded pain score for the preoperative group, 75.0% of the patients were in the low disability group, whereas 25.0% were in the high disability group. In contrast, patients in the postoperative group only fell into the low disability group (p < 0.05). CONCLUSION: The RDC/TMD Axis II was developed to diagnose TMD, but we believe the RDC/TMD Axis II can help to establish postoperative treatment plans by evaluating a patient's psychological and psychosocial state.

Biopsychosocial factors associated with the subcategories of acute temporomandibular joint disorders.

AIMS: To assess the biopsychosocial factors associated with acute temporomandibular disorders (TMD) based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). METHODS: Participants were assessed in community-based dental clinics and evaluated by trained clinicians using physical and psychosocial measures. A total of 207 subjects were evaluated. Patients' high-risk versus low-risk status for potentially developing chronic TMD was also determined. Analyses of variance and chi square analyses were applied to these data. RESULTS: Participants' characteristic pain intensity differed among RDC/TMD Axis I diagnoses. They also significantly varied in their self-reported graded chronic pain, depression, somatization (pain inclusive), somatization (pain excluded), and physical well-being. In addition, participants with differing RDC/TMD Axis I diagnoses varied in self-reported pain during their chewing performance. Finally, there were also significant differences in chewing performance between high-risk versus low-risk (for developing chronic TMD) patients. CONCLUSION: Participants with multiple diagnoses reported higher pain, as well as other symptoms, relative to participants without a TMD diagnosis. For chewing performance, participants with mutual diagnoses reported more pain compared to other participants. Finally, the risk-status of patients significantly affected chewing performance.

Clinical survey of the patients with temporomandibular joint disorders, using Research Diagnostic Criteria (Axis II) for TMD: preliminary study.

PURPOSE: The purpose of this study was to investigate the nonspecific physical and psychological symptoms in patients who suffered from temporomandibular joint disorder (TMD) using the Research Diagnosis Criteria (Axis II) for TMD diagnosis (RDC/TMD). STUDY DESIGN: A total of 317 patients were included (M: 75, F: 242). The signs and symptoms of physical, psychological and behavioral factors were evaluated using questionnaires in the RDC/TMD. The patients were examined through clinical and radiological method and diagnosed by the same investigator. Patients were divided into 3 different groups such as: the osteoarthritis group (group 1), the internal derangement (group 2) and the myofascial pain dysfunction syndrome group (MPDS, group 3). RESULTS: In the analysis of depression and vegetative symptoms, patients in the internal derangement group revealed a high ratio of 'normal'. In patients with MPDS, they appeared to suffer highly. According to nonspecific physical symptoms, there have been tendencies of a higher ratio of 'severe' patients with MPDS. In subjects aged 25 years or younger, the internal derangement group was the greatest, while the osteoarthritis group was the greatest for subjects over 40-years old. In the evaluation of depression and vegetative symptoms, the internal derangement group showed a relative normal value while the MPDS group showed a serious extent in comparison. CONCLUSION: According to the result of this study, MPDS group showed more severe depressive and nonspecific physical symptoms than internal derangement group. When making TMD diagnosis and treatment, it is thought to be important to analyze psychometric properties and nonspecific physical symptoms.

Extraarticular manifestations in Turkish patients with rheumatoid arthritis: impact of EAMs on the health-related quality of life in terms of disease activity, functional status, severity of pain, and social and emotional functioning.

The aim of our study was to investigate extraarticular manifestations (EAMs) in Turkish patients with rheumatoid arthritis (RA) and also assess the impact of EAMs on various health-related quality of life (HRQoL) domains, including physical, social, emotional, mental functioning, and bodily pain. A total of 150 patients were included in the study. EAMs were identified clinically. Pulmonary involvement was confirmed by using pulmonary function tests (PFT) and high-resolution computed tomography (HRCT), atlantoaxial subluxation by cervical spine X-rays. Peripheral neuropathy, rheumatoid nodules, and Sicca symptoms were picked up on clinical examination. Peripheral neuropathy was also confirmed by electroneurophysiologic studies. Patients were evaluated by Rheumatoid Arthritis Quality of Life (RAQoL), and Short form-36 (SF36). The quadrivariate Disease Activity Score- 28 (DAS28) was used for measuring disease activity. Functional status was evaluated by using the Stanford Health Assessment Questionnaire (HAQ). The severity of pain was documented by using 10-cm Visual Analog Scale-Pain (VAS-pain). EAMs were observed in 50 patients (33.3%). These were pulmonary involvement (28.7%), rheumatoid nodules (14.7%), Sicca Syndrome (8%), peripheral neuropathy (2.7%), and atlantoaxial subluxation (0.7%), respectively. It was not recorded any statistically significant difference in HAQ, DAS28, VAS-pain, and RAQoL scores between the patient groups with and without EAMs. Patients with EAMs scored significantly lower in physical functioning, role-physical, and role-emotional subgroups of SF36 (P < 0.01). Presence of EAMs is not directly associated with disease activity and functional status, but influences negatively HRQoL including physical and emotional functioning.

The effects of chronic pain on oral health related quality of life in patients with anterior disc displacement with reduction.

AIM: The aim of this study was to evaluate the effects of chronic pain on oral health related quality of life (oral QoL) in patients with anterior disc displacement with reduction (DDwR). MATERIAL AND METHODS: Thirty-seven patients who had disc displacement with reduction (DDwR, F/M: 23/14, median age: 29, range: 23-49) were selected. These patients had chronic pain and had not been undergoing any treatment protocols for the previous six months. Age- and gender-matched healthy subjects healthy control, F/M: 23/14, mean age: 33.0 +/- 15.7 years) were used as a control group. Data were collected by means of a clinical examination and a questionnaire about pain status which included a jaw disability checklist RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders). Pain status was scored between 0 (no pain) and 10 (poor pain status) by the patients. Oral health related quality of life (oral QoL) over the previous six months was evaluated by an oral health impact profile-14 (OHIP-14) questionnaire. RESULTS: OHIP-14 score was significantly higher in patients with DDwR (median:17, min-max:6-39) than healthy controls (9, 0-18) (p = 0.000). The median duration of orofacial pain was 12 (range 7-120) months. Statistically significant correlations were observed between OHIP-14 score and the worst pain intensity in the past six months (7, 0-10) (r = 0.5 p = 0.007) and average pain intensity in the past six months (5.5, 1-10) (r = 0.4 p = 0.018). In addition, an increase in OHIP-14 score was observed in patients experiencing difficulty in smiling/laughing, cleaning their teeth or face, swallowing or talking, according to the jaw disability checklist (p = 0.042, p = 0.001, p = 0.023 and p = 0.007, respectively). CONCLUSION: Poor oral QoL was related to chronic pain and limitations in jaw function in patients with DDwR.

Comparison of subjective symptoms among three diagnostic subgroups of adolescents with temporomandibular disorders.

AIM: To compare subjective symptoms among three diagnostic subgroups of young patients with temporomandibular disorders (TMDs). DESIGN: We comprehensively examined 121 patients with TMDs (age ≤20 years; 90 female patients and 31 male patients) who completed self-reported forms for assessing subjective symptoms, which consisted of five items on pain intensity in the orofacial region and six items on the level of difficulty in activities of daily living (ADL) (rating scale, 0-10). They were divided into three diagnostic subgroups: temporomandibular joint (TMJ) problem (JT) group, masticatory muscle pain (MM) group, and the group with a combination of TMJ problems and masticatory muscle pain (JM group). Their symptoms were compared using the Kruskal-Wallis and Mann-Whitney U-tests. RESULTS: The intensity of jaw or face tightness and difficulty in talking and yawning were not significantly different among the groups. However, the MM and JM groups had a significantly higher rating for jaw or face pain, headache, neck pain, tooth pain, and difficulty in eating soft foods (P < 0.01). CONCLUSIONS: Young patients with MM or JM report more intense pain in the orofacial region and have more difficulties in ADL than those with JT problems alone.

[Chronic right-sided pain-associated nondermatomal somatosensory deficit following an accident]. / Halbseitenstörung nach Unfall.

We present the case of a 48-year old man who, eight years after an industrial accident, presents with chronic right-sided nondermatomal pain and hypaesthesia to heat and touch. During symmetric peripheral touch functional magnetic resonance imaging revealed hypometabolism in the left thalamus, somatosensory cortex, and anterior cingulate cortex. Pain-associated nondermatomal somatosensory deficits (NDSDs) localizing to one side of the body are a frequent clinical entity, which are often triggered by an accident. The tendency of NDSDs to extend to adjunct ipsilateral body parts and to become chronic points to maladaptive adjustment of pain-processing areas in the central nervous system. Psychological stress prior to or around the triggering event seems an important risk factor for NDSDs.

Role of psychosocial factors in the etiology of temporomandibular disorders: relevance of a biaxial diagnosis.

AIM: The prevalence of temporomandibular disorders (TMD) is higher among women than men, indicating a multifactorial role for gender-related differences in the etiology of TMD: physiological hormonal differences, inflammatory response to stress, and sociocultural differences in response to pain. The aim of this study was to draw a biobehavioral picture of the TMD patient based on Research Diagnostic Criteria for TMD (RDC/TM) Axis II diagnosis and analysis of gender-related differences. METHODS: Between January 2006 and January 2008, 362 subjects were consecutively enrolled from patients who presented at the Clinic for Temporomandibular Disorders, School of Dental Medicine, University of Pavia, because of orofacial pain, limitation or joint sounds on mandibular movement. Of the 362 subjects evaluated, 308 met the inclusion criteria. RESULTS: The average age of the study population was 41 years; the female: male ratio was 4:1. When stratified according to chronic pain intensity grade and gender, 26% of the women had grade I, 36.4% grade II, 17% grade III, and 9.7% grade IV; 34.4% of the men had grade I, 32.8% grade II, 6.5% grade III, and 3.3% grade IV. Depression was moderate in 35 women and in 6 men and severe in 138 women and in 24 men; somatization was moderate in 59 women and in 20 men and severe in 143 women and in 19 men. CONCLUSIONS: Gender-related differences may be considered risk factors for TMD; psychological characteristics, including somatization, depression, and anxiety related to gender, appear to have a significant impact on the prevalence of TMD.

Non-selective cutaneous sensory neurectomy as an alternative treatment for auto-mutilation lesion following arthrodesis in three dogs.

OBJECTIVE: To describe an alternative method for the treatment of non-responsive self-mutilation injuries in three dogs after carpal/tarsal arthrodesis. STUDY DESIGN: Case series ANIMALS: Two dogs with carpal injury and one dog with tarsal injury treated by arthrodesis METHODS: All dogs developed self-mutilation injuries due to licking and/or chewing of the toes within 21-52 days of surgery. Clinical signs did not resolve within one week after conservative treatment with wound debridement and protective bandages. Following general anaesthesia, a deep horseshoe-shaped skin incision, including the subdermal tissue, was performed proximal to the self-mutilation injury transecting the sensory cutaneous afferent nerves. The skin incision was closed with simple interrupted sutures. RESULTS: All wounds healed without complication. Self-mutilation resolved completely within 24 hours after surgery in all dogs. No recurrence was observed (5 months to 3 years). CONCLUSION: Non-selective cutaneous sensory neurectomy may lead to resolution of self-mutilation following arthrodesis in dogs. CLINICAL RELEVANCE: Failure of conservative treatment in self-mutilation injuries often leads to toe or limb amputation as a last resort. The technique described in this case series is a simple procedure that should be considered prior to amputation. The outcome of this procedure in dogs self-multilating due to neurological or behavioral disturbances unrelated to carpal or tarsal arthrodesis is not known.

Comparison of occlusal discomfort in patients with temporomandibular disorders between myofascial pain and disc displacement.

We compared occlusal discomfort in patients with temporomandibular disorders (TMD) between myofascial pain (MFP) and disc displacement (DD) using a database created from Sep, 2003 to Aug, 2005. We selected 71 patients with MFP and 170 patients with DD to construct a null model of structural equation modeling (SEM) in which anxiety influenced depressive mood, depressive mood aggravated occlusal discomfort and sleep complaints, and sleep complaints or an onset event caused by another person aggravated occlusal discomfort. We performed a simultaneous analysis of patients with MFP and DD. The estimated parameter of the path from depressive mood to occlusal discomfort was significant for patients with MFP, but not for patients with DD. The path from an onset event caused by another person, such as dental treatment to occlusal discomfort was significant in patients with MFP and those with DD. The Goodness of Fit Index (=0.909), The Adjusted Goodness of Fit Index (=0.867), and The Root Mean Square Error of Approximation (=0.039) indicated good acceptability. These results suggested that an increase in depressive mood may aggravate occlusal discomfort in patients with MFP, and an onset event caused by another person, such as dental treatment, also may aggravate occlusal discomfort in patients with MFP and those with DD.