Pain-related worry in patients with chronic orofacial pain.

BACKGROUND: Pain-related worry is distinct from, but related to, pain catastrophizing (PC) and anxiety. Worry and its relationship with other variables have been studied in people with chronic pain but not in people with chronic orofacial pain. The authors explored the prevalence of trait, general and pain-related worry and the association of worry with higher pain levels and other variables. METHODS: The authors assessed people who had a diagnosis of chronic orofacial pain by using nonpain-related trait worry, state anxiety, trait anxiety, PC and pain measures. The participants' answers to an open-ended question about what they were most worried about led to the identification of worry domains, including worry about pain. RESULTS: The authors found that worrying about pain was related significantly to worst and least pain levels, pain interference and pain duration, as well as moderated trait worry in predicting pain interference. Although trait worry was not correlated directly with pain, when moderated by PC, it made substantial contributions in predicting pain interference. CONCLUSIONS: Participants with chronic orofacial pain reported experiencing substantial levels of trait worry, anxiety, PC and worry about pain that related to pain ratings directly and indirectly. PRACTICAL IMPLICATIONS: Clinicians should assess pain-related worry in patients with chronic orofacial pain to understand the effects of worry on pain and functioning. Clinicians could treat these patients more effectively by helping them reduce their levels of pain-related worry and focusing on improved coping.

Guidelines for Motivating and Assisting Patients With Smoking Cessation in Dental Settings.

Focused Clinical Question: Periodontal disease is related to use of tobacco, particularly cigarettes. Cigarette smoking is the leading cause of preventable death in the United States, with 20% of annual deaths attributable to smoking-related illness. How does motivating patients to quit smoking challenge periodontists and other providers to improve clinical management? Summary: Four patient cases from the author's (CED) clinical practice in behavioral medicine illustrate key points in management of two patients who were successful in quitting smoking and two who were unsuccessful quitting. Conclusion: These cases illustrate some of the characteristics of patients and factors that contribute to successful smoking cessation and provide examples and practical information for use in the dental office for helping patients with smoking cessation.

Posterior cortical atrophy: a case study of Benson's syndrome that initially presented as anxiety disorder.

The postmortem pathology of posterior cortical atrophy (PCA) and Alzheimer's disease (AD) are often identical. In contrast to AD, PCA is clinically different in that visuoperceptual skills are severely impaired, yet memory is relatively intact. In addition, patients with PCA often report depression with preserved insight. The present case study is a 56-year-old female who initially presented with anxiety and panic-like symptoms. The neuropsychological evaluation and imaging studies were consistent with PCA. This case study is relatively unique in that symptom onset presented as an anxiety disorder, yet formal evaluation revealed severe visuospatial impairment with minimal insight into the severity of cognitive impairment. Anxiety was alleviated following cessation of employment. This case highlights the importance of differential diagnostic consideration of affective and mood disorders and early forms of dementia.

Brain function with complex decision making using electroencephalography.

A computer-administered assessment for decision making relevant to daily-living decisions, using the technique of complex decision making (CDM), has been previously developed and tested in our laboratory. The present study sought to identify unique patterns of brain activity in the alpha band associated with CDM. We recorded electroencephalogram (EEG) from 30 scalp sites, during a series of baseline, eyes open fixation tasks, and CDM tasks, in different contexts, in a group of 9 male and 7 female young healthy adults, aged 18 to 34. The decision making contexts, designed to simulate real-world, daily-living decisions, were about taking a bus, choosing a friend, job, medication, and participating in research. Electroencephalograms (EEGs) were divided into the frequency bands, alpha, beta, delta, theta, and gamma, though the primary focus of this paper is the alpha band. Analysis of mean EEG power spectra across the alpha bands - alpha1 (8-10 Hz), alpha2 (10-12 Hz), and alpha 3 (12-14 Hz) - showed significant decreases from baseline to the CDM task. In addition, we observed significant increases in delta, theta, beta, and gamma. There were also significant bivariate correlations between EEG spectra, mostly in low and mid alpha bands, behavioral performance on the CDM task, and scores on standardized measures of executive functioning, including the Trail-making Test and the Wisconsin Card Sorting Task. These results demonstrate how brain activity in complex decision making is distributed across alpha frequency bands and electrode regions and this activity relates to executive functioning.

Use of a structural equation model for prediction of pain symptoms in patients with orofacial pain and temporomandibular disorders.

AIMS: To develop and test a biopsychosocial model using structural equation modeling for predicting orofacial pain symptoms in a sample of patients with masticatory muscle pain (MMP). METHODS: Data were collected from clinic records of 251 adult patients who presented for initial evaluation to the Orofacial Pain Center at the University of Kentucky College of Dentistry and were subsequently diagnosed with MMP. Data were used to fit a model relating stressors, psychological distress, arousal, sleep problems, oral parafunction, and pain symptoms. Items from the Multidimensional Pain Inventory (MPI) and the IMPATH:TMJ, a comprehensive biopsychosocial assessment of patients with temporomandibular disorders (TMD), were used to construct a measurement model of five latent variables. RESULTS: Estimation of the model indicated a good fit to the data and significant associations between stressors, psychological distress, arousal, sleep problems, and pain symptoms. Sleep problems partially mediated the relation between arousal and pain symptoms. Contrary to hypotheses, no association occurred between oral parafunction and pain symptoms, possibly indicating that any relationship between oral parafunction and pain symptoms may not exist. CONCLUSION: Results from the model tested in the present study are an additional step toward developing a more comprehensive biopsychosocial model explaining the nature and etiology of MMP in orofacial pain and TMD. With additional development and testing, it may also serve as an aid to planning interventions, especially psychosocial interventions targeting stress management, psychophysiological regulation, psychological distress, and sleep problems.

Brain activity during stimulation of the trigeminal nerve with noxious heat.

OBJECTIVE: The aim of this study was to observe areas of brain activation with painful hot stimulation to the trigeminal nerve. STUDY DESIGN: Nine healthy pain-free women (mean age 26.2 +/- 6.9 yrs) with a natural, regular menstrual cycle participated in the study. Whole-brain functional magnetic resonance imaging (fMRI) data were acquired for each participant on day 2 or 3 after the onset of menses using echo-planar imaging at 1.5T with near-isotropic spatial resolution and a temporal resolution of 4 s. RESULTS: Whole-brain fMRI with a Peltier thermode inside the head coil yielded a feasible imaging protocol with little disturbance from the thermode. Painful thermal stimulation of the left trigeminal system activated discrete brain regions within the insula, cingulate gyrus, thalamus, inferior parietal lobe/postcentral gyrus, right middle and inferior frontal gyri, cuneus, precuneus, and precentral gyrus. CONCLUSION: Painful stimulation of the trigeminal nerve resulted in activation of similar brain areas generally known for pain processing of painful peripheral stimulation.

Correlates of health-related quality of well-being in older patients with schizophrenia.

Research on correlates of health-related quality of life (HRQOL) among older patients with schizophrenia has been very limited. This study evaluated the relative impact of positive, negative, and depressive symptoms, movement disorders, and cognitive impairment on HRQOL among middle-aged and older patients with schizophrenia or schizoaffective disorder. Participants were 199 patients aged 45 to 85 years. The study was cross-sectional. The primary outcome measure was the Quality of Well-Being scale, and correlates were measures of positive and negative symptoms, depression, abnormal movements, and cognitive performance. Severity of depressive symptoms and of cognitive impairment correlated significantly with HRQOL and independently affected HRQOL scores. The initiation/perseveration subscale of the Dementia Rating Scale had the largest impact. These findings suggest that depressive symptoms and cognitive functioning should be part of the routine assessment of older people with schizophrenia and may be targets for psychopharmacological and psychosocial interventions to improve HRQOL.

Health-related quality of life and functioning of middle-aged and elderly adults with bipolar disorder.

OBJECTIVE: Data characterizing bipolar disorder in older people are scarce, particularly on functional status. We evaluated health-related quality of life and functioning (HRQoLF) among older outpatients with bipolar disorder as well as the relationship of HRQoLF to bipolar illness characteristics. METHOD: We compared community-dwelling middle-aged and older adults (age range, 45 to 85 years) with bipolar disorder (N=54; mean age=57.6 years), schizophrenia (N=55; mean age=58.5 years), or no psychiatric illnesses (N=38; mean age=64.7 years) on indicators of objective functioning (e.g., education, occupational attainment, medical comorbidity) and health status (e.g., Quality of Well-Being scale [QWB] and the Medical Outcomes Study-Short Form Health Survey [SF-36]). Within the group with bipolar disorder, we examined the relationship between HRQoLF and clinical variables (e.g., phase and duration of illness, psychotic symptoms, cognitive functioning). RESULTS: Patients with bipolar disorder were similar in educational and occupational attainment to the normal comparison group, but they obtained lower scores on the QWB and SF-36 (with large effect sizes). Compared with schizophrenia, bipolar disorder was associated with better educational and work histories but similar QWB and SF-36 scores and more medical comorbidity. Patients in remission from bipolar disorder had QWB scores that were worse than those of normal comparison subjects. Greater severity of psychotic and depressive symptoms and cognitive impairment were associated with lower HRQoLF. CONCLUSIONS: Bipolar disorder was associated with substantial disability in this sample of older adults, similar in severity to schizophrenia. Remission of bipolar disorder was associated with significant but incomplete improvement in functioning, whereas psychotic and depressive symptoms and cognitive impairment seemed to contribute to lower HRQoLF.

Review of longitudinal functional neuroimaging studies of drug treatments in patients with schizophrenia.

We systematically reviewed twenty-one functional neuroimaging studies that used longitudinal designs to investigate the effects of medication treatments on brain functioning among patients with schizophrenia. The studies reviewed were comprised of functional magnetic resonance imaging and positron emission tomography research using a baseline and at least one follow-up. The present review summarizes the different effects of medication and disease status on brain function, with attention to functional normalization, specific drug effects, and comparisons of typical versus atypical antipsychotics. Particular emphasis is given to methodological limitations in the existing literature, including lack of reliability data, clinical heterogeneity among studies, and inadequate study designs and statistics. Suggestions are made for improving future longitudinal neuroimaging studies of treatment effects in schizophrenia.

Regional brain response to faces of humans and dogs.

The extent to which the brain regions associated with face processing are selective for that specific function remains controversial. In addition, little is known regarding the extent to which face-responsive brain regions are selective for human faces. To study regional selectivity of face processing, we used functional magnetic resonance imaging to examine whole brain activation in response to human faces, dog faces, and houses. Fourteen healthy right-handed volunteers participated in a passive viewing, blocked experiment. Results indicate that the lateral fusiform gyrus (Brodmann's area 37) responds maximally to both dog and human faces when compared with other sites, followed by the middle/inferior occipital gyrus (BA 18/19). Sites that were activated by houses versus dog and human faces included the medial fusiform gyrus (BA 19/37), the posterior cingulate (BA 30), and the superior occipital gyrus (BA 19). The only site that displayed significant differences in activation between dog and human faces was the lingual/medial fusiform gyrus. In this site, houses elicited the strongest activation, followed by dog faces, while the response to human faces was negligible and did not differ from fixation. The parahippocampal gyrus/amygdala was the sole site that displayed significant activation to human faces, but not to dog faces or houses.