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1.
Arch Oral Biol ; 124: 105063, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33529837

RESUMEN

OBJECTIVE: To assess the correlation between the Central Sensitization Inventory (CSI) scores and the results of psychophysical tests and psychosocial questionnaires according to the presence of painful temporomandibular disorder (TMD). DESIGN: It was a cross-sectional study involving 146 participants, aged 20-65 years. Painful TMD was classified using the Research Diagnostic Criteria for Temporomandibular Disorders. CSI was applied to assess "central sensitization-related symptoms", as has been suggested. Wind-up ratio, pressure pain threshold and conditioned pain modulation were used as psychophysical tests to evaluate signs and symptoms of central sensitization. Psychosocial factors were assessed by the presence of non-specific physical symptoms, depressive and anxiety symptoms. The sample was divided into two groups: Control (n = 31); Painful TMD (n = 115). Descriptive statistics characterized the sample. Correlation analysis were performed using Pearson's and Spearman's correlation coefficients (α = 5%). RESULTS: Of the total sample, 78.8 % presented painful TMD, and the mean (standard deviation) age was 37.4 (±11.5) years. Anxiety symptoms (p = 0.028) and non-specific physical symptoms (p < 0.001) were more frequent in the painful TMD group than in controls. Painful TMD patients presented higher scores of the CSI (p < 0.001) and lower pressure pain thresholds (p ≤ 0.020) compared to controls. CSI scores were significantly correlated with psychosocial measures (p < 0.001) but not with psychophysical tests (p ≥ 0.089). CONCLUSION: The CSI scores did not correlate with psychophysical measures of central sensitization but were positively correlated with the results of psychosocial questionnaires.


Asunto(s)
Sensibilización del Sistema Nervioso Central , Trastornos de la Articulación Temporomandibular , Adulto , Anciano , Estudios Transversales , Humanos , Persona de Mediana Edad , Dolor , Umbral del Dolor , Adulto Joven
2.
J Endod ; 47(3): 345-357, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33340605

RESUMEN

Pain is a common symptom in endodontic conditions, but differential diagnostic procedures are often needed to exclude other pain origins. Thus, general dentists and endodontists need to be aware of alternative painful orofacial conditions and be able to identify them. The new International Classification of Orofacial Pain (ICOP) is the first comprehensive classification that uniquely deals with orofacial pain. The ICOP is a hierarchical classification modeled on the International Classification of Headache Disorders and covers pain in dentoalveolar and anatomically related tissues, muscle pain, temporomandibular joint pain, neuropathic pain affecting cranial nerves, pain resembling primary headaches, and idiopathic pain in the orofacial region. A description of each condition is given, and structured diagnostic criteria for each condition are proposed based on research data when available. This narrative review aims (1) to give an overview and brief explanation of the ICOP system, (2) to describe and give examples of how it can be of use to general dentists and endodontists with special attention to differential diagnosis of tooth pain, and (3) to highlight how endodontic research can contribute to validation and improvement of the classification. A comparison to other classification and diagnostic systems is also included.


Asunto(s)
Endodoncistas , Neuralgia , Diagnóstico Diferencial , Dolor Facial/diagnóstico , Humanos , Odontalgia/diagnóstico
3.
Eur J Pain ; 24(8): 1425-1439, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32557971

RESUMEN

BACKGROUND AND OBJECTIVE: Orofacial quantitative sensory testing (QST) is an increasingly valuable psychophysical tool for evaluating neurosensory disorders of the orofacial region. Here, we aimed to evaluate the current evidence regarding this testing method and to discuss its future clinical potential. DATA TREATMENT: We conducted a literature search in Medline, Embase and Scopus for English-language articles published between 1990 and 2019. The utilized search terms included QST, quantitative, sensory testing and neurosensory, which were combined using the AND operator with the terms facial, orofacial, trigeminal, intraoral and oral. RESULTS: Our findings highlighted many methods for conducting QST-including method of levels, method of limits and mapping. Potential stimuli also vary, and can include mechanical or thermal stimulation, vibration or pinprick stimuli. Orofacial QST may be helpful in revealing disease pathways and can be used for patient stratification to validate the use of neurosensory profile-specific treatment options. QST is reportedly reliable in longitudinal studies and is thus a candidate for measuring changes over time. One disadvantage of QST is the substantial time required; however, further methodological refinements and the combination of partial aspects of the full QST battery with other tests and imaging methods should result in improvement. CONCLUSIONS: Overall, orofacial QST is a reliable testing method for diagnosing pathological neurosensory conditions and assessing normal neurosensory function. Despite the remaining challenges that hinder the use of QST for everyday clinical decisions and clinical trials, we expect that future improvements will allow its implementation in routine practice.

4.
Cephalalgia ; 40(11): 1191-1201, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32486910

RESUMEN

BACKGROUND: Quantitative sensory testing protocols for perceptions of pleasantness and unpleasantness based on the German Research Network on Neuropathic Pain protocol were recently introduced. However, there are no reliability studies yet published. AIM: To evaluate the intra-examiner (test-retest) and inter-examiner reliability for orofacial pleasantness and unpleasantness quantitative sensory testing protocols. METHODS: Sixteen healthy participants from Aarhus University (11 women and five men, mean age 24, range 21-26 years) contributed. Two examiners were trained in performing the entire quantitative sensory testing protocols for pleasantness and unpleasantness, which included the additional dynamic tactile stimulation test using a goat-hair brush. Each participant underwent examination of both protocols by each examiner (inter-examiner reliability) on day 1. They returned at least 8 days following the testing to be re-examined by one examiner (intra-examiner reliability). All testing was performed on the skin of the right mandibular mental region. The intraclass correlation (ICC) was used to determine reliability. RESULTS: For the protocol investigating pleasantness, the majority of parameters had good to excellent intra-examiner (11/14: Intraclass correlation 0.67-0.87) and inter-examiner (13/14: Intraclass correlation 0.62-0.96) reliabilities. Similarly, the protocol investigating unpleasantness had good to excellent intra-examiner (intraclass correlation 0.63-0.99) and inter-examiner (intraclass correlation 0.65-0.98) reliabilities for most (13/15) of the parameters. CONCLUSION: Intra and inter-examiner reliabilities in the majority of quantitative sensory testing parameters (apart from the summation ratio) investigating pleasantness and unpleasantness are acceptable when assessing somatosensory function of the orofacial region.Trial registration: NA.

5.
J Oral Rehabil ; 47(6): 720-730, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32187404

RESUMEN

BACKGROUND: Knowledge of pain modulation from oro-facial somatosensory stimuli with different valence (pleasant-unpleasant) is limited. OBJECTIVES: To investigate (a) the modulatory effects of painful, pleasant and unpleasant somatosensory stimuli on two models of experimental facial pain, (b) whether modulation could be changed by blocking peripheral nerves via application of a local anaesthetic, EMLA, or blocking endogenous opioid receptors via naltrexone and (c) whether pain ratings were significantly correlated with participant psychological profiles. METHODS: Thirty-eight healthy women received experimental facial skin burning pain or jaw myalgia for four randomised sessions on different days. The painful region was stimulated with mechanical or thermal painful, pleasant, unpleasant and control stimuli, with ratings recorded before and during stimulation. Sessions differed in pre-treatment: EMLA/naltrexone/placebo tablet/cream. RESULTS: Significant effects of thermal or mechanical stimuli (P < .017), but not session (P > .102), were found on pain ratings for both models. In myalgia, painful cold resulted in a greater reduction in pain ratings than unpleasant cold, pleasant cold, control and pleasant warmth (P < .004). Decreases in pain ratings from painful, unpleasant and pleasant mechanical stimuli were greater than control (P < .002). In burning pain, painful cold resulted in a greater reduction in pain ratings than all but one of the other thermal stimuli (P < .033). The pleasant mechanical stimulus reduced pain ratings more than all other mechanical stimuli (P ≤ .003). There were no significant correlations between pain and psychometrics. CONCLUSION: Valence-targeted thermal and mechanical stimuli modulated experimental myalgia and skin burning pain (P < .017). Partially blocking peripheral afferents or opioid receptors did not affect modulation.


Asunto(s)
Dolor Facial , Estimulación Física , Sensación , Emociones , Femenino , Humanos , Dimensión del Dolor
6.
Clin J Pain ; 36(5): 321-335, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-31977376

RESUMEN

OBJECTIVE: The present study assessed somatosensory changes related to trigeminal nerve damage using extensive evaluation tools and assessed the effect of such damage on the patients' psychosocial status and quality of life compared with healthy participants. METHODS: In 37 patients with intraorally or extraorally presenting trigeminal nerve damage diagnosed as painful or nonpainful posttraumatic trigeminal neuropathy, psychophysical tests like quantitative sensory testing (QST) and qualitative sensory testing and the electrophysiological "nociceptive-specific" blink reflex were performed. The patients and 20 healthy participants completed a set of questionnaires assessing their psychosocial status and quality of life. RESULTS: A loss or gain of somatosensory function was seen in at least 1 QST parameter in >88.9% of the patients. Patients in whom extraoral QST was performed showed an overall loss of somatosensory function, whereas intraoral QST showed a general gain of somatosensory function. Qualitative sensory testing identified a side-to-side difference in the tactile and pinprick stimulation in >77% of the patients. An abnormal "nociceptive-specific" blink reflex response was seen in 42.1% to 71.4% of patients dependent on the trigeminal branch stimulated, though comparisons with healthy reference values showed ambiguous results. Compared with the healthy participants, patients showed higher scores for pain catastrophizing, symptoms of depression and anxiety, limited jaw function, more somatic symptoms, and significantly impaired oral health-related quality of life (all P<0.038). DISCUSSION: The results from the present study showed presence of varied somatosensory abnormalities when assessed using psychophysical and electrophysiological investigations and a significantly impaired psychosocial status.

7.
J Oral Facial Pain Headache ; 34(2): 92­107, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31560736

RESUMEN

AIMS: To assess the pain and/or unpleasantness and the somatosensory changes caused by two experimental models of trigeminal nerve damage (topical application of capsaicin and local anesthetics) in healthy participants using extensive evaluation tools. METHODS: This double-blinded, randomized, placebo-controlled, crossover study included 20 healthy adult participants who underwent three separate sessions of testing. In each session, the psychophysical quantitative sensory testing (QST) and the electrophysiologic electrically evoked trigeminal "nociceptive-specific" blink reflex (nBR) investigations were performed at baseline. Following a 15-minute topical application of 0.1% capsaicin, 5% EMLA, or Vaseline (placebo) agents, the maximum numeric rating scale pain and unpleasantness scores were recorded. Additionally, qualitative sensory testing and somatosensory mapping were performed. The QST and nBR investigations were repeated immediately after each application. Data were analyzed using repeated-measures analysis of variance. RESULTS: Capsaicin application was associated with significantly higher pain and unpleasantness scores when compared to EMLA and Vaseline (P < .001), with varied bidirectional somatosensory changes among the participants and significant loss of thermosensory function (P < .030). EMLA application induced loss of thermal and mechanical somatosensory function (P < .030) and a significant reduction in electrically evoked pain scores on nBR investigation (P < .001). No significant changes were seen in the electrophysiologic component of the nBR after any of the applications (P = .922). CONCLUSION: Topical capsaicin and EMLA application mimicked certain aspects of somatosensory changes seen in trigeminal nerve damage patients and may be used as surrogate models of such changes.


Asunto(s)
Anestesia Local , Dolor , Traumatismos del Nervio Trigémino , Adulto , Capsaicina , Estudios Cruzados , Método Doble Ciego , Humanos , Nervio Trigémino
8.
J Oral Rehabil ; 47(2): 113-122, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31418881

RESUMEN

BACKGROUND: Changes in quantitative sensory testing (QST) parameters following topical anaesthesia could contribute to better elucidate underlying mechanisms of somatosensory alterations in temporomandibular disorder (TMD) pain patients. This placebo-controlled crossover investigation compared the somatosensory profile following topical anaesthesia between TMD patients (n = 20) and healthy participants (n = 20). METHODS: Cold detection threshold, warm detection threshold, cold pain threshold, heat pain threshold, mechanical detection threshold, mechanical pain threshold, wind-up ratio and pressure pain threshold were assessed on the skin overlying the masseter at three consecutive days (baseline and immediately after lidocaine 4%/placebo cream). Mixed ANOVA and a coding system that accounts for the diversity of types of peripheral axons associated with the somatosensory parameters were applied for data analysis. RESULTS: The lidocaine application caused no changes in the somatosensory sensitivity in the masseter region in TMD patients (P > .050), but sensitivity to cold, cold pain, touch and pinprick stimuli were reduced after topical anaesthesia in healthy participants (P < .050). Also, the degree of topical anaesthesia was greater in healthy participants (P = .008). The coding system suggested that TMD patients presented only Aδ-fibre block, whereas a combination of either Aß- and/or C-fibre block was observed in 35% of healthy participants in addition to Aδ-fibre block following lidocaine application. CONCLUSION: Quantitative sensory testing can be successfully applied to identify meaningful differences in the degree of hypoalgesia and hypoesthesia following short-time topical anaesthesia.


Asunto(s)
Anestesia Local , Lidocaína , Umbral del Dolor , Trastornos de la Articulación Temporomandibular , Humanos , Dolor , Dimensión del Dolor
9.
J Oral Rehabil ; 47(2): 164-169, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31430389

RESUMEN

As yet, there are still no evidence-based clinical diagnostic and management guidelines for ambulatory single-channel EMG devices, like the BUTLER® GrindCare® (GrindCare), that are used in patients with sleep bruxism. Therefore, a consensus meeting was organised with GrindCare developers, researchers, and academic and non-academic clinicians experienced with the use of ambulatory EMG devices. The aim of the meeting was to discuss and develop recommendations for clinical guidelines for GrindCare usage, based on the existing clinical and research experience of the consensus meeting's participants. As an important outcome of the consensus meeting, clinical guidelines were proposed in which an initial 2-week baseline phase with the device in its inactive (non-stimulus) mode for habituation and assessment of the number of jaw-muscle activities is followed by a 4-week active phase with contingent electrical stimuli suppressing the jaw-muscle activities. As to avoid the commonly reported reduction in sensitivity to the stimuli, a 2-week inactive phase is subsequently installed, followed by a repetition of active and inactive phases until a lasting reduction in the number of jaw-muscle activities and/or associated complaints has been achieved. This proposal has the characteristics of a single-patient clinical trial. From a research point of view, adoption of this approach by large numbers of GrindCare users creates a great opportunity to recruit relatively large numbers of study participants that follow the same protocol.


Asunto(s)
Bruxismo , Terapia por Estimulación Eléctrica , Bruxismo del Sueño , Consenso , Estimulación Eléctrica , Electromiografía , Humanos
10.
Clin Oral Investig ; 24(2): 883-896, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31236734

RESUMEN

OBJECTIVES: The "nociceptive-specific" blink reflex (nBR) evoked by extraoral stimulation has been used to assess trigeminal nociceptive processing in patients with trigeminal nerve damage regardless of the site of damage. This study aimed to test the feasibility of nBR elicited by intraoral stimulation, compare intraoral and extraoral nBR and assess the intrarater and interrater reliability of the intraoral nBR for the maxillary (V2) and mandibular (V3) branches of the trigeminal nerve. MATERIALS AND METHODS: In 17 healthy participants, nBR was elicited by stimulation of two extraoral and two intraoral sites by two operators and repeated intraorally by one operator. Main outcome variables were intraoral stimulus-evoked pain scores and nBR R2 responses at different stimulus intensities. Intraclass correlation coefficients (ICC) were used to assess reliability. RESULTS: Dependent on the stimulus intensity, intraoral stimulation evoked R2 responses in up to 12/17 (70.6%) participants for V2 and up to 8/17 (47.1%) participants for V3. Pain scores (p < 0.003) and R2 responses (p < 0.004) increased with increasing intensities for V2, but not V3. The R2 responses were significantly smaller with intraoral stimulation compared to extraoral stimulation (p < 0.014). Overall, ICCs were fair to excellent for V2 but poor for V3. CONCLUSION: Intraorally evoked nBR was feasible in a subset of healthy participants and was less responsive than nBR with extraoral stimulation. The V2 nBR showed better reliability than V3. CLINICAL RELEVANCE: The nBR can be used to assess nerve damage to the maxillary intraoral regions, though other measures may need to be considered for the mandibular intraoral regions.


Asunto(s)
Parpadeo , Reflejo , Estimulación Eléctrica , Estudios de Factibilidad , Humanos , Reproducibilidad de los Resultados
11.
Psychol Res ; 2019 Oct 19.
Artículo en Inglés | MEDLINE | ID: mdl-31630220

RESUMEN

Pleasantness is generally overlooked when investigating tactile functions. Addition of a pleasant stimulus could allow for a more complete characterisation of somatosensory function. The aims of this review were to systematically assess the methodologies used to elicit a pleasant sensation, measured via psychophysical techniques, and to perform a meta-analysis to measure the effect of brush stroking velocity on touch pleasantness. Eighteen studies were included in the systematic review, with five studies included in the meta-analysis. The review found that factors such as texture, velocity, force, and the duration of continuous stroking influence tactile evoked pleasantness. Specifically, using a soft material and stroking at a velocity of 3 cm/s with light force is generally considered as particularly pleasant. The meta-analysis showed that a brush stroking velocity of 30 cm/s was rated as less pleasant than 3 cm/s, on the forearm. The present study collates the factors that are most likely to provide a stimulus to elicit a pleasant sensation. The results should be important for studies requiring a well-defined pleasant stimulus including neurosensory assessment protocols, allowing for a more complete multimodality assessment of somatosensory function.

12.
J Oral Facial Pain Headache ; 33(4): 389­398, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31247061

RESUMEN

AIMS: To investigate whether an international consensus exists among TMD experts regarding indications, performance, follow-up, and effectiveness of jaw exercises. METHODS: A questionnaire with 31 statements regarding jaw exercises was constructed. Fourteen international experts with some geographic dispersion were asked to participate in this Delphi study, and all accepted. The experts were asked to respond to the statements according to a 5-item verbal Likert scale that ranged from "strongly agree" to "strongly disagree." The experts could also leave free-text comments, which was encouraged. After the first round, the experts received a compilation of the other experts' earlier responses. Some statements were then rephrased and divided to clarify the essence of the statement. Subsequently, the experts were then asked to answer the questionnaire (32 statements) again for the second round. Consensus was set to 80% agreement or disagreement. RESULTS: There is consensus among TMD experts that jaw exercises are effective and can be recommended to patients with myalgia in the jaw muscles, restricted mouth opening capacity due to hyperactivity in the jaw closing muscles, and disc displacement without reduction. The patients should always be instructed in an individualized jaw exercise program and also receive both verbal advice and written information about the treatment modality. CONCLUSION: This Delphi study showed that there is an international consensus among TMD experts that jaw exercises are an effective treatment and can be recommended to patients with TMD pain and disturbed jaw function.


Asunto(s)
Trastornos de la Articulación Temporomandibular , Consenso , Técnica Delfos , Terapia por Ejercicio , Humanos , Mialgia
13.
J Oral Rehabil ; 46(9): 845-861, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31090938

RESUMEN

The aim of the present systematic review was to answer the overall research question: "To what extent is bruxism associated with musculoskeletal signs and symptoms?". The review was performed in accordance with the PRISMA guidelines. A PubMed search of articles published until 23 November 2017 was conducted. The search string included both MeSH terms and text words. Results were presented in categories according to study design, study population (eg, adults, children), bruxism sub-type (awake, sleep), assessment methods for bruxism and musculoskeletal symptoms (self-report, validated test) and type of outcome (pain, non-painful musculoskeletal symptoms). It could be concluded that bruxism is to some extent associated with musculoskeletal symptoms, even though the evidence is conflicting and seems to be dependent on many factors, such as age, whether the bruxism occurs during sleep or wakefulness, and also the quality of the diagnostic methodology regarding bruxism and musculoskeletal signs and symptoms. The literature does not support a direct linear causal relationship between bruxism and such symptoms, but points more in the direction of a multifaceted relationship dependent on the presence of other risk factors. Pain is by far the most commonly assessed symptom, whereas non-painful musculoskeletal symptoms have generally not been systematically evaluated. In the light of recent findings indicating that non-painful symptoms may precede TMD pain, it is suggested to increase the scientific focus on non-painful musculoskeletal symptoms in future studies. Also, future studies should use validated methods for case definition and outcome assessments.


Asunto(s)
Bruxismo , Bruxismo del Sueño , Trastornos de la Articulación Temporomandibular , Adulto , Niño , Dolor Facial , Humanos , Autoinforme , Vigilia
14.
J Oral Facial Pain Headache ; 33(3): 278­286, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30893407

RESUMEN

AIMS: To compare somatosensory function profiles and psychologic factors in patients with primary burning mouth syndrome (BMS) and healthy controls and to evaluate correlations of subjective pain ratings with somatosensory and psychologic parameters. METHODS: A quantitative sensory testing (QST) protocol-including cold detection threshold (CDT), warmth detection threshold (WDT), thermal sensory limen (TSL), paradoxical heat sensation (PHS), cold pain threshold (CPT), heat pain threshold (HPT), mechanical pain threshold (MPT), wind-up ratio (WUR), and pressure pain threshold (PPT)-was performed at the oral mucosa of the tongue, buccal, and palatal sites in 30 Chinese patients (25 women and 5 men, mean age 50.9 ± 9.2 years) with primary BMS and in 18 age- and gender-matched healthy controls (15 women and 3 men, mean age 53.2 ± 7.0 years). For each BMS patient, z scores and loss/gain scores were computed. Psychologic status was evaluated in both groups using the Self-Rating Anxiety Scale and Self-Rating Depression Scale. Correlations of BMS patients' subjective pain ratings with somatosensory and psychologic profiles were assessed with the use of Pearson or Spearman correlations and multiple linear regression. RESULTS: In BMS patients, 53.3% had somatosensory abnormalities according to z scores vs 22.2% of healthy controls (P = .033). The abnormalities in BMS patients were somatosensory loss to thermal nonnoxious stimuli (TSL = 20.0%, CDT = 13.3%, WDT = 13.3%), mechanical pressure stimuli (PPT = 16.7%), pinprick stimuli (MPT = 6.7%), and thermal pain stimuli (CPT = 3.3%), and somatosensory gain to repetitive pinprick stimuli (WUR = 6.7%), pressure stimuli (PPT = 6.7%), and thermal pain stimuli (HPT = 3.3%). The most frequent loss/gain score was 13.3% for loss of thermal somatosensory function with no somatosensory gain; 13.3% for loss of thermal and mechanical somatosensory function with no somatosensory gain; and 13.3% for gain of mechanical somatosensory function with no somatosensory loss. Mild elevations in anxiety scores were seen in 30% of the BMS patients, and 50% and 36.7% had mild and moderate elevations, respectively, in depression scores. No anxiety or depression was detected in the control group. QST results, but not psychologic scores, were significantly correlated with patients' subjective pain ratings (PHS, Spearman coefficient -0.384, P = .029; CPT, Pearson coefficient -0.370, P = .034; MPT, Pearson coefficient -0.376, P = .032; PPT, Pearson coefficient 0.363, P = .037). CONCLUSION: The present findings documented distinct differences in somatosensory function in patients with primary BMS compared to controls, indicating a complex pathophysiology and interaction between impairments in nociceptive processing and psychologic functioning.


Asunto(s)
Síndrome de Boca Ardiente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor , Dimensión del Dolor , Umbral del Dolor , Sensación Térmica
15.
Eur J Pain ; 23(7): 1297-1308, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30848048

RESUMEN

BACKGROUND: Somatosensory assessment within the orofacial region may be performed using highly standardized quantitative sensory testing (QST). However, the function of the C-tactile (CT) afferent, a nerve fibre linked to the perception of pleasant touch, is usually not evaluated. Furthermore, the perception of unpleasantness is also rarely assessed, a dimension not only limited to a painful experience. Therefore, the primary aim was to apply standardized QST stimuli as well as standardized pleasant stimuli and evaluate their potential capacity for evocation of perceived pain, pleasant and unpleasant sensations in the facial region. METHODS: Twenty-one female participants underwent QST as per the protocol derived from the German Research Network on Neuropathic Pain. For the first time, two modified protocols were used to investigate stimuli for perceived pleasantness and unpleasantness. RESULTS: Thermal stimuli provided separate thresholds for each sensation. From certain mechanical stimuli (e.g., vibration), overlap between the perceived sensations of pleasantness and unpleasantness was identified. It was not possible to evoke only an unpleasant sensation without a painful contribution, and both these sensations increased significantly when utilizing an increasing pinprick force (p < 0.011). Between dynamic stimuli, the brush was rated as significantly more pleasant than the cotton wool tip (p = 0.015). A quadratic model provided the best fit for velocity against mean pleasantness ratings (R2  = 0.62 ± 0.08), supporting previous CT afferent literature to some extent. CONCLUSION: Stimuli were generally not isolated to one sensation, highlighting the multidimensional construct of stimulus perception and the need for scales to capture this. SIGNIFICANCE: The battery of QST tests from the DFNS protocol has been modified to investigate pleasant and unpleasant sensations. This allows the evaluation of psychophysical properties across standardized dimensions to provide a thorough view of somatosensory function and to better understand the affective spectrum of somatosensory function.


Asunto(s)
Dolor Facial/fisiopatología , Percepción del Dolor/fisiología , Percepción del Tacto/fisiología , Adulto , Emociones , Femenino , Humanos , Vibración , Adulto Joven
16.
Clin Oral Investig ; 23(6): 2637-2649, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30327949

RESUMEN

OBJECTIVES: The aims were to use different techniques to assess the degree of sensory changes and magnitude of perceived size changes in the facial region induced by nerve blocks of two different trigeminal nerve branches in healthy participants. MATERIALS AND METHODS: This placebo-controlled study included 30 healthy volunteers. The participants underwent quantitative and qualitative sensory testing (QST and QualST) thrice: before, 10 min, and 2 h after mental (n = 15) and infraorbital (n = 15) nerve blocks and during control (saline) sessions. Perceived numbness, temperature changes, and perceptual distortion were also measured at all time points during the nerve block and control sessions. Differences in outcome parameters between the sessions and time points were analyzed using analyses of variance and McNemar's tests. RESULTS: There was a significant degree of sensory loss to most QST and all QualST parameters, with significant numbness and increased perceived size at the injection site 10 min and 2 h after the nerve blocks compared with saline (P < 0.030) and the baseline (P < 0.042). Two hours after the nerve blocks, the sensitivity was significantly closer to baseline than after 10 min to most of the QST parameters (P < 0.011). CONCLUSIONS: QST and QualST revealed that the nerve blocks in the orofacial region resulted in complete or partial blockade of afferent nerve fibers mediating thermal and mechanical function for more than 2 h with significant numbness and perceptual distortion. CLINICAL RELEVANCE: Both QST and QualST can provide information on the degree of blockade of afferent nerve fibers after nerve blocks in the orofacial region.


Asunto(s)
Anestésicos Locales , Bloqueo Nervioso , Sensación , Nervio Trigémino/efectos de los fármacos , Adulto , Cara , Femenino , Humanos , Inyecciones , Masculino , Sensación Térmica , Adulto Joven
17.
J Oral Facial Pain Headache ; 32(4): 418-427, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30365578

RESUMEN

AIMS: To investigate whether glutamate-evoked pain in the masseter region differs between three different depths of injection, targeting subcutaneous, muscle, and bone tissues. METHODS: A total of 16 healthy volunteers participated and, in a randomized order, received injections of glutamate (1.0 M, 0.2 mL) and isotonic saline (0.9%, 0.2 mL) in the masseter region that targeted subcutaneous, intramuscular, and bone surface tissues. Following injection, pain intensity was measured using electronic visual analog scale (eVAS) and numeric rating scale (NRS) scores of unpleasantness, tiredness, tension, soreness, and stiffness. Pressure pain sensitivity (PPS), pain drawing areas, and McGill Pain Questionnaire (MPQ) scores were also assessed. Repeated-measures analysis of variance, McNemar test, and Tukey post hoc tests were used for statistical analyses. P < .05 was considered statistically significant. RESULTS: Overall, subcutaneous injections induced significantly more unpleasantness and pain than intramuscular injections, and PPS scores evoked after glutamate injection at the surface of the bone were significantly higher than after intramuscular glutamate injection. Subcutaneous glutamate injections were more often described as "sharp" and "pinching." CONCLUSION: The subcutaneous injection was more painful and unpleasant than the intramuscular injection. The glutamate injection at the surface of the bone sensitized the deep pain tissues to pressure stimulation. Clinically, it may be difficult to differentiate between the source or site of pain originating from the masseter region, but the specific quality and word descriptors could assist in differential diagnosis.


Asunto(s)
Huesos/efectos de los fármacos , Inyecciones Intramusculares , Inyecciones Subcutáneas , Músculo Masetero/efectos de los fármacos , Glutamato de Sodio/farmacología , Síndrome de la Disfunción de Articulación Temporomandibular/fisiopatología , Adulto , Dolor Facial , Femenino , Voluntarios Sanos , Humanos , Hiperalgesia , Inyecciones , Masculino , Dimensión del Dolor , Umbral del Dolor/efectos de los fármacos , Presión , Adulto Joven
18.
J Am Dent Assoc ; 149(6): 422-431, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29653670

RESUMEN

BACKGROUND: Evidence in the field of dentistry has demonstrated the importance of pain-related disability and psychological assessment in the development of chronic symptoms. The Diagnostic Criteria for Temporomandibular Disorders offer a brief assessment for the diagnostic process in patients with orofacial pain (Axis II). The authors describe relevant outcomes that may guide general oral health care practitioners toward tailored treatment decisions and improved treatment outcomes and provide recommendations for the primary care setting. METHODS: The authors conducted a review of the literature to provide an overview of knowledge about Axis II assessment relevant for the general oral health care practitioner. RESULTS: The authors propose 3 domains of the Axis II assessment to be used in general oral health care: pain location (pain drawing), pain intensity and related disability (Graded Chronic Pain Scale [GCPS]), and psychological distress (Patient Health Questionnaire-4 [PHQ-4]). In the case of localized pain, low GCPS scores (0-II), and low PHQ-4 scores (0-5), patients preferably receive treatment in primary care. In the case of widespread pain, high GCPS scores (III-IV), and high PHQ-4 scores (6-12), the authors recommend referral to a multidisciplinary team, especially for patients with temporomandibular disorder (TMD) pain. CONCLUSIONS: The authors recommend psychological assessment at first intake of a new adult patient or for patients with persistent TMD pain. The authors recommend the pain-related disability screening tools for all TMD pain symptoms and for dental pain symptoms that persist beyond the normal healing period. PRACTICAL IMPLICATIONS: A brief psychological and pain-related disability assessment for patients in primary care may help the general oral health care practitioner make tailored treatment decisions.


Asunto(s)
Dolor Crónico , Trastornos de la Articulación Temporomandibular , Adulto , Dolor Facial , Humanos , Salud Bucal , Trastornos Somatomorfos
19.
J Oral Facial Pain Headache ; 32(2): 159­166, 2018 03 21.
Artículo en Inglés | MEDLINE | ID: mdl-29561916

RESUMEN

AIMS: To determine if standardized palpation of the masseter muscle can evoke referred pain and/or sensations in healthy individuals and to compare the mechanical sensitivities in response to three different levels of palpation force. METHODS: A total of 32 pain-free individuals participated. The right masseter muscle was divided into 15 test sites. Mechanical sensitivity of the masseter was assessed with three mechanical stimuli (0.5 kg, 1.0 kg, or 2.0 kg) applied by palpometers to the 15 test sites for 5 seconds each site. Participants scored the perceived intensity of pain and unpleasantness of each of the three mechanical stimuli on 0-100 numeric rating scales (NRS). After each stimulus, the duration of aftersensation was measured, and the participants were also asked to indicate areas within the orofacial region with referred pain/sensations. Data were tested using analysis of variance, Tukey post hoc, and McNemar's tests with a 5% level of significance. RESULTS: Referred pain/sensations were most commonly evoked with the 2.0-kg stimulus (34.4% of participants; P < .05) compared to the 1.0-kg (12.5%) and 0.5-kg stimuli (3.1%). There were significant effects of stimulus intensity on NRS scores for pain and unpleasantness, as well as for aftersensation (P < .05). There were significant effects on NRS scores for pain and unpleasantness for the 1.0- and 2.0-kg stimuli (P < .05) and on aftersensation for the 2.0-kg stimulus (P < .05). CONCLUSION: These results indicate that referred pain/sensations in the orofacial region are frequent phenomena among healthy individuals during standardized palpation of the masseter muscle.

20.
J Oral Facial Pain Headache ; 31(3): 199-209, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28738104

RESUMEN

AIMS: To propose a visual method to screen and assess psychosocial functioning in temporomandibular disorder (TMD) pain patients in comparison with age- and gender-matched healthy controls by forming individual profiles and to evaluate the association between psychosocial profiles and quantitative sensory testing (QST) findings of TMD pain patients. METHODS: TMD patients (n = 58) and control participants (n = 41) completed a set of questionnaires profiling their psychosocial function, and QST was performed at the temporomandibular joint (TMJ) on both sides of the face in all participants. Psychosocial parameters from the Research Diagnostic Criteria for TMD (RDC/TMD), Oral Health Impact Profile (OHIP), and Pain Catastrophizing Scale (PCS) instruments were transformed into T scores, and QST parameters were transformed into z scores based on reference data. Group differences for psychosocial T scores were analyzed with t tests. T scores of psychosocial parameters and z scores of QST parameters were correlated using Spearman's correlation (ρ). RESULTS: Most (96.6%) TMD pain patients exhibited one or more parameters indicative of psychosocial distress, with psychological disability scores being the scores most frequently encountered outside the reference 95% confidence intervals (CI). TMD patients were psychosocially more distressed with regard to all psychosocial parameters compared with controls (P < .009). After Bonferroni corrections, a significant correlation was detected between the sleep dysfunction parameter and mechanical detection threshold (MDT) in TMD pain patients (ρ = 0.427, P < .001). CONCLUSION: T score psychosocial profiles created an easy overview of psychosocial function in TMD pain patients. Increased sensitivity to tactile stimuli was associated with higher sleep dysfunction T scores.


Asunto(s)
Trastornos de la Articulación Temporomandibular/diagnóstico , Trastornos de la Articulación Temporomandibular/psicología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Psicológicas , Autoinforme , Adulto Joven
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