Sensory characteristics according to chronic diseases and chronic pain in adults: cross-sectional study.

Aim: To investigate somatosensory, gustative and olfactory characteristics of subjects according to their chronic diseases and the presence of chronic pain complaints. Materials & methods: A total of 254 chronic pain patients and 52 healthy subjects were evaluated with a clinical and sensory systematized evaluation. Statistical analysis consisted of Fisher's exact, Student's t-tests, Pearson's co-efficient and multivariate nonlinear/logistic regressions. Results: Patients had more chronic diseases (p < 0.001) than healthy subjects. Chronic pain was associated with vibratory hypoesthesia (p = 0.047) and sour hypergeusia (p = 0.001) and several chronic diseases correlated with sensory features. Hyposmia was strongly associated with chronic pain symptoms, chronic diseases and cardiovascular disease. Conclusion: The sensory findings observed suggest the need for further investigation about the overlap between the olfactory function, pain chronification, chronic diseases and cognitive impairment in these patients.

Association between craniofacial pain complaints, somatoform symptoms and chronic diseases.

OBJECTIVE: This case-control study aimed to investigate associations between craniofacial pain complaints, somatoform symptoms and chronic diseases. DESIGN: 306 subjects were included in this study (174 patients and 132 healthy subjects). The evaluation consisted of demographic data, number of functional and nonfunctional chronic diseases, medications, somatoform symptoms (xerostomia, dry mucosa, numbness, gastrointestinal complaints), and pain complaints with associated characteristics (number of pain areas, sensation of tired face, bruxism, sleep disturbances, masticatory musculoskeletal evaluation). Statistical analysis included descriptive data, tested with chi-square, Fisher's exact, nonparametric Kolmogorov-Smirnoff, Student's t-test, Pearson's coefficient, two-steps cluster classification, multivariate linear and LASSO regressions. RESULTS: Functional disorders were prevalent in 111 (63.8 %) patients with facial pain. They were taking more medication (p < 0.001) and had more sleep disturbances (p < 0.001), higher xerostomia scores (p < 0.001) and more gastrointestinal complaints (p < 0.001) than controls. There was a positive correlation between the functional score and the number of cranial areas with headache (R2 = 0.266, <0.001). The regression models for facial pain (R2 = 0.632), craniofacial pain (R2 = 0.623) and headache (R2 = 0.252) showed significant dependency of functional disorders (p < 0.001). CONCLUSION: craniofacial pain was associated with functional diseases and somatoform symptoms. This association needs further investigation to understand the role of those disorders in craniofacial pain, considering that pain complaints are common somatoform and functional symptoms.

Chronic pain, somatic unexplained complaints and multimorbidity: A mutimorbidity painful syndrome?

INTRODUCTION: Chronic illnesses are a major research challenge due to its implications in aging and quality of life of adults and elders, and it can be associated with chronic illnesses and other complaints. The objective of this study was to investigate the role of morbidities (chronic diseases with or without somatic unexplained symptoms) and somatic unexplained complaints in a hypothetical model of a multimorbidity painful syndrome. Our hypothesis is that chronic pain should be considered part of a syndrome that includes other chronic diseases and pathological states, especially conditions with somatic unexplained symptoms, and fibromyalgia is one of the evidence on that. METHODS: A pilot sample of 306 subjects was investigated in this study (254; 83.0% with chronic pain). The following features were investigated: demographic data, chronic diseases (classified as with or without somatic unexplained symptoms), medications in use, pain characteristics, fulfillment of diagnostic criteria of fibromyalgia, and somatic unexplained complaints (gastric complaints, sleep disturbances, numbness, and the dry mucosa score). Statistical analysis included descriptive data, tested with chi-square, Fisher's exact, nonparametric Kolmogorov-Smirnoff, Student's t test; data normalization with Z-score; Pearson's coefficient for correlation, two-steps cluster classification, multivariate linear regression, LASSO and logistic regression. RESULTS: Both groups of chronic diseases were more prevalent in the group of patients (p < 0.001 and p = 0.013, respectively), which had higher frequency of somatic unexplained complaints (gastrointestinal, dry mucosa and numbness) than controls. There was a high positive correlation between number of pain areas and somatic unexplained symptoms score (R2 = 0.626; p < 0.001), and diseases with these symptoms were a risk factor for chronic pain (R2 = 0.5748) and fibromyalgia (AIC = 5.8952). CONCLUSIONS: Diseases with somatic unexplained symptoms and somatic unexplained complaints were associated with chronic pain, including fibromyalgia. They may be risks factors for pain spread. The findings support that chronic pain could be further investigated as part of a multimorbid syndrome, which should be better assessed to improve aging and quality of life of patients.

Oral infections and orofacial pain in Alzheimer's disease: a case-control study.

BACKGROUND: Dental infections are frequent and have recently been implicated as a possible risk factor for Alzheimer's disease (AD). Despite a lack of studies investigating orofacial pain in this patient group, dental conditions are known to be a potential cause of pain and to affect quality of life and disease progression. OBJECTIVES: To evaluate oral status, mandibular function and orofacial pain in patients with mild AD versus healthy subjects matched for age and gender. METHODS: Twenty-nine patients and 30 control subjects were evaluated. The protocol comprised a clinical questionnaire and dental exam, research diagnostic criteria for temporomandibular disorders, the McGill Pain Questionnaire, the decayed, missing, and filled teeth index, and included a full periodontal evaluation. AD signs and symptoms as well as associated factors were evaluated by a trained neurologist. RESULTS: A higher prevalence of orofacial pain (20.7%, p < 0.001), articular abnormalities in temporomandibular joints (p < 0.05), and periodontal infections (p = 0.002) was observed in the study group compared to the control group. CONCLUSION: Orofacial pain and periodontal infections were more frequent in patients with mild AD than in healthy subjects. Orofacial pain screening and dental and oral exams should be routinely performed in AD patients in order to identify pathological conditions that need treatment thus improving quality of life compromised due to dementia.

Spirituality of chronic orofacial pain patients: case-control study.

The objective of this study was to investigate spirituality and blood parameters associated with stress in patients with facial musculoskeletal pain. Twenty-four women with chronic facial musculoskeletal pain (CFMP) and 24 healthy women were evaluated with a protocol for orofacial characteristics, research diagnostic criteria for temporomandibular disorders and the Spiritual Perspective Scale. Blood samples were collected to analyze blood count, cortisol, ACTH, C3, C4, thyroid hormones, total immunoglobulin, C-reactive protein and rheumatoid factor. The study group was more spiritualized than control group. Individuals with a high score of spirituality had less myofascial pain, less bruxism and fewer complaints. They also had lower levels of ACTH and IgE. Spirituality was higher in the study group and can be considered an important tool for coping with CFMP.

Oral infections and orofacial pain in Alzheimer's disease: Case report and review.

Dental infections, frequent in the general population, are a common cause of inflammation with systemic impact, and are the most common cause of orofacial pain. Temporomandibular disorders are also frequent in the elderly and represent an important cause of secondary headache. Both inflammation and pain can also contribute to cognitive, functional and behavioral impairment of the elderly and aggravate symptoms of patients with Alzheimer's disease (AD). We report a case of a 74-year-old woman with AD and chronic facial pain who had a significant improvement in functional activities as well as in cognition and depressive symptoms after successful treatment of her facial pain. Patients with AD have higher compromise of oral health with infections and teeth loss. The investigation of orofacial pain should be performed in patients with AD, because of the associations reviewed and given the potential for improvement as highlighted by this case.

Infecções dentárias, frequentes na população e geral, são uma causa comum de inflamação com impacto sistêmico e a causa mais comum de dor orofacial. Disfunções temporomandibulares também são prevalentes nos idosos, causam cefaléia secundária. Tanto a dor quanto a inflamação podem também contribuir com o comprometimento cognitivo, funcional e comportamental em idosos e agravar sintomas em pacientes com doença de Alzheimer (DA). Este é um relato de um caso de uma mulher com 74 anos de idade com DA e dor orofacial crônica que apresentou uma melhora significante nas atividades funcionais assim como na cognição e sintomas depressivos depois do tratamento da dor facial. Pacientes com DA tem alto comprometimento da saúde oral com infecções e perdas dentárias. A investigação da dor orofacial deveria ser realizada em pacientes com DA devido às associações revisadas e à possibilidade de melhora como destacadas por este relato.

The long-term effect of craniotomy on temporalis muscle function.

OBJECTIVE: The objective of this study was to evaluate jaw movements and the masticatory muscle in patients who underwent craniotomy for treatment of cerebral aneurysm. STUDY DESIGN: Descriptive study. RESULTS: There were 71 patients evaluated between 4 and 6 months after craniotomy, by means of a systematized approach. Their mean age was 45.3 years. Thirty-four (47.9%) patients complained of headache during dental evaluation. Twenty (28.2%) patients reported pain during normal jaw movements. There was a correlation between pain complaints and jaw movements during dental examinations (P = .03). Patients with postcraniotomy headache had more masticatory muscle tenderness on palpation than those without post-craniotomy headache (P < .02). Jaw protrusion was worse than the reference values (P < .01). CONCLUSIONS: Headache was the complaint in 47.9% of the sample. Jaw movement was statistically a pain-precipitating factor. Patients who suffered from postcraniotomy headache had more masticatory muscle tenderness. There were functional jaw limitations.

SUNCT syndrome associated with temporomandibular disorders: a case report.

This case report relates the association between a rare neuralgiform syndrome (SUNCT) and masticatory myofascial pain (TMD); two different diseases with different diagnosis criteria and treatments. SUNCT syndrome was treated with a balloon microcompression procedure of the trigeminal ganglion, and the myofascial pain with injections and physical therapy. The patient was without pain at a twelve-month follow-up evaluation.