Prevalence of headache and orofacial pain in adults and elders in a Brazilian community: an epidemiological study.

BACKGROUND AND OBJECTIVE: Headache and orofacial pain are often persistent and not easy to be evaluated. The objective of this study was to investigate the epidemiology of headache and orofacial pain in Brazilian adults and elders in a district of São Paulo (Brazil). STUDY DESIGN: population-based cross-sectional; Adults (18-59 years old) and elderly people (above 60 years old) were evaluated according to their socio-demographic characteristics, prevalence and location of pain and associated factors. The subjects were interviewed about their orofacial complaints, which were investigated with a validated questionnaire. RESULTS: Five hundred and five adults and 385 elders agreed in participating of this study. More than half of the population had pain (45.3% of adults and 56.6% of elderly); 10.6% of subjects had bruxism and 10.2% had toothache; 48.6% of the adults with pain and 58.7% of the elders with pain had impairment in daily activities due to the pain. The prevalence of head and facial pain was 55.5%. Headache was more prevalent in the adult group compared with the elderly group. Bruxism was associated with headache (p = 0.029), toothache (p < 0.001), facial pain (p < 0.001) and fatigue at the face (p = 0.004). CONCLUSION: This study showed a high prevalence of head and orofacial pain, and their potential aetiologies need further investigation. The pain complaints were associated with comorbidities and the use of medication. Facial painful diseases impact the quality of life of adults and should be diagnosed and treated.

The Expression of Nitric Oxide in the Gingival Tissue in Subjects with Periodontitis and Chronic Pain / Expression de Oxido Nítrico en el Tejido Gingival de Sujetos con Periodontitis y Dolor Crónico

Periodontal disease (PD) is a chronic infection that may have local and systemic rebound. Although a series of inflammatory mediators are involved in PD, the mechanisms involved in chronic craniofacial pain associated with it require elucidation. The aim of this study was to evaluate the immunoreactivity of substance P (SP), neuronal (nNOS) and inducible (iNOS) nitric oxide synthases in gingival samples of patients with severe PD with and without chronic craniofacial pain. Gingival specimens were obtained during routine periodontal surgery while managing 20 patients with both PD and chronic craniofacial pain (CFP Group) and 18 patients with only PD (PD Group). Following surgical removal, the tissue underwent routine histological techniques and was stained by immunohistochemistry with antibodies against SP, nNOS and iNOS. Using an image analysis system, we assessed the SP, nNOS and iNOS content in total gingival tissue as well as in both epithelial and connective gingival area. We observed high expression of nNOS in gingival tissue obtained from CFP patients (p<0.001), particularly in the epithelium area (p<0.001) comparatively to PD patients. In addition, the iNOS expression was also increased in the CFP group in the connective gingival tissue (p=0.003). There was no difference concerning SP expression between the groups. Our results suggest that nitric oxide, particularly derived from nNOS, modulates not only PD but also chronic craniofacial pain, since patients with this association presented an increase in nNOS and iNOS expression in gingival tissue.

La enfermedad periodontal (EP) es una patología crónica que pueden tener acción local y sistémica. A pesar de que hay una serie de mediadores inflamatorios implicados en la EP, los mecanismos implicados en el dolor craneofacial crónico asociado con la EP aún no están elucidados. El objetivo fue evaluar la inmunoreactividad de la sustancia P (SP), óxido nítrico sintetasas neuronal (nNOS) e inducible (iNOS) en muestras gingivales de pacientes con enfermedad periodontal severa con y sin dolor craneofacial crónico. Fueron obtenidas muestras gingivales durante la cirugía periodontal rutinaria de 20 pacientes que presentaron con EP y dolor craneofacial crónico (Grupo PPC) y 18 pacientes sólo con PD (Grupo PD). Después de la extirpación quirúrgica, el tejido se sometió a las técnicas histológicas de rutina y se tiñó por inmunohistoquímica con anticuerpos contra el SP, nNOS e iNOS. Se evaluaron el contenido de SP, nNOS e iNOS en el tejido gingival total, así como la superficie gingival, epitelio y tejido conectivo mediante análisis de imagen. Se observó alta expresión de nNOS en el tejido gingival obtenido a partir de pacientes PPC (p<0,001) en comparación a los pacientes con EP, particularmente en el área de epitelio (p<0,001). Además, la expresión de iNOS se incrementó en el tejido conjuntivo gingival (p= 0,003) del grupo PPC. No hubo diferencia en la expresión de SP entre los grupos. Nuestros resultados sugieren que el óxido nítrico, en particular derivado de nNOS, modula no sólo PD, sino también el dolor craneofacial crónico, ya que los pacientes con esta asociación presentan un aumento de la expresión de nNOS e iNOS en el tejido gingival.

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.

Cardiovascular response during trigeminal ganglion compression for trigeminal neuralgia according to the use of local anesthetics.

OBJECTIVES: There are controversies about the use of local anesthetics during balloon compression for trigeminal neuralgia (TN) as a protective factor for cardiovascular events. The objective of this study was to investigate cardiovascular parameters (blood pressure and heart rate [HR]) of patients that underwent trigeminal balloon compression with local anesthetics compared to a control group (placebo). METHODS: This is a randomized controlled study; 55 patients were randomized into two groups: study (deep sedation and trigeminal block with 0.8-mL lidocaine 2%) and control group (deep sedation and trigeminal injection of 0.8-mL saline). Blood pressure and HR were measured in five distinct moments: preoperative, during puncture for local anesthesia/placebo, during puncture with the catheter, during balloon compression, and final evaluation. Statistical analysis was performed with Pearson's chi (2) and McNemar tests and the analysis of variance for repetitive measures. RESULTS: The means of systolic and diastolic blood pressures (SBP and DBP, respectively) were higher in the control group when compared to the study group at the evaluation during puncture with the catheter (p < 0.001) and balloon compression (p < 0.001 and p = 0.018 for DBP and SBP, respectively). There was an increase in the HR in the control group during the procedure (p = 0.017). CONCLUSION: The use of local anesthetics during the trigeminal balloon compression for TN can have a preventive role for the risk of cardiovascular events.

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.