The Orofacial Pain Clinic Questionnaire (EDOF-HC) in the evaluation and diagnosis of orofacial pain.

BACKGROUND: Diagnostic tools are necessary for the anamnesis and examination of orofacial pain, in order to fulfill diagnostic criteria and to screen potential causes of pain. OBJECTIVE: To evaluate the Orofacial Pain Clinic Questionnaire (EDOF-HC) in the assessment and diagnosis of orofacial pain. METHODS: Overall, 142 patients were evaluated and classified according to the criteria of the International Headache Society and International Association for the Study of Pain. All of them were evaluated with the EDOF-HC questionnaire, which consists of the orofacial and medical history, as well as the orofacial examination. Data were statistically analyzed with chi-square test and Bonferroni correction, one-way ANOVA with Tukey post hoc test, the two-step cluster and decision tree methods. RESULTS: There were diferences in pain descriptors, pain in maximum mouth opening, number of trigger points, and history of previous surgery between the groups, which were classified into trigeminal neuralgia, burning mouth syndrome, temporomandibular disorders and trigeminal posttraumatic neuropathic pain with classification analysis. CONCLUSIONS: The EDOF-HC is a clinical supportive tool for the assessment of orofacial pain. The instrument may be used to support data collection from anamnesis and examination of patients according to the diagnostic criteria of most common orofacial conditions. It is also useful in the investigation of local and systemic abnormalities and contributes for the diagnosis of conditions that depend on exclusion criteria.

The Orofacial Pain Clinic Questionnaire (EDOF-HC) in the evaluation and diagnosis of orofacial pain / Questionário da Equipe de Dor Orofacial (EDOF-HC) na avaliação e diagnóstico da dor orofacial

ABSTRACT Background: Diagnostic tools are necessary for the anamnesis and examination of orofacial pain, in order to fulfill diagnostic criteria and to screen potential causes of pain. Objective: To evaluate the Orofacial Pain Clinic Questionnaire (EDOF-HC) in the assessment and diagnosis of orofacial pain. Methods: Overall, 142 patients were evaluated and classified according to the criteria of the International Headache Society and International Association for the Study of Pain. All of them were evaluated with the EDOF-HC questionnaire, which consists of the orofacial and medical history, as well as the orofacial examination. Data were statistically analyzed with chi-square test and Bonferroni correction, one-way ANOVA with Tukey post hoc test, the two-step cluster and decision tree methods. Results: There were diferences in pain descriptors, pain in maximum mouth opening, number of trigger points, and history of previous surgery between the groups, which were classified into trigeminal neuralgia, burning mouth syndrome, temporomandibular disorders and trigeminal posttraumatic neuropathic pain with classification analysis. Conclusions: The EDOF-HC is a clinical supportive tool for the assessment of orofacial pain. The instrument may be used to support data collection from anamnesis and examination of patients according to the diagnostic criteria of most common orofacial conditions. It is also useful in the investigation of local and systemic abnormalities and contributes for the diagnosis of conditions that depend on exclusion criteria.

RESUMO Introdução: Instrumentos diagnósticos são necessários para a anamnese e exame da dor orofacial, auxiliando na identificação das causas potenciais de dor. Objetivo: Avaliar o Questionário da Equipe de Dor Orofacial (EDOF-HC) na abordagem e diagnóstico da dor orofacial. Métodos: Ao todo, 142 pacientes foram avaliados e classificados de acordo com os critérios da Sociedade Internacional de Cefaleias e da Associação Internacional para o Estudo da Dor. Todos foram avaliados com o questionário EDOF-HC, que consiste na anamnese orofacial e médica, além do exame físico orofacial. Os dados foram analisados estatisticamente com os testes qui-quadrado com correção de Bonferroni, ANOVA de um fator e post hoc de Tukey, além dos métodos de classificação em cluster e árvore decisória. Resultados: Houve diferenças entre os diagnósticos quanto aos descritores da dor, dor na abertura bucal máxima, número de pontos-gatilho mastigatórios e história prévia de cirurgia, o que esteve de acordo com a classificação nos diagnósticos de neuralgia do trigêmeo, síndrome da ardência bucal, disfunção temporomandibular e dor neuropática pós-traumática trigeminal. Conclusões: O Questionário da Equipe de Dor Orofacial (EDOF-HC) mostrou ser um instrumento de apoio para a avaliação da dor orofacial, útil na coleta de dados de anamnese e exame clínico dos pacientes, observando os principais sinais e sintomas relacionados aos critérios diagnósticos das condições orofaciais dolorosas mais comuns. Também é útil na avaliação de comorbidades locais e sistêmicas e contribui para o diagnóstico de condições que dependem em critérios de exclusão.

Quantitative sensory testing in elderly: longitudinal study.

OBJECTIVE: To evaluate elderly patients in a geriatric service, along with their sensory characteristics and their association with clinical aspects. METHODS: This was a descriptive longitudinal study. We enrolled 36 healthy participants of both sexes in this study. The following instruments were used and evaluations performed: clinical evaluation, Mini-Mental State Exam, and quantitative sensory testing. RESULTS: During the follow-up, there was reduction of mean corpuscular volume at each evaluation (p < 0.001) and significant increase in mean corpuscular hemoglobin concentration (p < 0.001). There was an increase of the olfactory (p < 0.001), salty (p = 0.024), sour (p = 0.020), bitter (p = 0.001), facial cold (p = 0.019), hand cold (p = 0.004), facial tactile (p < 0.001), hand tactile (p = 0.012) and facial vibration (p = 0.018) thresholds. Previous existing morbidities were associated with sensitivity changes in the individuals in this sample. CONCLUSION: This longitudinal study suggests that the loss of sensitivity with aging may be associated with the presence of morbidities in elders.

Quantitative sensory testing in elderly: longitudinal study / Teste sensitivo quantitativo em idosos: estudo longitudinal

ABSTRACT Objective: To evaluate elderly patients in a geriatric service, along with their sensory characteristics and their association with clinical aspects. Methods: This was a descriptive longitudinal study. We enrolled 36 healthy participants of both sexes in this study. The following instruments were used and evaluations performed: clinical evaluation, Mini-Mental State Exam, and quantitative sensory testing. Results: During the follow-up, there was reduction of mean corpuscular volume at each evaluation (p < 0.001) and significant increase in mean corpuscular hemoglobin concentration (p < 0.001). There was an increase of the olfactory (p < 0.001), salty (p = 0.024), sour (p = 0.020), bitter (p = 0.001), facial cold (p = 0.019), hand cold (p = 0.004), facial tactile (p < 0.001), hand tactile (p = 0.012) and facial vibration (p = 0.018) thresholds. Previous existing morbidities were associated with sensitivity changes in the individuals in this sample. Conclusion: This longitudinal study suggests that the loss of sensitivity with aging may be associated with the presence of morbidities in elders.

RESUMO Objetivo: Avaliar pacientes idosos em um serviço de geriatria, juntamente com as características sensitivas e sua associação com aspectos clínicos. Métodos: Este é um estudo longitudinal descritivo. Foram avaliados 36 sujeitos saudáveis de ambos os sexos. Os seguintes instrumentos e avaliações foram realizados: Avaliação clínica, Mini Exame de Estado Mental (Mini-Mental) e testes sensitivos quantitativos. Resultados: Durante o acompanhamento houve redução do volume corpuscular médio (VCM) em cada avaliação (P < 0,001) e aumento significativo das concentrações de hemoglobina corpuscular média (CHCM) (P < 0,001). Houve aumento dos limiares olfativos (p < 0,001), salgado (p = 0,024), azedo (p = 0,020), amargo (p = 0,001), frio face (p = 0,019), frio mão (p = 0,004), tato face (p < 0,001), tato mão (p = 0.012) e vibração face (p = 0,018). Morbidades prévias foram associadas às alterações de sensibilidade nos indivíduos desta amostra. Conclusão: Este estudo longitudinal sugere que a perda de sensibilidade no envelhecimento pode estar associada à presença de morbidades em idosos.

Clinical evidence on visceral pain. Systematic review / Evidência clínica sobre dor visceral. Revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Visceral pain is induced by abnormalities of organs such as stomach, kidneys, bladder, gallbladder, intestines and others and includes distension, ischemia, inflammation and mesenteric traction. It is responsible for physical and psychic incapacity, absenteeism and poor quality of life. This study aimed at discussing major aspects of visceral pain with regard to prevalence, etiology and diagnosis. CONTENTS: According to Evidence-Based Medicine concepts, visceral pain etiology, diagnosis and prognosis were reviewed in LILACS, EMBASE and Pubmed databases. Therapeutic studies were not selected. The following terms were used as search strategy: ("visceral pain"[MeSH Terms] OR ("visceral"[All Fields] AND "pain"[All Fields]) OR "visceral pain"[All Fields]). Only studies published in Portuguese, English or Spanish were included. Narrative reviews with opinionated content and specific therapeutic procedures of medical specialties were excluded. Studies on visceral pain related to heart, cancer and musculoskeletal diseases and pregnancy were also excluded. CONCLUSION: Visceral pain is a heterogeneous condition where most frequent presentation is abdominal pain in the course of irritable bowel syndrome. Other diseases induce visceral pain and adequate diagnosis is critical for effective treatment.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor visceral é causada por anormalidades de órgãos como o estômago, rim, bexiga, vesícula biliar, intestinos ou outros e inclui distensão, isquemia, inflamação e tração do mesentério. É responsável por incapacidade física e psíquica, absenteísmo do trabalho e má qualidade de vida. O objetivo deste estudo foi discutir os principais aspectos da dor visceral relacionados a prevalência, etiologia e diagnóstico. CONTEÚDO: Foram revisados segundo os preceitos da Medicina Baseada em Evidência os enfoques etiológicos, diagnóstico e prognóstico da dor visceral nas bases de indexações biomédicas, LILACS, EMBASE e Pubmed. Não foram selecionados os estudos terapêuticos. Utilizou-se como estratégia de busca os termos: ("visceral pain"[MeSH Terms] OR ("visceral"[All Fields] AND "pain"[All Fields]) OR "visceral pain"[All Fields]). Somente foram incluídos os estudos publicados em português, inglês ou espanhol. Foram excluídas as revisões narrativas de conteúdo opinativo e procedimentos terapêuticos específicos das especialidades médicas. Também foram excluídos os estudos sobre dor visceral relacionada às doenças do coração, neoplásicas, musculoesqueléticas e a gestação. CONCLUSÃO: A dor visceral é uma condição heterogênea, cuja apresentação mais frequente é de dor abdominal no curso de síndrome do intestino irritável. Outras doenças cursam com dor visceral e o diagnóstico adequado é fundamental para o tratamento eficaz.

Could pain understanding by patients help the assessment of trigeminal neuralgia? / A compreensão da dor pelo paciente pode ajudar no tratamento da neuralgia do trigêmeo?

ABSTRACT BACKGROUND AND OBJECTIVES: To observe the efficacy of pain management by means of an educational proposal to address patients with trigeminal neuralgia, which is a chronic pain with high daily activity limitation rates. METHODS: Eight patients being treated of trigeminal neuralgia participated in weekly meetings on pain in a general reference hospital. Patients had uncontrollable pain in spite of treatments so they would come very frequently to the hospital (once every one or two weeks). Patients were invited to participate in a series of meetings (four) to receive information and discuss about the disease and pain. RESULTS: There has been increased interval between appointments for two patients, who went from weekly to biannual visits, and six patients were discharged with controlled symptoms. CONCLUSION: Education on pain has helped its management and coping by patients, by means of understanding their condition, in addition to improving their abilities to deal with it, decreasing hospital visits due to less pain recurrence.

RESUMO JUSTIFICATIVA E OBJETIVOS: Verificar a eficácia do tratamento da dor, por meio de uma proposta educativa para a abordagem de pacientes com neuralgia do trigêmeo, uma dor crônica com alto índice de limitações em atividades diárias. MÉTODOS: Oito pacientes com neuralgia do trigêmeo em tratamento frequentaram encontros semanais sobre a dor em um hospital geral de referência. Eles apresentavam dor incontrolável apesar dos tratamentos e por isso compareciam em atendimentos com alta frequência (1 vez a cada 1 ou 2 semanas). Eles foram convidados a participar de uma série de encontros (4) para receber informações e discutir sobre a doença e a dor. RESULTADOS: Observou-se que houve um aumento nos intervalos de tempo entre as consultas de 2 pacientes, que passaram de visitas semanais para bienais, e 6 pacientes tiveram alta e controle dos sintomas. CONCLUSÃO: Educação em dor auxiliou no seu manuseio pelos pacientes e em seu enfrentamento, por meio do entendimento de sua condição e no aumento de habilidades para lidar com ela, reduzindo visitas ao ambulatório por conta da menor recorrência de dor.

Temporomandibular disorders in fibromyalgia patients: are there different pain onset?

OBJECTIVE: To identify temporomandibular disorders (TMD) symptoms in two groups of fibromyalgia patients according to the temporal relation between the onset of facial pain (FP) and generalized body pain (GBP). CROSS-SECTIONAL STUDY DESIGN: Fifty-three consecutive women with fibromyalgia and FP were stratified according to the onset of orofacial pain: Group-A (mean age 47.30 ± 14.20 years old), onset of FP preceded GBP; Group-B (mean age 51.33 ± 11.03 years old), the FP started concomitant or after GBP. CLINICAL ASSESSMENT: Research Diagnostic Criteria for Temporomandibular Disorders and the Visual Analogue Scale. RESULTS: Myofascial pain with mouth opening limitation (p = 0.038); right disc displacement with reduction (p = 0.012) and jaw stiffness (p = 0.004) were predominant in Group A. Myofascial pain without mouth opening limitation (p = 0.038) and numbness/burning were more common in Group B. CONCLUSION: All patients had temporomandibular joint symptoms, mainly muscle disorders. The prevalence of myofascial pain with limited mouth opening and right TMJ disc displacement with reduction were higher in Group A.

Temporomandibular disorders in fibromyalgia patients: are there different pain onset? / Disfunção termomandibuar em doentes com fibromialgia: há diferença no início das dores?

ABSTRACT Objective To identify temporomandibular disorders (TMD) symptoms in two groups of fibromyalgia patients according to the temporal relation between the onset of facial pain (FP) and generalized body pain (GBP). Cross-sectional study design: Fifty-three consecutive women with fibromyalgia and FP were stratified according to the onset of orofacial pain: Group-A (mean age 47.30 ± 14.20 years old), onset of FP preceded GBP; Group-B (mean age 51.33 ± 11.03 years old), the FP started concomitant or after GBP. Clinical assessment Research Diagnostic Criteria for Temporomandibular Disorders and the Visual Analogue Scale. Results Myofascial pain with mouth opening limitation (p = 0.038); right disc displacement with reduction (p = 0.012) and jaw stiffness (p = 0.004) were predominant in Group A. Myofascial pain without mouth opening limitation (p = 0.038) and numbness/burning were more common in Group B. Conclusion All patients had temporomandibular joint symptoms, mainly muscle disorders. The prevalence of myofascial pain with limited mouth opening and right TMJ disc displacement with reduction were higher in Group A.

RESUMO Objetivo Identificar sintomas de disfunção temporomandibular (DTM) em dois grupos de pacientes fibromiálgicas, segundo a relação temporal entre o início da dor facial (DF) e das dores generalizadas no corpo (DGC). Estudo transversal: 53 pacientes consecutivas com fibromialgia e DF foram divididas de acordo com o início da dor orofacial: Grupo A (média de idade 47,30 ± 14,20anos), o início da DF precedeu o da DGC; Grupo-B (idade média 51,33 ± 11,03anos), a DF iniciou concomitantemente ou após a DGC. Avaliação clínica: Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) e escala visual analógica (EVA). Resultados Dor miofascial com limitação de abertura bucal (p = 0,038); deslocamento de disco à direita com redução (p = 0,012) e rigidez mandibular (p = 0,004) foram predominantes no Grupo A. Dor miofascial sem limitação de abertura bucal (p = 0,038) e dormência/queimação foram mais comuns no Grupo-B. Conclusão Todos os pacientes tiveram sintomas de DTM, principalmente disfunção muscular. A prevalência de dor miofascial com limitação de abertura bucal e deslocamento de disco à direita com redução foi maior no Grupo A.

Chronic pain relief after the exposure of nitrous oxide during dental treatment: longitudinal retrospective study.

The objective was to investigate the effect of nitrous/oxygen in chronic pain. Seventy-seven chronic pain patients referred to dental treatment with conscious sedation with nitrous oxide/oxygen had their records included in this research. Data were collected regarding the location and intensity of pain by the visual analogue scale before and after the treatment. Statistical analysis was performed comparing pre- and post-treatment findings. It was observed a remarkable decrease in the prevalence of pain in this sample (only 18 patients still had chronic pain, p < 0.001) and in its intensity (p < 0.001). Patients that needed fewer sessions received higher proportions of nitrous oxide/oxygen. Nitrous oxide may be a tool to be used in the treatment of chronic pain, and future prospective studies are necessary to understand the underlying mechanisms and the effect of nitrous oxide/oxygen in patients according to the pain diagnosis and other characteristics.

Chronic pain relief after the exposure of nitrous oxide during dental treatment: longitudinal retrospective study / Alívio da dor crônica após exposição ao óxido nitroso durante tratamento odontológico: estudo retrospectivo longitudinal

The objective was to investigate the effect of nitrous/oxygen in chronic pain. Seventy-seven chronic pain patients referred to dental treatment with conscious sedation with nitrous oxide/oxygen had their records included in this research. Data were collected regarding the location and intensity of pain by the visual analogue scale before and after the treatment. Statistical analysis was performed comparing pre- and post-treatment findings. It was observed a remarkable decrease in the prevalence of pain in this sample (only 18 patients still had chronic pain, p < 0.001) and in its intensity (p < 0.001). Patients that needed fewer sessions received higher proportions of nitrous oxide/oxygen. Nitrous oxide may be a tool to be used in the treatment of chronic pain, and future prospective studies are necessary to understand the underlying mechanisms and the effect of nitrous oxide/oxygen in patients according to the pain diagnosis and other characteristics.

O objetivo deste estudo foi investigar o efeito do óxido nitroso na dor crônica. Os prontuários de 77 pacientes com dor crônica submetidos a tratamento odontológico com sedação consciente (óxido nitroso/oxigênio) foram incluídos. Os dados sobre localização e intensidade de dor pela escala visual analógica foram considerados, e foi realizada comparação e análise estatística entre os momentos pré- e pós-tratamento. Foi observada redução marcante na prevalência de dor nesta amostra (apenas 18 doentes ainda tinham dor, p < 0,001) e na intensidade de dor (p < 0,001). Os doentes que precisaram de menor quantidade de sessões receberam maiores proporções de óxido nitroso/oxigênio. Em conclusão, pode-se considerar o oxido nitroso como uma ferramenta a ser investigada no tratamento da dor crônica em estudos futuros prospectivos, que poderão identificar os mecanismos associados de acordo com o diagnóstico de dor e outras características.

Periodontitis and Metabolic Control: A Preliminary Study / Periodontitis y Control Metabólico: Estudio Preliminar

The aim of this study was to evaluate the periodontal condition and the metabolic control of patients with diabetes mellitus type 2. Patients with diabetes mellitus type 2 were evaluated pre- and post (30 days) treatment of the periodontitis through the following exams: glycemia, glycosylated hemoglobin, plaque index, gingival bleeding index and periodontal pocket depth index. Periodontal treatment consisted of: Scaling, root planning and plaque control, associated with systemic antibiotic therapy with amoxicillin. Seventeen patients (12 women and 5 men; mean age = 55.94 years) were included. The chief complaints were: gingival bleeding (n=13); gingival pain (n=8), tooth mobility (n=3), gingival swelling (n=2) and halitosis (n=2). The mean time of these complaints ranged from 2 months to 20 years. None of them had ever received guidance on oral hygiene or dental assessment. There was a reduction in the following indexes (30 days after the periodontal treatment): plaque, from 41.79±24% to 12.26±13%) (p0.0005), gingival bleeding from 51.58±25%) to 15.77±15% (p0.0005), periodontal pocket depth from 0.98±0.91 mm to 1.76±0.63 mm) (p0.0005). In 15 patients there was a reduction in the glycosylated hemoglobin (10.85±3.03% to 8.72±1.68%) (p0.0005). This preliminary study shows that patients of this sample had chronic and severe periodontal disease; there was a reduction in the glycosylated hemoglobin levels, but not of glycemia, 30 days after periodontal treatment. Long-standing studies are necessary; however patients with diabetes mellitus need control of chronic infections, including periodontal disease.

El objetivo fue evaluar la condición periodontal y el control metabólico de pacientes con diabetes mellitus tipo 2. En los pacientes con diabetes mellitus tipo 2 se evaluaron previo y posterior (30 días) al tratamiento de la periodontitis los siguientes exámenes: glucemia, hemoglobina glicosilada, índice de placa bacteriana, índice de sangrado gingival e índice de profundidad de la bolsa periodontal. El tratamiento periodontal consistió en: curetage, alisado radicular y control de placa, asociado a la terapia sistémica antibiótica con amoxicilina. Se evaluaron 17 pacientes (12 mujeres y 5 hombres, con una edad media de 55,94 años). Las principales complicaciones fueron: sangrado gingival (n= 13), dolor gingival (n= 8), movilidad dental (n= 3), edema gingival (n= 2) y halitosis (n= 2). El tiempo medio de estas complicaciones varió entre 2 meses y 20 años. Ninguno de ellos reconoció haber recibido orientación sobre higiene oral o evaluación dental. Hubo una reducción (30 días después del tratamiento periodontal) en los siguientes índices: placa, de 41,79±24% a 12,26±13%) (p0,0005); sangrado gingival, de 51,58±25%) a 15,77±15% (p0,0005), profundidad de la bolsa periodontal, de 0,98±0,91 mm a 1,76±0,63 mm) (p0,0005). En 15 pacientes se observó una reducción en la hemoglobina glucosilada (10,85±3,03% a 8,72±1,68%) (p0,0005). Observamos que los pacientes de esta muestra tenían enfermedad periodontal crónica y severa; que hubo una reducción en los niveles de hemoglobina glucosilada, pero no de la glucemia, 30 días después del tratamiento periodontal. Estudios longitudinales son necesarias, sin embargo los pacientes con diabetes mellitus requieren control de las infecciones crónicas, como la enfermedad periodontal.

Recommendations for the use of opioids in Brazil: Part IV. Adverse opioid effects / Recomendações para uso de opioides no Brasil: Parte IV. Efeitos adversos de opioides

BACKGROUND AND OBJECTIVES: Adequate opioid use in the short and long term, as well as diagnosis, management of adverse effects, abuse and chemical dependence of such agents are still an investigation area for many researchers. This study aimed at discussing actions for monitoring, diagnosing and managing adverse effects common to those drugs. CONTENTS: This article addresses diagnosis and management of common opioid adverse effects, as well as abuse and chemical dependence, discussing the frequency of such alterations, the pharmacological and complementary management, risks associated to therapy and most relevant recommendations. CONCLUSION: Several are the effects of acute or chronic opioid administration. A recommended strategy is to monitor, diagnose the occurrence and adequately treat effects so that there is no damage for patients needing such substances, thus preventing therapy interruption...

JUSTIFICATIVA E OBJETIVOS: O emprego adequado de opioides em curto e em longo prazo, assim como o diagnóstico, o tratamento dos efeitos adversos, o abuso e a dependência química desses agentes continuam sendo um campo de investigação de vários pesquisadores. O objetivo deste estudo foi discutir as ações para a monitoração, diagnóstico e tratamento dos efeitos adversos comuns a esses fármacos. CONTEÚDO: Neste artigo abordou-se o diagnóstico e tratamento dos efeitos adversos comuns dos opioides, assim como abuso e dependência química, discutindo a frequência dessas alterações, o tratamento farmacológico e complementar, os riscos associados à terapêutica e as recomendações mais importantes. CONCLUSÃO: São variados os efeitos adversos decorrentes da administração aguda ou crônica de opioides. Uma estratégia recomendada é monitorar, diagnosticar a ocorrência e tratar os efeitos de forma adequada para que não haja prejuízo para o paciente que necessita dessas substâncias, evitando a interrupção da terapêutica...

Association between painful temporomandibular disorders, sleep bruxism and tinnitus.

The present cross-sectional study was designed to investigate the association between sleep bruxism (SB), tinnitus and temporomandibular disorders (TMD). The sample consisted of 261 women (mean age of 37.0 years). The Research Diagnostic Criteria for Temporomandibular Disorders were used to classify TMD and self-reported tinnitus. SB was diagnosed by clinical criteria proposed by the American Academy of Sleep Medicine. The results showed an association between painful TMD and tinnitus (OR=7.3; 95%CI=3.50-15.39; p<0.001). With regard to SB, the association was of lower magnitude (OR=1.9; 95%CI=1.16-3.26; p<0.0163). When the sample was stratified by the presence of SB and painful TMD, only SB showed no association with tinnitus. The presence of painful TMD without SB was significantly associated with tinnitus (OR=6.7; 95%CI=2.64-17.22; p<0.0001). The concomitant presence of painful TMD and SB was associated with a higher degree of tinnitus severity (OR=7.0; 95%CI=3.00-15.89; p<0.0001). It may be concluded that there is an association between SB, painful TMD and self-reported tinnitus; however, no relationship of a causal nature could be established.

Effects of acupuncture in adults with temporomandibular disorders / Efeito da acupuntura em adultos com disfunção temporomandibular

BACKGROUND AND OBJECTIVES: Temporomandibular disorders are functional and/or structural temporomandibular joint changes, of multifactorial origin, thus difficult to treat. So, acupuncture is a very useful alternative to handle such disorders. This study aimed at evaluating in adults with temporomandibular disorders, after at least 12 months of acupuncture treatment, whether results were maintained. METHODS: Participated in the study 20 patients with temporomandibular disorders, treated in the acupuncture clinic of the Dentistry School of Piracicaba, State University of Campinas, who were evaluated in the beginning, immediately after treatment and at least 12 months after treatment, through the visual analog scale (VAS). Patients' history was obtained in the initial visit, according to Traditional Chinese Medicine patterns, being checked pain intensity reported by patients (VAS0). Acupuncture was performed aiming at the energetic balance according to diagnosed pattern and reported pain (VAS1) was again evaluated at treatment completion (mean of six sessions lasting 20 minutes). Patients were revaluated (VAS2) after at least 12 months (12 to 18 months). ANOVA was used to compare moments initial, post-treatment and one year after, with significance of 5%. RESULTS: Means for VAS0, VAS1 and VAS2 were 5.9, 1.65 and 2.45, respectively. There has been statistical difference between VAS0 and VAS1 (p<0.01) and between VAS0 and VAS2 (p<0.01), however not between VAS1 and VAS2 (p>0.05). CONCLUSION: Data have shown that acupuncture treatment in adults with temporomandibular disorders has decreased pain and that such decrease was maintained for at least 12 months. .

JUSTIFICATIVA E OBJETIVOS: As disfunções temporomandibulares são alterações funcionais e/ou estruturais das articulações temporomandibulares, de origem multifatorial e, portanto de difícil tratamento. Sendo assim, a acupuntura apresenta-se como uma alternativa muito útil no manuseio dessas disfunções. O objetivo deste estudo foi avaliar em adultos com disfunções temporomandibulares, após no mínimo 12 meses do tratamento com acupuntura, se houve manutenção dos resultados. MÉTODOS: Foram avaliados 20 pacientes com disfunções temporomandibulares, na clínica de acupuntura da Faculdade de Odontologia de Piracicaba da Universidade Estadual de Campinas, ao início, imediatamente após tratamento e após no mínimo 12 meses do tratamento com acupuntura, através da escala analógica visual (EAV). Na consulta inicial foi realizada uma anamnese segundo os padrões da Medicina Tradicional Chinesa sendo verificada a intensidade de dor relatada pelo paciente (EAV0). A acupuntura foi realizada buscando-se o equilíbrio energético de acordo com o padrão diagnosticado, sendo ao final do tratamento (em média seis sessões de 20 minutos) avaliada novamente a dor relatada (EAV1). Após no mínimo 12 meses (12 a 18 meses) os pacientes foram reavaliados (EAV2). Utilizou-se a ANOVA para comparação entre os momentos inicial, pós-tratamento e após um ano, com significância de 5%. RESULTADOS: As médias para EAV0, EAV1 e EAV2 foram 5,9, 1,65 e 2,45 respectivamente. Houve diferença estatística entre EAV0 e EAV1 (p<0,01), e entre EAV0 e EAV2 (p<0,01), porém não entre EAV1 e EAV2 (p>0,05). CONCLUSÃO: Os dados apontaram que o tratamento com acupuntura em adultos com disfunção temporomandibular reduziu a dor e que essa redução ...

Recommendations for the use of opioids in Brazil: Part III. Use in special situations (postoperative pain, musculoskeletal pain, neuropathic pain, gestation and lactation) / Recomendações para uso de opioides no Brasil: Parte III. Uso em situações especiais (dor pós-operatória, dor musculoesquelética, dor neuropática, gestação e lactação)

BACKGROUND AND OBJECTIVES: The use of opioids as first and second line agents to adequately treat pain requires systematization in different clinical syndromes which course with acute pain. This study aimed at discussing recommendations for the use of opioids in acute postoperative pain, neuropathic pain, musculoskeletal pain and pain during gestation and lactation. CONTENTS: This review has addressed the use of opioids in frequent chronic and acute painful syndromes, in gestation and lactation, discussing indications, drugs used, doses, risks, complications and recommendations. CONCLUSION: Opioids for acute postoperative pain have been broadly studied and are established for minor medium and major surgeries. Recommendations for the use of opioids in neuropathic and musculoskeletal pain are restricted to second line treatment and require further discussions. Few studies have investigated the interaction of opioids with physiologic changes typical of gestation and the repercussions of the use of such agents to treat acute and chronic pain in the short and long term. .

JUSTIFICATIVA E OBJETIVOS: O emprego de opioides como agentes de primeira e segunda linha no tratamento da dor ainda é motivo de discussão na literatura. O uso de opioides de maneira adequada exige sistematização em diversas síndromes clínicas que cursam com dor aguda e crônica. O objetivo deste estudo foi discutir recomendações para o emprego de opioides na dor aguda de pós-operatório, na dor neuropática, na dor musculoesquelética e na dor durante a gestação e lactação. CONTEÚDO: Nesta revisão abordou-se o emprego de opioides em síndromes dolorosas agudas e crônicas frequentes, na gestação e lactação discutindo as indicações, os fármacos utilizados, as doses, os riscos, as complicações e as recomendações. CONCLUSÃO: O uso de opioides na dor aguda pós-operatória tem sido bem estudado e está estabelecido em cirurgias de pequeno, médio e grande porte. As recomendações para o emprego de opioides na dor neuropática e musculoesquelética são restritas à segunda linha de tratamento e exigem futuras discussões. Poucos estudos investigaram a interação dos opioides com as alterações fisiológicas próprias da gestação e as repercussões do emprego desses agentes no tratamento da dor aguda e crônica em curto e em longo prazo. .

The role of xerostomia in burning mouth syndrome: a case-control study.

OBJECTIVE: To assess the efficacy of anti-xerostomic topical medication (urea 10%) in patients with burning mouth syndrome (BMS). METHOD: Thirty-eight subjects diagnosed with BMS according to the International Association for the Study of Pain guidelines were randomized to either placebo (5% sodium carboxymethylcellulose, 0.15% methyl paraben, and 10% glycerol in distilled water qsp 100 g) or treatment (urea 10%) to be applied to the oral cavity 3-4 times per day for 3 months. The patients were evaluated before and after treatment with the following instruments: the EDOF-HC protocol (Orofacial Pain Clinic - Hospital das Clínicas), a xerostomia questionnaire, and quantitative sensory testing. RESULTS: There were no differences in salivary flow or gustative, olfactory, or sensory thresholds (P>0.05). Fifteen (60%) patients reported improvement with the treatments (P=0.336). CONCLUSION: In conclusion, there were no differences between groups, and both exhibited an association between reported improvement and salivation.

Recomendações para uso de opioides no Brasil: Parte II. uso em crianças e idosos / Recommendations for the use of opioids in Brazil: Part II. Use in children and the elderly

Justificativa e objetivos: O tratamento da dor nos extremos de idade e na criança ainda exige atenção e revisão de paradigmas. Inúmeras são as doenças ou procedimentos que provocam dor desde o período neonatal até a adolescência. Nos idosos, há maior prevalência de doenças degenerativas que cursam com dor aguda e crônica. O objetivo deste estudo foi discutir recomendações para o emprego de opioides no neonato, na criança e no idoso. Conteudo: Nesta revisão foi abordado o emprego de opioides no período neonatal, em crianças maiores e nos idosos, suas indicações, fármacos usados, doses, riscos, complicações e recomendações. Conclusão: O emprego de opioides em extremos de idade ainda é um desafio. No entanto, é necessária a educação continuada em torno do tema, estimulando a pesquisa clínica e a construção de recomendações baseadas em evidências. O uso seguro desses agentes na indicação e proporção corretas para o alívio da dor diminui riscos e deve ser a base da boa conduta clínica.

Background and objectives: Pain management in age extremes and in children still requires attention and paradigms review. There are several diseases or procedures inducing pain from the neonatal period to adolescence. In the elderly, there is higher prevalence of degenerative diseases which induce acute and chronic pain. This study aimed at discussing recommendations for the use of opioid in neonates, children and the elderly. Contents: This review has addressed the use of opioids in the neonatal period, in older children and in the elderly, their indications, drugs used, doses, risks, complications and recommendations. Conclusion: The use of opioids in age extremes is still a challenge. However, ongoing education about the subject is needed, encouraging clinical trials and the development of evidence-based recommendations. The safe use of such agents in correct indication and proportion for pain relief decreases risks and should be the basis for good clinical practice.

The role of xerostomia in burning mouth syndrome: a case-control study / O papel da xerostomia na sindrome da ardencia bucal: estudo caso controle

Objective : To assess the efficacy of anti-xerostomic topical medication (urea 10%) in patients with burning mouth syndrome (BMS). Method : Thirty-eight subjects diagnosed with BMS according to the International Association for the Study of Pain guidelines were randomized to either placebo (5% sodium carboxymethylcellulose, 0.15% methyl paraben, and 10% glycerol in distilled water qsp 100 g) or treatment (urea 10%) to be applied to the oral cavity 3-4 times per day for 3 months. The patients were evaluated before and after treatment with the following instruments: the EDOF-HC protocol (Orofacial Pain Clinic – Hospital das Clínicas), a xerostomia questionnaire, and quantitative sensory testing. Results : There were no differences in salivary flow or gustative, olfactory, or sensory thresholds (P>0.05). Fifteen (60%) patients reported improvement with the treatments (P=0.336). Conclusion : In conclusion, there were no differences between groups, and both exhibited an association between reported improvement and salivation. .

Objetivo : Avaliar a eficácia do uso de medicação tópica anti xerostomica (ureia 10%) em pacientes com síndrome de ardência bucal. Método : Trinta e oito sujeitos diagnosticados com síndrome de ardência bucal de acordo com os critérios da Associação Internacional para Estudo da Dor foram randomizados para grupo placebo (5% de carboximetilcelulose de sódio, 0,15% de metilparabeno e 10% de glicerol em água destilada qsp 100g) ou grupo tratamento (ureia 10%) para ser aplicada na cavidade oral 3-4 vezes ao dia, durante três meses. Os pacientes foram avaliados antes e depois do tratamento: protocolo EDOF-HC, questionário de xerostomia, testes sensitivos quantitativos. Resultados : Não houve diferenças no fluxo salivar, limiares gustativos, olfativos e somestésicos (Mann-Whitney P>0,05). Quinze (60%) dos pacientes tiveram melhora com o tratamento (P=0,336, oneway ANOVA ). Conclusão : Em conclusão não houve diferenças entre os grupos, ambos apresentaram uma associação entre melhora e salivação. .

Painful temporomandibular disorders, self reported tinnitus, and depression are highly associated.

OBJECTIVE: The aim of this study was to investigate the association among painful temporomandibular disorders (TMD), self reported tinnitus, and levels of depression. METHOD: The sample consisted of 224 individuals with ages ranges from 18 to 76 years. The Research Diagnostic Criteria for Temporomandibular Disorders Axis I were used to classify TMD and Axis II were used for self reported tinnitus, and to score the levels of depression. The odds ratio (OR) with 95% confidence interval (CI) was applied. RESULTS: The presence of painful TMD without tinnitus was significantly associated with moderate/severe levels of depression (OR=9.3, 95%; CI: 3.44-25.11). The concomitant presence of painful TMD and tinnitus self-report increased the magnitude of the association with moderate/severe levels of depression (OR=16.3, 95%; CI, 6.58-40.51). CONCLUSION: Painful temporomandibular disorders, high levels of depression, and self reported tinnitus are deeply associated. However, this association does not imply a causal relationship.