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1.
Sleep Breath ; 26(2): 941-948, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34365593

RESUMO

BACKGROUND: Temporomandibular disorders (TMD) is a collective term that refers to complaints of temporomandibular joint (TMJ) pain, fatigue and/or pain of the craniocervical muscles, limitation of movement of the mandible, and TMJ noises. Sleep bruxism (SB) is a disorder involving rhythmic (phasic) or non-rhythmic (tonic) masticatory muscle activity during sleep and is not a movement disorder or a sleep disorder in otherwise healthy individuals. The present study aimed to support or reject the null hypothesis that there is no association between SB and TMD. METHODS: The study population was recruited from patients who visited the Artmedica Clinic, Mossoro city, Rio Grande do Norte, Brazil. Patients who underwent polysomnography received information about the research and were invited to participate following the inclusion and exclusion criteria. The study sample consisted of 40 individuals with age ranging from 19 to 76 years. The subjects were administered the questionnaire of the European Academy of Craniomandibular Disorders (AEDC). Those who answered affirmatively to at least one question of the questionnaire were recommended to visit the primary researcher's dental clinic for examination; those who met the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were evaluated, and their condition was classified into one or more subtypes of TMD. The subjects were divided into 4 groups according to the polysomnographic findings and the responses to the AEDC questionnaire. Of the 40 individuals who answered the AEDC questionnaire and underwent polysomnography, 28 presented with TMD symptoms. The data were expressed as simple frequency and percentage values using statistical software. Values of p < 0.05 were considered to be significant. RESULTS: The results showed that the frequency of TMD in individuals diagnosed to have SB was 46.4%. According to the DC/TMD of the 28 individuals, the most prevalent TMD subtype was local myalgia (85.7%). Of the total subjects, 32.5% had TMD and SB, 36.4% were males, and in the age range of 31 to 40 years (40%). CONCLUSION: In this study sample, there was no association between SB as currently defined and TMD, thus confirming previous findings on this topic.


Assuntos
Bruxismo do Sono , Transtornos da Articulação Temporomandibular , Adulto , Idoso , Estudos de Casos e Controles , Dor Facial , Feminino , Humanos , Masculino , Músculos da Mastigação , Pessoa de Meia-Idade , Bruxismo do Sono/diagnóstico , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/epidemiologia , Adulto Jovem
2.
Sleep Sci ; 15(Spec 2): 398-405, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35371398

RESUMO

Obstructive sleep apnea (OSA) is the most prevalent sleep-disordered breathing in the adult population and if untreated remains a significant cause of morbidity and mortality. Continuous positive airway pressure (CPAP) therapy is still the gold standard treatment for OSA, but patient acceptance and adherence are often poor due to a multitude of factors, thereby compromising treatment success. Mandibular advancement devices (MADs) have been proposed not only as a first line therapy for symptomatic snoring patients, but also for those suffering from mild to moderate OSA, or those who refuse or do not tolerate CPAP. Yet, improved understanding of MAD regarding design, construction, and mechanisms of action is an important requirement to successfully implement MAD as a therapeutic tool. Therefore, the main focus of this paper is to focus on the general concepts and mechanisms of action of MAD, while highlighting important characteristics in the context of their use as a viable and effective treatment option for OSA patients.

3.
Neurosci Biobehav Rev ; 128: 12-20, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34118294

RESUMO

Pain is a multidimensional experience comprising sensory-discriminative, affective-motivational, and cognitive-evaluative dimensions. Clinical and research findings have demonstrated a complex interplay between social burdens, individual coping strategies, mood states, psychological disorders, sleep disturbances, masticatory muscle tone, and orofacial musculoskeletal pain. Accordingly, current classification systems for orofacial pain require psychosocial assessments to be an integral part of the multidimensional diagnostic process. Here, we review evidence on how psychosocial and biological factors may generate and perpetuate musculoskeletal orofacial pain. Specifically, we discuss studies investigating a putative causal relationship between stress, bruxism, and pain in the masticatory system. We present findings that attribute brain structures various roles in modulating pain perception and pain-related behavior. We also examine studies investigating how the nervous and immune system on cellular and molecular levels may account for orofacial nociceptive signaling. Furthermore, we review evidence pointing towards associations between orofacial musculoskeletal pain and neuroendocrine imbalances, sleep disturbances, and alterations of the circadian timing system. We conclude with several proposals that may help to alleviate orofacial pain in the future.


Assuntos
Dor Musculoesquelética , Transtornos do Sono-Vigília , Dor Facial , Humanos , Motivação , Percepção da Dor
4.
J Biomech ; 122: 110494, 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33991898

RESUMO

Alloplastic total temporomandibular joint replacement (TJR) is a surgical procedure used to restore normal mandibular function when conservative therapies fail. The instantaneous helical axis (HA), is a mathematical model used to visualize globally rigid body kinematics. It can be applied to mandibular motion for quantification of movement patterns and irregularities. Aim of this study was to analyze HA pathways in subjects with unilateral and bilateral TJR and compare them to a control group. An optoelectronic system was employed to track mouth opening/closing cycles (n = 3) of 15 patients (7 operated unilaterally, 8 bilaterally, 11 F, aged 24-72) and 12 controls (6 F, aged 23-40). HA position in space was determined for 30 equally-distributed steps of the observed movement. Total mandibular rotation around HA (Φtot) and total translation along HA (Ttot) were determined. Angles between HA and the anatomical coordinate system of the head (θx, θy, θz); global fluctuation of HA spatial orientation (θe), distance between condylar center (CP) and HA (dCP) and its projections on the axes (xdCP, ydCP, zdCP) were calculated. Overall, Φtot was larger in controls than in bilaterally operated subjects (p = 0.002, p = 0.003) and θz was larger in unilaterally operated subjects than in controls (p = 0.004) and bilaterally operated subjects (p = 0.002, p = 0.024). During opening, θe¯ was smaller in controls than in unilaterally operated subjects (p = 0.01). The distance dCP was smaller for alloplastic joints than for controls (p < 0.01 overall). In conclusion, mandibular HA pathways in patients with TJR differ significantly from controls in terms of spatial location and variability.

5.
Sleep Sci ; 14(3): 291-295, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35186209

RESUMO

Fibromyalgia (FM) is a chronic, often disabling disorder characterized by multisite pain along with sleep problems and fatigue. Pain and sleep exhibit a reciprocal relationship. When FM and obstructive sleep apnea/hypopnea (OSA) co-exist, treatment options include continuous positive airway pressure or mandibular advancement device. We present a patient experiencing fibromyalgia and OSA whose symptoms vanished wearing a Mandibular Advancement Device (MAD) during sleep. To our knowledge, this is the first documented case of FM symptom resolution by MAD treatment.

6.
Front Neurol ; 11: 557415, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33343482

RESUMO

Introduction: Orofacial pain features may negatively influence a person's well-being and vice versa. Some aspects of well-being can be measured with axis II instruments that assess patients' psychosocial and behavioral status. The aim of this study was to investigate associations between pain features and psychosocial variables as indicators of well-being. Materials and Methods: Seven hundred ninety-nine anonymized datasets collected using the Web-based Interdisciplinary Symptom Evaluation (WISE) of patients reporting to the Interdisciplinary Orofacial Pain Unit, University of Zurich, between March 19, 2017 and May 19, 2019, were analyzed. Pain features including intensity, number of locations, impact, and duration were evaluated. Psychometric measures assessed pain-related catastrophizing and disability, illness perception, distress, anxiety, depression, injustice experience, dysmorphic concerns, and insomnia. Results: Most patients were between 30 and 59 years old (58.3%), female (69.8%), working (66.0%), and experienced pain for more than 6 months (68.5%). Pain intensities were higher in women than men and higher in disabled than working patients. Scores indicating elevated stress and depression were also observed in disabled patients. The sample prevalence rates of clinically relevant axis II instrument scores were as follows: Graded Chronic Pain Scale for the Head (GCPS-H), 27%; Patient Health Questionnaire 4 (PHQ4), 21%; PHQ9, 21%; Pain Catastrophizing Scale (PCS), 20%; General Anxiety Disorder 7 (GAD7), 15%; Insomnia Severity Index (ISI), 15%; Injustice Experience Questionnaire (IEQ), 14%; GCPS for the Body (GCPS-B), 13%; PHQ for Stress (PHQstr), 6%; and Dysmorphic Concern Questionnaire (DCQ), 2%. Noteworthy results of correlation analysis of the clinically relevant axis II scores and pain measures were as follows: the PHQstr had moderate associations (0.34-0.43) with the sum of pain intensity at rest and during function, number of pain locations, and typical pain intensity. The IEQ scores were moderately associated with typical pain intensity at 0.39. The DCQ scores were moderately associated with pain extension at 0.41. Conclusions: Moderate correlations of certain pain and well-being measures were found in patients reporting clinically relevant stress, injustice experience, and dysmorphic concern, all of which reflect impaired well-being. PHQ4 is suitable for routine distress screening in the clinical setting.

7.
Ultrasound Med Biol ; 46(10): 2717-2735, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32753287

RESUMO

Botulinum toxin type A (BTX-A) injections in masseter muscle can alleviate muscle tightness and aching pain caused by idiopathic masticatory myalgia, a subform of the myofascial pain syndrome. Yet the injection procedure (number, amount) is currently empirical. In this ex vivo study, we determined the feasibility of using contrast-free ultrasound imaging to visualize the short-term injectate propagation. Ultrasound annotations of BTX-A injectate spread in N = 12 porcine masseter muscles were compared with the histopathology of the excised masseter. BTX-A presence was automatically detected in the ultrasound cine by: compensating tissue motion and deformation during injection with a novel spatiotemporal filtering (SF) algorithm, and by imaging tissue swelling strains with strain elastography (SE). BTX-A injectate introduced 6.5% (standard deviation = 5.0%) echogenicity contrast and 13.9% (standard deviation = 3.7%) tissue swelling strain. Muscle fasciae were a border for BTX-A distribution. The SF algorithm achieved significantly higher noise rejection (contrast-to-noise ratio = 4.63) than SE (2.56, p = 0.01), and state-of-the-art 2-D digital image correlation (1.81, p < 0.001) and direct image subtraction (1.29, p < 0.001) methods. Histopathology agreed well with ultrasound (Dice coefficient = 0.48), with deviations mainly explained by the three-dimensional inhomogeneous distribution of BTX-A. Preliminary in vivo patient results indicated that SF and SE discard artifactual BTX-A detection outside the injection region. The proposed methods contribute to objectivize ultrasound-guided injections, with additional applications, for instance, to monitor injectate spread of local anesthetics.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Técnicas de Imagem por Elasticidade , Músculo Masseter/diagnóstico por imagem , Músculo Masseter/patologia , Mialgia/diagnóstico por imagem , Mialgia/tratamento farmacológico , Fármacos Neuromusculares/administração & dosagem , Adulto , Algoritmos , Animais , Meios de Contraste , Estudos de Viabilidade , Feminino , Humanos , Injeções/métodos , Análise Espaço-Temporal , Suínos
8.
Swiss Dent J ; (7-8): 593-598, 2020 Jul 20.
Artigo em Alemão | MEDLINE | ID: mdl-32674531

RESUMO

The interdisciplinary Orofacial Pain Unit at the Center of Dental Medicine of the University of Zurich celebrates its 15th anniversary. This article outlines the evidence-based integrative treatment concept with a focus on psychosocial aspects of pain. We exemplify how the evaluation and treatment by a pain psychologist complements the dental therapy. For example, self-management techniques can assist in reducing apprehension, worries and fears, which are often associated with an increased tone of the masticatory muscles. Manifestations include clenching and grinding of teeth, orofacial pain, and other less specific symptoms such as tinnitus. The clinical relevance is illustrated by selected case studies from routine clinical practice.


Assuntos
Dor Facial , Transtornos da Articulação Temporomandibular , Humanos , Músculos da Mastigação
9.
J Oral Rehabil ; 47(5): 549-556, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31999846

RESUMO

The aim of the present paper was to give an overview of the general project and to present the macrostructure of a comprehensive multidimensional toolkit for the assessment of bruxism, viz. a bruxism evaluation system. This is a necessary intermediate step that will be detailed in a successive extended publication and will ultimately lead to the definition of a Standardized Tool for the Assessment of Bruxism (STAB) as the final product. Two invitation-only workshops were held during the 2018 and 2019 General Session & Exhibition of the International Association for Dental Research (IADR) meetings. Participants of the IADR closed meetings were split into two groups, to put the basis for a multidimensional evaluation system composed of two main axes: an evaluation Axis A with three assessment domains (ie subject-based, clinically based and instrumentally based assessment) and an aetiological/risk factors Axis B assessing different groups of factors and conditions (ie psychosocial assessment; concurrent sleep and non-sleep conditions; drug and substance use or abuse; and additional factors). The work of the two groups that led to the identification of different domains for assessment is summarised in this manuscript, along with a road map for future researches. Such an approach will allow clinicians and researchers to modulate evaluation of bruxism patients with a comprehensive look at the clinical impact of the different bruxism activities and aetiologies. The ultimate goal of this multidimensional system is to facilitate the refinement of decision-making algorithms in the clinical setting.


Assuntos
Bruxismo , Bruxismo do Sono , Humanos , Sono
10.
J Pain ; 21(3-4): 440-454, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31521794

RESUMO

Acupuncture is a complementary and nonpharmacological intervention that can be effective for the management of chronic pain in addition to or instead of medication. Various animal models for neuropathic pain, inflammatory pain, cancer-related pain, and visceral pain already exist in acupuncture research. We used a newly validated human pain model and examined whether acupuncture can influence experimentally induced dental pain. For this study, we compared the impact of manual acupuncture (real acupuncture), manual stimulation of a needle inserted at nonacupuncture points (sham acupuncture) and no acupuncture on experimentally induced dental pain in 35 healthy men who were randomized to different sequences of all 3 interventions in a within-subject design. BORG CR10 pain ratings and autonomic responses (electrodermal activity and heart rate variability) were investigated. An initial mixed model with repeated measures included preintervention pain ratings and the trial sequence as covariates. The results showed that acupuncture was effective in reducing pain intensity when compared to no acupuncture (ß = -.708, P = .002), corresponding to a medium Cohen's d effect size of .56. The comparison to the sham acupuncture revealed no statistically significant difference. No differences in autonomic responses between real and sham acupuncture were found during the intervention procedures. PERSPECTIVE: This study established a dental pain model for acupuncture research and provided evidence that experimentally induced dental pain can be influenced by either real acupuncture or manual stimulation of needles at nonacupuncture points. The data do not support that acupoint specificity is a significant factor in reducing experimental pain.


Assuntos
Terapia por Acupuntura , Avaliação de Resultados em Cuidados de Saúde , Odontalgia/terapia , Adulto , Estudos Cross-Over , Resposta Galvânica da Pele/fisiologia , Frequência Cardíaca/fisiologia , Humanos , Masculino , Medicina Tradicional Chinesa , Medição da Dor , Placebos , Adulto Jovem
11.
Ther Umsch ; 76(5): 261-266, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31577185

RESUMO

Temporomandibular disorders - a biopsychosocial perspective Abstract. Clinicians encountering patients complaining of jaw joint symptoms need to see and understand the patients' somatic complaint in the context of possible biographic, psychological and social burdens and to select the appropriate therapeutic options accordingly.


Assuntos
Transtornos da Articulação Temporomandibular , Humanos , Articulação Temporomandibular
12.
J Psychosom Res ; 125: 109778, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31442843

RESUMO

Anger is prevalent in chronic pain and has been associated with pain perception, disability, behavior and treatment outcome. Objectives were (1) to survey in the context of chronic pain the application (and omission) of validated anger self-report instruments, (2) to discuss the instruments found in the context of emotion theories and (3) to identify a possible instrument preference. A systematic search of textbooks and review articles was first performed on validated instruments designed to measure the cognitive, the motivational and the subjective feeling component of anger. Thereafter, a systematic review aimed at finding chronic pain studies from 2005 to 2019 reporting on these instruments. Textbooks and reviews listed 16 validated self-report anger measurement instruments. 28 papers applying four of these were identified and two new instruments were additionally detected. The State-Trait Anger Expression (STAXI) and its precursors were most commonly used. Studies on chronic low back pain patients prevailed. In conclusion, anger in chronic pain patients is reliably measurable at low cost with self-report tools. The STAXI-II qualifies best for this purpose based on its extensive validation history. The majority of instruments lack sufficient theoretical and psychometric adequacy. A more detailed exploration of the cognitive anger component in chronic pain patients in future research is recommended.


Assuntos
Ira , Dor Crônica/psicologia , Autorrelato/normas , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes
13.
Front Neurol ; 10: 542, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31191436

RESUMO

Introduction: Orofacial pain and dysfunction include a broad range of disturbances among which pain and insomnia are some of the most common complaints. Sleep strengthens physiological and psychological resilience and is an absolute requirement for health. Insomnia is a common symptom or sleep disorder, yet data on its prevalence is sparse. Here we extracted data from the insomnia severity index which was part of the web-based interdisciplinary symptom evaluation (WISE) tool given to a large sample of patients seeking care at an orofacial pain unit for analyzing insomnia prevalence in this clinical population. Material and methods: Anonymized data were available from 952 patients who consulted the Orofacial Pain Unit at the Center of Dental Medicine, University of Zurich, Zurich, Switzerland between January 2017 and December 2018. Prevalence data for insomnia stratified by gender and 10 age groups (decades) were calculated. The distribution of four insomnia severity grades was determined, also stratified by age and gender. Results: 952 patients (290 men: 30.5%) with a mean age of 44.8 ± 17.4 years completed a WISE. Three hundred and fifty-two (37.0%) patients with a mean age of 45.8 ± 16.7 years positively responded to a screening question for insomnia and/or hypersomnia. Insomnia was severe in women from the 2nd to 8th decade, ranging from 4.3% (3rd decade) to 14.5% (6th decade), and moderately severe from the 2nd to 9th decade, ranging from 18.8% (6th decade) to 27.8% (2nd decade). In men, severe insomnia was present from the 3rd to 7th decade, ranging from 2.3% (7th decade) to 4.4% (4th decade) and moderately severe insomnia from the 3rd to 7th decade, ranging from 4.6% (7th decade) to 12.2% (5th decade). Conclusions: This is the first study reporting on insomnia in a large sample of patients seeking care at an orofacial pain unit. One in three patients reported some form of sleep disturbances, which for almost half of them was moderate to severe insomnia. The gender ratio was almost equal throughout adulthood, yet younger and older women were more frequently affected and experienced higher insomnia severity than men.

14.
J Oral Rehabil ; 46(6): 549-555, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30802997

RESUMO

BACKGROUND: Quantification of dentin hypersensitivity (DH) is challenging and requires standardised, graded stimulation by natural-like stimuli. OBJECTIVE: The present study aimed at identifying DH subjects and longitudinally monitoring their pain thresholds by cold air quantitative sensory testing (QST). METHODS: Subject recruitment started with an online DH questionnaire. Respondents were screened by dental air stimulation. Sensitising and habituating subjects were excluded. A recently developed stimulation device was employed for cold air QST. Single tooth DH was verified by applying an equi-intense stimulus to a control tooth. Descriptive statistics were applied for subject characteristics. Mean values were calculated for the stimulation parameters temperature and air flow. Reliability of temperatures for detecting pain and for evoking moderate pain over multiple time points within a 3-week period was analysed by two-way random single- and average-measure intra-class correlation coefficients. RESULTS: A total of 353 persons completed the online DH questionnaire of which 117 were screened. Forty-four passed the screening, yet 15 were excluded for various reasons. Twenty-nine subjects were monitored by QST across 3 weeks. Results revealed a high intra-individual stability of the temperature inducing moderate to strong pain intensity (MPI) (single-measure ICC of TMPI 0.83, P < 0.001). Mean TMPI was -13.69°C, yet it highly varied among the 29 subjects (SD ± 10.04°C). CONCLUSIONS: Using a novel approach, namely dental QST based on cold air stimuli, we present evidence for temporally stable DH perceptions over a 3-week period. The method fulfils international guideline requirements and is recommendable for obtaining valid results when testing various interventions for DH management.


Assuntos
Sensibilidade da Dentina , Temperatura Baixa , Humanos , Dor , Medição da Dor , Limiar da Dor , Reprodutibilidade dos Testes , Limiar Sensorial
15.
J Oral Rehabil ; 46(1): 14-22, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30252949

RESUMO

BACKGROUND: Deformation of the mandibular condyle can be associated with anterior disk displacement (ADD) or involvement of the temporomandibular joint (TMJ) by juvenile idiopathic arthritis (JIA). Diagnostic differentiation is critical for proper management. OBJECTIVES: To compare morphology and inflammation between TMJs with ADD and JIA. METHODS: Retrospective assessment of contrast-enhanced TMJ MRI in 18 adolescents (15 female, mean age 15.1 ± 1.9 years) with ADD and age- and gender-matched patients with JIA. Articular disk findings, inflammatory signs and osseous morphology were compared. RESULTS: In the ADD group, 31 of 36 disks were displaced. In total, 28 of 31 displaced disks showed thickening of the bilaminar zone. In JIA patients, the disks were mainly flattened (19/36), centrally perforated (12/36) and/or anteriorly displaced (2/36). In total, 19 of 31 TMJs with ADD showed various degrees of inflammation, with joint effusion, synovial thickening and joint enhancement not significantly different from JIA patients. Osseous deformity was present in 27 of 31 TMJs with ADD, with frequent erosions in both groups (ADD 25/31; JIA 32/36, P = 0.55) but lower grades of condylar and temporal bone flattening than in JIA (P ≤ 0.001). Glenoid fossa depth was preserved in 28 of 31 joints with ADD and decreased in 26 of 36 joints with JIA (P < 0.0001). Mandibular ramus height was decreased in both groups. CONCLUSION: In adolescents, inflammatory signs are common MRI findings in symptomatic TMJs with ADD and thus should not be considered diagnostic for JIA involvement. In this cohort, both entities had high rates of condylar deformity, while TMJs with ADD showed a better-preserved and often normal shape of the glenoid fossa.


Assuntos
Artrite Juvenil/diagnóstico por imagem , Inflamação/diagnóstico por imagem , Imageamento por Ressonância Magnética , Disco da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Adolescente , Artrite Juvenil/fisiopatologia , Feminino , Humanos , Inflamação/fisiopatologia , Masculino , Estudos Retrospectivos , Disco da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/fisiopatologia
16.
Trials ; 19(1): 704, 2018 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-30587219

RESUMO

BACKGROUND: This study aimed to describe recruitment challenges encountered during a phase IIa study of vixotrigine, a state and use-dependent Nav1.7 channel blocker, in individuals with trigeminal neuralgia. METHODS: This was an international, multicenter, placebo-controlled, randomized withdrawal study that included a 7-day run-in period, a 21-day open-label phase, and a 28-day double-blind phase in which patients (planned n = 30) were randomized to vixotrigine or placebo. Before recruitment, all antiepileptic drugs had to be stopped, except for gabapentin or pregabalin. After the trial, patients returned to their original medications. Patient recruitment was expanded beyond the original five planned (core) centers in order to meet target enrollment (total recruiting sites N = 25). Core sites contributed data related to patient identification for study participation (prescreening data). Data related to screening failures and study withdrawal were also analyzed using descriptive statistics. RESULTS: Approximately half (322/636; 50.6%) of the patients who were prescreened at core sites were considered eligible for the study and 56/322 (17.4%) were screened. Of those considered eligible, 26/322 (8.1%) enrolled in the study and 6/322 (1.9%) completed the study. In total, 125 patients were screened across all study sites and 67/125 (53.6%) were enrolled. At prescreening, reasons for noneligibility varied by site and were most commonly diagnosis change (78/314; 24.8%), age > 80 years (75/314; 23.9%), language/distance/mobility (61/314; 19.4%), and noncardiac medical problems (53/314; 16.9%). At screening, frequently cited reasons for noneligibility included failure based on electrocardiogram, insufficient pain, and diagnosis change. CONCLUSIONS: Factors contributing to recruitment challenges encountered in this study included diagnosis changes, anxiety over treatment changes, and issues relating to distance, language, and mobility. Wherever possible, future studies should be designed to address these challenges. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01540630 . EudraCT, 2010-023963-16. 07 Aug 2015.


Assuntos
Analgésicos/uso terapêutico , Seleção de Pacientes , Doenças Raras/tratamento farmacológico , Bloqueadores dos Canais de Sódio/uso terapêutico , Nervo Trigêmeo/efeitos dos fármacos , Neuralgia do Trigêmeo/tratamento farmacológico , Adulto , Idoso , Analgésicos/efeitos adversos , Método Duplo-Cego , Europa (Continente) , Humanos , Pessoa de Meia-Idade , Canal de Sódio Disparado por Voltagem NAV1.7/efeitos dos fármacos , Canal de Sódio Disparado por Voltagem NAV1.7/metabolismo , Medição da Dor , Doenças Raras/diagnóstico , Doenças Raras/metabolismo , Doenças Raras/fisiopatologia , Tamanho da Amostra , Bloqueadores dos Canais de Sódio/efeitos adversos , África do Sul , Fatores de Tempo , Resultado do Tratamento , Nervo Trigêmeo/metabolismo , Nervo Trigêmeo/fisiopatologia , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/metabolismo , Neuralgia do Trigêmeo/fisiopatologia , Adulto Jovem
17.
J Dent Educ ; 82(10): 1065-1076, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30275141

RESUMO

The biopsychosocial model is advocated as part of a more comprehensive approach in both medicine and dentistry. However, dentists have not traditionally been taught psychosocial screening as part of their predoctoral education. The aim of this systematic review was to provide an overview of published studies on the implementation of screening for psychological comorbidity in dental and dental hygiene education. The term "psychological comorbidity" refers to the degree of coexisting anxiety, depression, or other mental health problems in a patient presenting with a physical condition. The review followed a protocol registered in PROSPERO (CRD42016054083) and was carried out in accordance with the PRISMA guidelines. The methodological quality of the included studies was assessed using a ten-item tool developed for medical education. The electronic search in PubMed, Scopus, and PsycINFO from the inception of each database until December 31, 2016, together with a hand search, identified 1,777 articles. After abstracts were screened, 52 articles were reviewed in full text applying inclusion and exclusion criteria; four articles remained for the qualitative synthesis. Generally, the reported data on specific methods or instruments used for psychological screening were limited. Only one of the included articles utilized a validated screening tool. The results of this systematic review show that published data on the implementation of psychological patient assessment in dental and dental hygiene education are limited. To address this gap, the authors recommend short screening tools such as the Graded Chronic Pain Scale and the Patient Health Questionnaire for Depression and Anxiety. Educating dental and dental hygiene students about easy-to-use, reliable, and validated screening tools for assessing psychological comorbidity warrants more research attention and greater implementation in educational curricula.


Assuntos
Educação em Odontologia , Transtornos Mentais/diagnóstico , Higiene Bucal/educação , Ansiedade/diagnóstico , Comorbidade , Depressão/diagnóstico , Educação em Odontologia/métodos , Humanos , Programas de Rastreamento/métodos
19.
Neuroimage ; 162: 162-172, 2017 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-28882631

RESUMO

The trigeminal brainstem sensory nuclear complex is the first central relay structure mediating orofacial somatosensory and nociceptive perception. Animal studies suggest a substantial involvement of neurochemical alterations at such basal CNS levels in acute and chronic pain processing. Translating this animal based knowledge to humans is challenging. Human related examining of brainstem functions are challenged by MR related peculiarities as well as applicability aspects of experimentally standardized paradigms. Based on our experience with an MR compatible human orofacial pain model, the aims of the present study were twofold: 1) from a technical perspective, the evaluation of proton magnetic resonance spectroscopy at 3 T regarding measurement accuracy of neurochemical profiles in this small brainstem nuclear complex and 2) the examination of possible neurochemical alterations induced by an experimental orofacial pain model. Data from 13 healthy volunteers aged 19-46 years were analyzed and revealed high quality spectra with significant reductions in total N-acetylaspartate (N-acetylaspartate + N-acetylaspartylglutamate) (-3.7%, p = 0.009) and GABA (-10.88%, p = 0.041) during the pain condition. These results might reflect contributions of N-acetylaspartate and N-acetylaspartylglutamate in neuronal activity-dependent physiologic processes and/or excitatory neurotransmission, whereas changes in GABA might indicate towards a reduction in tonic GABAergic functioning during nociceptive signaling. Summarized, the present study indicates the applicability of 1H-MRS to obtain neurochemical dynamics within the human trigeminal brainstem sensory nuclear complex. Further developments are needed to pave the way towards bridging important animal based knowledge with human research to understand the neurochemistry of orofacial nociception and pain.


Assuntos
Dor Facial/metabolismo , Espectroscopia de Prótons por Ressonância Magnética/métodos , Núcleos do Trigêmeo/metabolismo , Adulto , Ácido Aspártico/análogos & derivados , Ácido Aspártico/análise , Ácido Aspártico/metabolismo , Dipeptídeos/análise , Dipeptídeos/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Ácido gama-Aminobutírico/análise , Ácido gama-Aminobutírico/metabolismo
20.
Lancet Neurol ; 16(4): 291-300, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28216232

RESUMO

BACKGROUND: Current standard of care for trigeminal neuralgia is treatment with the sodium channel blockers carbamazepine and oxcarbazepine, which although effective are associated with poor tolerability and the need for titration. BIIB074, a Nav1.7-selective, state-dependent sodium-channel blocker, can be administered at therapeutic doses without titration, and has shown good tolerability in healthy individuals in phase 1 studies. We therefore assessed the safety and efficacy of BIIB074 in patients with trigeminal neuralgia in a phase 2a study. METHODS: We did a double-blind, multicentre, placebo-controlled, randomised withdrawal phase 2a trial in 25 secondary care centres in Denmark, Estonia, France, Germany, Italy, Latvia, Lithuania, Romania, South Africa, Spain, Switzerland, and the UK. After a 7-day run-in phase, eligible patients aged 18-80 years with confirmed trigeminal neuralgia received open-label, BIIB074 150 mg three times per day, orally, for 21 days. Patients who met at least one response criteria were then randomly assigned (1:1) to BIIB074 or placebo for up to 28 days in a double-blind phase. We used an interactive web response system to assign patients with a computer-generated schedule, with stratification (presence or absence of existing pain medication). Patients, clinicians, and assessors were masked to treatment allocation. The primary endpoint was the difference between groups in the number of patients classified as treatment failure during the double blind phase assessed in the modified intention-to-treat population. We assessed safety in all patients who received one or more doses of BIIB074. This study is registered with ClinicalTrials.gov (NCT01540630) and EudraCT (2010-023963-16). FINDINGS: The first patient was enrolled on April 23, 2012, and the last patient completed the study on February 26, 2014. We enrolled 67 patients into the open-label phase; 44 completed open-label treatment, and 29 were randomly assigned to double-blind treatment (15 to BIIB074 and 14 to placebo). During the double-blind phase, five (33%) patients assigned to BIIB074 versus nine (64%) assigned to placebo were classified as treatment failures (p=0·0974). BIIB074 was well tolerated, with similar adverse events in the double-blind phase to placebo. Headache was the most common adverse event with BIIB074 in the open-label phase (in 13 [19%] of 67 patients), followed by dizziness (in six [9%] patients). In the double-blind phase, headache, pyrexia, nasopharyngitis, sleep disorder, and tremor were the most frequent adverse events in patients assigned to BIIB074 (in one [7%] of 15 patients for each event), and headache, dizziness, diarrhoea, and vomiting were the most frequent adverse events in patients assigned to placebo (in one [7%] of 14 patients for each event). No severe or serious adverse events were reported in the BIIB074 group during the double-blind phase. One patient assigned to placebo reported intestinal adhesions with obstruction as a severe and serious adverse event, which was considered as unrelated to study medication. INTERPRETATION: The primary endpoint of treatment failure was not significantly lower in the BIIB074 group than in the placebo group. However, our findings provide a basis for continued investigation of BIIB074 in patients with trigeminal neuralgia in future clinical trials. FUNDING: Convergence Pharmaceuticals.


Assuntos
Bloqueadores dos Canais de Sódio/uso terapêutico , Resultado do Tratamento , Neuralgia do Trigêmeo/tratamento farmacológico , Adulto , Idoso , Área Sob a Curva , Método Duplo-Cego , Eletrocardiografia , Feminino , Humanos , Cooperação Internacional , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Éteres Fenílicos/farmacologia , Éteres Fenílicos/uso terapêutico , Prolina/análogos & derivados , Prolina/farmacologia , Prolina/uso terapêutico , Estudos Retrospectivos , Adulto Jovem
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