[Technical specification of epidural blood patch for treatment of spinal cerebrospinal fluid leakage].

Spinal cerebrospinal fluid leakage is a common cause of spontaneous intracranial hypotension. Traditional treatment methods include conservative treatment and surgical treatment, but conservative treatment is ineffective for some patients, while surgical treatment is rarely used in clinical practice due to severe trauma. Minimally invasive surgery at appropriate time is an important method to handlecerebrospinal fluid leakage. Therefore, the Group of Headache and Facial Pain, Pain Branch of Chinese Medical Association formulated this technical specification of epidural blood patch for treatment of normal dural sac tension spinal cerebrospinal fluid leakage. This paper mainly discusses the concept and mechanism, indications and contraindications, operation methods, complications and treatment methods of epidural blood patch in order to improve clinical efficacy, reduce neuralsystem complications and reduce the incidence of adverse events.

Could painful temporomandibular disorders be nociplastic in nature? A critical review and new proposal.

Classification of temporomandibular disorders (TMD) and, indeed, all types of orofacial pains has significantly progressed in the last decade based on international consensus work and operationalized clustering of signs and symptoms. A challenging gap nevertheless continues to exist in terms of understanding the underlying pain mechanisms and link to management. Recently, a novel mechanistic descriptor 'nociplastic pain' was introduced, and diagnostic algorithms and characteristic features were proposed. This narrative and critical review aim to discuss to what extent could painful TMD conditions fit into this category. Moreover, a number of less common types of orofacial pain could possibly also reflect nociplastic pain mechanisms. A model to differentiate TMD pain mechanisms is proposed, and the implications for management are discussed. The purpose of this review is to stimulate original and novel research into mechanisms of orofacial pain and hopefully thereby improve management of the individual patient.

Other Secondary Headaches: Odontogenic Pain and Other Painful Orofacial Conditions.

This article discusses extremely common odontogenic pain conditions, which may occasionally present to the neurology clinic mimicking headache, and other uncommon orofacial pain conditions, which may do the same. Typical presentations, investigative strategies, and management are discussed, as well as highlighting key diagnostic criteria and the importance of involving oral or dental specialists where diagnostic uncertainty exists.

[Specificities of orofacial neuropathic pain]. / Spécificités de la douleur neuropathique oro-faciale.

Head pain and notably orofacial pain differs from spinal pain on pathophysiological, clinical, therapeutic and prognostic levels. Its high prevalence, important impact on quality of life and significant socio-economical burden justify specific study of such type of pain. Among them, neuropathic orofacial pain resulting from disease or trauma of the trigeminal nervous system is among the most difficult types of pain to diagnose and to treat. Deciphering of underlying peripheral and central mechanisms has allowed numerous conceptual, clinical and therapeutic advances, notably the role of neural and non neural cell types, such as glia, immunocytes, vascular endothelial cells or the role of trigeminal sensory complex neural circuitry reconfiguration in the development of post-traumatic trigeminal neuropathic pain. Cellular interactions within the trigeminal ganglion, allowing a better understanding of several painful dental, ocular or cephalalgic comorbidities, are also described.

Title: Spécificités de la douleur neuropathique oro-faciale. Abstract: Les douleurs de la région céphalique ­ et notamment les douleurs oro-faciales ­ diffèrent des douleurs spinales sur les plans physiopathologique, clinique, thérapeutique et pronostique. Leur prévalence élevée, leur fort retentissement sur la qualité de vie individuelle et leur impact économique et sociétal important justifient une étude spécifique. Parmi ces douleurs, les douleurs neuropathiques, résultant d'une maladie ou d'un traumatisme du système nerveux trigéminal, sont parmi les plus difficiles à diagnostiquer et à soigner. L'étude des mécanismes neurobiologiques, périphériques et centraux les sous-tendant a permis de nombreuses avancées conceptuelles, cliniques et thérapeutiques, avec, par exemple, la mise en évidence du rôle des cellules nerveuses et non nerveuses, telles que la glie, les immunocytes, les cellules endothéliales vasculaires ou le rôle de la reconfiguration de la circuiterie nerveuse au niveau du complexe sensitif trigéminal, dans la genèse des douleurs neuropathiques post-lésionnelles. Les interactions cellulaires au sein du ganglion trigéminal, susceptibles d'éclairer la compréhension de certaines comorbidités douloureuses dentaires, oculaires ou céphalalgiques, sont également décrites.

Effects of Two Different Cold Application Methods After Rhinoplasty: A Randomized Clinical Trial.

The aim of this prospective, randomized controlled clinical trial was to evaluate the effects of two methods of cold application on eye ecchymosis, periorbital edema, pain around the eyes and face, and patient comfort in postoperative rhinoplasty patients. Patients were randomly divided and evaluated in two groups: an ice in disposable latex gloves (IDLG) group and a cooling gel eye mask (CGEM) group. We used the CONSORT checklist to report the study. There were no significant differences between the groups in terms of age, gender, preoperative blood pressure, respiration, fever status, oxygen saturation, or postoperative vital signs. Patients in the IDLG group had significantly higher scores for pain around the eyes, facial pain, and periorbital edema on the first postoperative day, and significantly higher facial edema scores during the first postoperative hour (p ≤ .05). Patients in the CGEM group reported that they slept more comfortably (p ≤ .05). The results of our study showed that CGEMs reduce pain, periorbital edema, and facial edema after rhinoplasty.

Chronic temporomandibular disorder pain patients with a history of neuropathic pain treatment: a narrative research on their diagnosis and treatment history.

The aims of this qualitative research were (1) to gain more insight in the diagnostic and treatment history of patients with chronic temporomandibular disorder (TMD) pain; (2) to get a deeper understanding of possible factors that are involved in the possible delay in setting a TMD-pain diagnosis and receiving appropriate treatment; and (3) to get a deeper understanding of the perspectives and experiences of chronic TMD-pain patients on the possible improvement of various aspects of their diagnostic and treatment journey.MethodsIn this narrative research, semi-structured interviews took place with patients who experienced chronic orofacial pain (OFP) for at least three years before getting diagnosed with, and treated for, TMD pain by an OFP specialist in an interprofessional setting.ResultsIn total, ten patients were interviewed in-depth. Patients experienced their chronic OFP in different ways, but all reported a significant impact of their pain on their quality of life. All patients visited numerous health care professionals before their TMD diagnosis was set. Among others, they underwent anti-neuropathic pain medication therapies and invasive surgeries, which did not significantly reduce their chronic OFP. The interprofessional TMD-pain treatment reduced the suffering of the chronic OFP substantially, also 6 months after the start of therapy, and improved the quality of life for all patients. In most of them, the OFP intensity was also decreased.ConclusionChronic TMD-pain patients with a history of neuropathic pain treatment may experience a long journey until receiving the appropriate diagnosis and treatment. This stresses the need to improve the implementation of chronic TMD-pain guidelines.

Knowledge and experience of dentists with patients with trigeminal neuralgia: A prospective, cross-sectional survey study.

OBJECTIVE: Trigeminal neuralgia (TN) and orofacial pain (OFP) patients frequently refer to dentists. It is often confused with odontogenic pain and dental procedures are performed. In this study, the authors aimed to reveal the knowledge and experience of dentists about TN. METHODS: This is a cross-sectional study that includes dentists who participate in volunteering via an online questionnaire. The questionnaire form contains demographic data, TN treatment, and diagnosis consisting of 18 questions. RESULTS: The data of 229 dentists were examined. Almost 82% of the participants reportedly knew the diagnostic criteria of TN and 61.6% reported that they had previously referred patients with TN. The most frequently confused diagnosis was odontogenic pains (45.9%). CONCLUSION: TN diagnostic criteria should be included more often in the education of dentists. Thus, it is possible to prevent unnecessary dental procedures. There is a need to increase knowledge on this subject with further studies involving dental students.

Lymphoma masquerading as jaw pain, headache, and syncope: A case report.

BACKGROUND: Lymphomas of parapharyngeal space often have complex manifestations, posing a diagnostic dilemma for clinicians. CASE DESCRIPTION: A 64-year-old man sought treatment for a 4-month history of unresolving right-sided headache and jaw pain associated with syncope, all of which started with a toothache. Since the onset of pain, the patient had undergone multiple diagnostic tests with various specialists, with no pain relief. A detailed clinical and radiologic examination by an orofacial pain specialist revealed diffuse large B-cell lymphoma in the parapharynx. PRACTICAL IMPLICATIONS: A thorough knowledge of the head and neck anatomy helps in identifying the pathophysiology of complex orofacial pain manifestations, which assists in early diagnosis and treatment.

Predictors of patients' satisfaction after temporomandibular disorder treatment in a referral clinic.

BACKGROUND: Evaluating patients' satisfaction after received care for temporomandibular disorders (TMD) pain provides oral health care professionals with knowledge and tools to improve their clinical procedures. However, knowledge on patient characteristics that determine satisfaction with the received care for TMD pain is lacking. OBJECTIVE: To identify potential baseline predictors for patients' satisfaction regarding the management of TMD pain upon treatment completion in a referral clinic. METHODS: Eligible patients, viz., individuals of ≥16 years of age, with a TMD-pain diagnosis according the diagnostic criteria for TMD (DC/TMD), and who were treated in a referral clinic, were included. As part of their standard care, a set of diagnostic questionnaires was filled in (e.g. TMD-pain screener, graded chronic pain scale (GCPS), etc.). After completion of the received care, patients filled in a custom-made questionnaire based on patient reported experience measures (PREMs) to quantify their satisfaction with their treatment results and received care. To identify potential predictors associated with patients' satisfaction, univariate and multivariate linear regression analyses were used. RESULTS: Twenty-seven patients (mean 39.6, SD 15.0) were included in this study. Overall, the patients were satisfied with the treatment results and the received care. Depressive feelings were negatively associated with satisfaction of treatment results (p = .01) and positively associated with satisfaction of received care (p = .01), while pain intensity was negatively associated with satisfaction of the received care. CONCLUSION: Depressive feelings are a significant negative predictor of patients' satisfaction with the treatment result for TMD pain, while average pain intensity is a significant negative predictor of patients' satisfaction with the received care.

Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation of C2 Dorsal Root Ganglion for the Treatment of Refractory Atypical Facial Pain: A Technical Report and Case Series.

BACKGROUND: Chronic craniofacial pain can be difficult to manage clinically. This technical report documents the peripheral nerve stimulation of the C2 dorsal root ganglion as an effective modality to treat refractory atypical facial pain. MATERIALS AND METHODS: In this case series, three patients with chronic refractory atypical facial pain and p >50% pain relief following diagnostic C2 dorsal root ganglion blockade underwent ultrasound-guided percutaneous placement of a peripheral nerve stimulator adjacent to the C2 dorsal root ganglion. Patients were then observed clinically and monitored for improvement in symptoms and adverse events. RESULTS: Three patients underwent peripheral nerve stimulator placement. At follow-up, there were no reported adverse events, and all patients reported satisfactory improvement in pain. CONCLUSION: The neuromodulation of C2 dorsal root ganglion via ultrasound-guided percutaneously implanted peripheral nerve stimulator is a novel and potentially effective approach for the management of chronic refractory craniofacial pain.

Debilitating lower back pain during menses unexpectedly resolved after treatment of subclinical temporomandibular disorder: a case report.

This case report describes a patient in whom debilitating lower back pain that always occurred during menses resolved when she received treatment for subclinical temporomandibular disorder (TMD). The patient was diagnosed with subclinical TMD and facial myalgia based on the results of clinical and radiographic examinations. She was treated with maxillary (nighttime) and mandibular (daytime) dental orthotics to provide stabilization and decompression of the temporomandibular joints. After 12 weeks of appliance therapy, which resulted in resolution of the TMD symptoms, the patient reported that the debilitating lower back pain she experienced during menses had ceased. Her back pain did not return after the use of the mandibular appliance was discontinued. The authors discuss how neurologic, postural, inflammatory, and qi flow changes attributed to the patient's TMD treatment may have contributed to the cessation of the patient's menses-related lower back pain.

Temporomandibular treatments are significantly efficient in improving otologic symptoms.

Symptoms of temporomandibular disorders (TMD) could be present as otologic symptoms like earache and dizziness in some patients. In most cases, these symptoms are not recognized because otolaryngologists fail to diagnose TMD as a source of the problem. This investigation was conducted to evaluate the effect of TMD treatments on the otologic symptoms which after taking history and clinical examinations seemed to be related to TMD. In the present study, the patients who were complaining of otalgia, ear fullness, tinnitus, hearing loss, and dizziness were evaluated by an ear fellow. Forty patients who had no known otologic or other primary causes to explain their symptoms, were referred to the orofacial pain clinic with the possible diagnosis of TMD. If the diagnosis was confirmed by an orofacial pain specialist, a combination of TMD treatments was administered to each case and the patients were followed up. The results showed that following implementation of treatment protocols for TMD, more than 50% of the patients reported complete or partial recovery in the second follow-up (p < 0.05). The most common otologic symptom of the referred cases was earache, and the most common associated complaint was neck pain. All the patients had one or more parafunctional habits. This study showed that TMD treatments were significantly efficient in improving otologic symptoms partially or completely and the authors concluded that for the patients with otolaryngologic unexplained symptoms, an overhaul examination is needed to assess TMD as a possible cause of the patient complaint. It is recommended that in cases with unexplained otologic symptoms, otolaryngologists care more about the neck trigger points (TP) and ask about the patient's parafunctional habits. Otolaryngologists and dentists need to be aware of the risk of developing otologic symptoms caused by these habits or cervical TPs.

Orofacial Migraine and Other Idiopathic Non-Dental Facial Pain Syndromes: A Clinical Survey of a Social Orofacial Patient Group.

Background: Orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes mainly characterized by painful attacks localized in facial and oral structures. According to the International Classification of Orofacial Pain (ICOP), the last three groups (non-dental facial pain, NDFP) are cranial neuralgias, facial pain syndromes resembling primary headache syndromes, and idiopathic orofacial pain. These are often clinical challenges because the symptoms may be similar or common among different disorders. The diagnostic efforts often induce a complex diagnostic algorithm and lead to several imaging studies or specialized tests, which are not always necessary. The aim of this study was to describe the encountered difficulties by these patients during the diagnostic-therapeutic course. Methods: This study was based on the responses to a survey questionnaire, administered to an Italian Facebook Orofacial Patient Group, searching for pain characteristics and diagnostic-therapeutic care courses. The questionnaire was filled out by patients affected by orofacial pain, who were 18 years and older, using a free online tool available on tablets, smartphones, and computers. Results: The sample was composed of 320 subjects (244F/76M), subdivided by age range (18-35 ys: 17.2%; 36-55 ys: 55.0%; >55 ys 27.8%). Most of the patients were affected by OFP for more than 3 years The sample presented one OFP diagnosis in 60% of cases, more than one in 36.2% of cases, and 3.8% not classified. Trigeminal neuralgia is more represented, followed by cluster headaches and migraines. About 70% had no pain remission, showing persisting background pain (VAS median = 7); autonomic cranial signs during a pain attack ranged between 45 and 65%. About 70% of the subjects consulted at least two different specialists. Almost all received drug treatment, about 25% received four to nine drug treatments, 40% remained unsatisfied, and almost 50% received no pharmacological treatment, together with drug therapy. Conclusion: To the authors' knowledge, this is the first study on an OFP population not selected by a third-level specialized center. The authors believe this represents a realistic perspective of what orofacial pain subjects suffer during their diagnostic-therapeutic course and the medical approach often results in unsatisfactory outcomes.

Impact of physiotherapy on orofacial manifestations of juvenile idiopathic arthritis.

BACKGROUND: Physiotherapy appears as a promising therapy option for patients with Juvenile Idiopathic Arthritis (JIA) [1, 2], but the effects of physiotherapy and jaw exercises on JIA-related orofacial symptoms remain unknown [3]. The aim of this proof-of-concept study was to assess the impact of orofacial physiotherapy and home-exercise programs in patients with JIA and temporomandibular joint (TMJ) involvement. METHODS: Twelve patients with JIA and TMJ involvement received a treatment of physiotherapy, complemented by prescribed home exercises spanning over eight weeks. Orofacial symptoms and dysfunction were monitored pre-treatment, during treatment, after treatment, and at a three-months follow-up. RESULTS: Orofacial pain frequency and intensity significantly decreased during the course of the treatment (p = 0.009 and p = 0.006), with further reductions observed at the three-month follow-up (p = 0.007 and p = 0.002). During treatment, the mandibular function improved significantly in terms of maximal mouth opening capacity, laterotrusion, and protrusion. CONCLUSIONS: This proof-of-concept study shows favourable effects of physiotherapy and home excercises in the management of JIA-related orofacial symptoms and dysfunctions.

Comparison of therapeutic effects of 940 nm diode laser acupuncture with transcutaneous electrical nerve stimulation in the myofascial pain dysfunction syndrome: a comparative randomized clinical trial.

Myofascial pain dysfunction syndrome (MPDS) is one of the most common sources of orofacial pain. There are different types of physical therapy for patients with MPDS, but there is insufficient evidence that any one treatment method is superior. This study aimed to compare the clinical efficacy of transcutaneous electrical nerve stimulation (TENS) and laser acupuncture (LA) using a 940-nm diode on MPDS improvement. In this randomized clinical trial, 22 MPDS patients were randomly assigned to TENS (180 HZ, 300 µs, 20 min) and LA (940 nm, continuous wave, 0. 5 w, 40 s, 105 J/cm2) groups. Data on overall facial pain, tenderness in the masticatory muscles, deviation, joint sound, and maximum mouth opening without pain (MMO) were collected from all patients at baseline, before and after each treatment session, and 1 month after the end session. Data were analyzed using an independent t-test, repeated measures ANOVA, and Fisher's exact test at a significance level of P < 0.05. The decreases in overall facial pain (P = 0.000), muscle tenderness (P = 0.000), and increase in MMO (P = 0.01, P = 0.001) were statistically significant compared to the baseline in the TENS and AL groups. No significant differences were detected between TENS and LA for overall facial pain, muscle tenderness, or MMO at 1 month follow-up (P > 0.05). Both LA and TENS are effective physical therapies with promising effects on sign and symptom improvements in MPDS patients.

Manejo das disfunções temporomandibulares. Parte I: tratamento conservador / Management of temporomandibular joint disorders. Part I: conservative treatment

Objetivo: Apresentar as modalidades de tratamentos conservadoras e minimamente invasivas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTM). Revisão da literatura: Os objetivos do tratamento invariavelmente incluem redução da dor, diminuição das atividades parafuncionais e restauração da função. Dentre as alternativas conservadoras e minimamente invasivas, podemos citar os dispositivos interoclusais, exercícios terapêuticos, eletrofototermoterapia, agulhamento seco e infiltração de anestésicos locais em pontos gatilho, injeção de sangue autógeno para controle da luxação mandibular, terapia cognitivo comportamental, toxina botulínica, viscossuplementação, controle farmacológico da dor aguda e crônica. As DTMs afetam uma proporção significativa da população. Somente após o fracasso das opções não invasivas é que devem ser iniciados tratamentos mais invasivos e irreversíveis. No entanto, algumas condições, como a anquilose e neoplasias, por exemplo, são essencialmente tratadas cirurgicamente e tentativas de tratamentos conservadores podem trazer piora na qualidade de vida ou risco de morte. Considerações finais: Uma abordagem de equipe multidisciplinar para o manejo é essencial no cuidado fundamental de todos os pacientes com DTM, para que o tratamento possa ser especificamente adaptado às necessidades individuais do paciente.

Aim: To present the most widely used conservative and minimally invasive treatment modalities available in the therapeutic arsenal for temporomandibular disorders (TMD). Literature review: Treatment goals invariably include pain reduction, reduction of parafunctional activities and restoration of function. Among the conservative and minimally invasive alternatives, we can mention interocclusal devices, therapeutic exercises, electrophototherapy, dry needling and infiltration of local anesthetics in trigger points, autogenous blood injection to control mandibular dislocation, cognitive behavioral therapy, botulinum toxin, viscosupplementation, pharmacological control of acute and chronic pain. TMD affects a considerable proportion of the population. Only after non-invasive options have failed should more invasive and irreversible treatments be initiated. However, some conditions, such as ankylosis and neoplasms, for example, are treated surgically and attempts at conservative treatments can lead to worsening quality of life or risk of death. Conclusions: A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients, so that treatment can be specifically tailored to the patient's individual needs.

Craniofacial disorders and headaches. A narrative review.

OBJECTIVES: Craniofacial- and headache disorders are common co-morbid disorders. The aim of this review is to provide an overview of the research discussing craniofacial pain, especially temporomandibular disorders, and its relationship and impact on headaches, as well as suggestions for diagnostic assessment tools and physical therapeutic management strategies. METHOD: A narrative structured review was performed. A search was conducted in MEDLINE using terms related to craniofacial pain and headaches. Additionally, papers regarding this topic were also extracted from the authors' personal libraries. Any study design (i.e., RCT, observational studies, systematic review, narrative review) that reported the concepts of interest was included, using Covidence. Results were narratively synthesized and described. RESULTS: From an epidemiological perspective, craniofacial pain and headaches are strongly related and often co-existing. This may be due to the neuroanatomical connection with the trigeminal cervical complex, or due to shared predisposing factors such as age, gender, and psychosocial factors. Pain drawings, questionnaires, and physical tests can be used to determine the cause of pain, as well as other perpetuating factors in patients with headaches and craniofacial pain. The evidence supports different forms of exercise and a combination of hands-on and hands-off strategies aimed at both the craniofacial pain as well as the headache. CONCLUSION: Headaches may be caused or aggravated by different disorders in the craniofacial region. Proper use of terminology and classification may help in understanding these complaints. Future research should look into the specific craniofacial areas and how headaches may arise from problems from those regions. (249 words).

Orthodontic care in orthodontic patients during the COVID-2019 pandemic: emergency, emergency response and orthodontic treatment preference.

BACKGROUND: The objective of this study was to investigate the characteristics of emergencies and the requirement for emergency treatment after the suspension of orthodontic appointments. The attitude towards orthodontic treatment preference was evaluated as well, including receiving orthodontic treatment and the preference for orthodontic appliances. SUBJECTS AND METHODS: An electronic questionnaire was distributed to the patients, including 4 sections: Section 1 - demographic and basic information; Section 2 - the characteristics of emergencies and emergency treatment requirements; Section 3 - the NRS-11 for pain and Manchester Orofacial Pain Disability Scale used to evaluate the intensity of orofacial pain and disability; and Section 4 - attitudes towards receiving orthodontic treatment and appliance preference. Descriptive statistics, Pearson's chi-square test, Wilcoxon's rank-sum test and stepwise generalized linear model (GLM) were performed with significance set at P < 0.05. RESULT: Most participants' (91.61%) follow-up appointments were suspended. The emergency rate and emergency treatment requirements were not different between the fixed appliance (FA) and clear aligner (CA) groups. Patients who reported emergencies (P < 0.01) in the FA group (P < 0.05) and some emergencies in the FA (P < 0.05) suffered worse pain and disability. More FA participants preferred alternative appliances (P < 0.05) due to pain and disability (P < 0.05). CONCLUSION: FA patients' emergencies caused worse pain and disability when orthodontic appointments were suspended. Pain and disability were not the causes of emergency treatment requirements. The CA group seemed to show a tendency towards orthodontic appliance preference, which was an ideal modality to weather the epidemic, combined with telemedicine.

Manual Therapy Applied to the Cervial Joint Reduces Pain and Improves Jaw Function in Individuals with Temporomandibular Disorders: A Systematic Review on Manual Therapy for Orofacial Disorders.

AIMS: To examine the effect of manual therapy applied to the cervical joint for reducing pain and improving mouth opening and jaw function in people with TMDs. METHODS: A systematic review of randomized controlled trials was performed. Participants were adults diagnosed with TMDs. The experimental intervention was manual therapy applied to the cervical joint compared to no intervention/placebo. Outcome data relating to orofacial pain intensity, pressure pain threshold (PPT), maximum mouth opening, and jaw function were extracted and combined in meta-analyses. RESULTS: The review included five trials involving 213 participants, of which 90% were women. Manual therapy applied to the cervical joint decreased orofacial pain (mean difference: -1.8 cm; 95% CI: -2.8 to -0.9) and improved PPT (mean difference: 0.64 kg/cm2; 95% CI: 0.02 to 1.26) and jaw function (standardized mean difference: 0.65; 95% CI: 0.3 to 1.0). CONCLUSION: Manual therapy applied to the cervical joint had short-term benefits for reducing pain intensity and improving jaw function in women with TMDs. Further studies are needed to improve the quality of the evidence and to investigate the maintenance of benefits beyond the intervention period.

Educación, ejercicio terapéutico y terapia manual en el dolor orofacial. Estudio de casos / Education, therapeutic exercise, and manual therapy approaches in orofacial pain. Case reports

Introducción Los trastornos temporomandibulares son la causa más común de dolor crónico orofacial. Intervenciones pasivas como la terapia manual (TM) es de las herramientas más utilizadas. Sin embargo, este tipo de abordajes puede resultar insuficiente. La investigación de nuevas estrategias, ahora de naturaleza activa, como son el ejercicio o la educación, es necesaria para generar un cambio en la práctica clínica de los profesionales sanitarios y brindar una atención completa al paciente con dolor crónico. Objetivos Analizar el efecto de tres abordajes principales de forma combinada sobre el dolor, factores psicosociales, variables funcionales y biomecánicas. Métodos Se siguió un diseño de estudio de casos compuesto por tres sujetos divididos en tres modelos de intervención: educación para el dolor y terapia manual (PEdu+TM), ejercicio terapéutico y terapia manual (PEjerc+TM) y terapia manual cervical y orofacial (PTM). El periodo de intervención duró 3-4 semanas; las medidas fueron tomadas en tres momentos: preintervención, postintervención inmediata y 45 días postintervención. Dolor, características psicosociales y funcionalidad del paciente fueron evaluadas con diferentes herramientas validadas. Resultados Los resultados mostraron a corto plazo una mejora en todas las variables analizadas en el PEdu+TM y en el PEjerc+TM, pero no en el PTM. A medio plazo (45 días postintervención), el PEdu+TM mostró beneficios en todas las variables estudiadas mientras que el PEjerc+TM generó cambios positivos en las mismas variables excluyendo el dolor. Conclusión El tratamiento combinado podría ser una intervención más eficaz que la terapia manual a solas, siendo necesarios ensayos clínicos aleatorizados que corroboren dichos hallazgos (AU)

Introduction Temporomandibular disorders are the most common cause of chronic orofacial pain. Passive interventions such us manual therapy (MT) is being one of the most used tools. However, this type of approach may be insufficient. The investigation of new strategies, now of an active nature such as exercise or education, it is necessary to generate a change in the clinical practice of health professionals and provide comprehensive care to patients with chronic pain. Objectives To analyze the effect of three main approaches in combination on pain, psychosocial factors, functional and biomechanical variables. Methods A case study design was followed consisting of three subjects divided into three intervention models: pain education and manual therapy (PEdu+TM), therapeutic exercise and manual therapy (PExer+TM), and cervical and orofacial manual therapy (PTM). The intervention period lasted 3-4 weeks, the measurements were taken at three moments: pre-intervention, immediate post-intervention and 45 days post-intervention. Pain, psychosocial characteristics and functionality of the patient were evaluated with different validated tools. Results The results showed in the short-term an improvement in all the variables analyzed in the PEdu+TM and in the PExer+TM, but not in the PTM. In the medium term (45 days post-intervention), the PEdu+TM showed benefits in all the variables studied, while the PExer+TM generated positive changes in the same variables, excluding pain. Conclusion Combined treatment could be a more effective intervention than manual therapy alone, requiring randomized clinical trials to corroborate these findings (AU)