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1.
Medicine (Baltimore) ; 99(40): e22589, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019477

RESUMO

BACKGROUND: Trigeminal neuralgia (TN) is a disease accompanied by severe facial pain, which seriously affects the daily life of patients. Acupuncture is widely used by Traditional Chinese Medicine doctors to treat various painful diseases. Acupuncture combined with the treatment of trigeminal neuralgia can increase the analgesic effect and reduce side effects. However, there is still a lack of more quality multi-center clinical controlled trials and comprehensive meta-analysis, and a lack of more comprehensive and stronger evidence-based medical evidence. METHODS: The 2 reviewers used the same search strategy to search CNKI, PubMed, Web of Science, Cochrane Library, Scopus, EBSCO, and the search date is until July 19, 2020. Two people read the retrieved literatures independently, and then delete duplications. Then, use the "risk of bias" tool in Cochrane Handbook 5.2 to score. Only documents with a score greater than 5 can be included. Make a table of literature characteristics, extract baseline patient data, research methods and possible risks of bias in the literature, interventions in treatment and control groups, outcome evaluation indicators (BNI, VAS, ER and AE), and research funding support. Use Review Manager 5.3.5 for meta-analysis, use Stata 15 for regression analysis to find the source of heterogeneity, and then perform subgroup analysis to resolve the heterogeneity based on the corresponding source. RESULTS: The analysis of BNI, VAS, ER and AE data can provide high-quality evidence for high-quality synthesis and/or descriptive analysis of the effectiveness and safety of acupuncture treatment of various causes of urinary retention. CONCLUSION: This study can provide more comprehensive and strong evidence to prove whether acupuncture is effective and safe in the treatment of TN patients. REGISTRATION: The research has been registered and approved on the PROSPERO website. The registration number is CRD42019119606.


Assuntos
Terapia por Acupuntura/métodos , Medicina Tradicional Chinesa/métodos , Neuralgia do Trigêmeo/terapia , Terapia por Acupuntura/efeitos adversos , Estudos de Avaliação como Assunto , Dor Facial/etiologia , Dor Facial/terapia , Feminino , Humanos , Masculino , Medicina Tradicional Chinesa/efeitos adversos , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Segurança , Resultado do Tratamento , Neuralgia do Trigêmeo/patologia , Retenção Urinária/etiologia , Escala Visual Analógica
2.
Occup Ther Int ; 2020: 5168457, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32684869

RESUMO

Objectives: The pressure pain threshold (PPT) may be an efficient approach to screen and evaluate orofacial pain. However, the results of previous PPT studies have varied greatly. The aim of this paper was to determine whether the PPT is an efficient approach for screening and evaluating orofacial pain. Methods: The search yielded 123 articles. After removal of duplicates and screening of abstracts, 32 articles were selected for further evaluation. The Cochrane Collaboration tool for assessing the risk of bias was used for the evaluation of the studies. Results: The studies covered a total of 4403 adult patients, aged 16-62, and 30 children. The studies investigated the reliability and validity of the PPT (measured by a pressure algometer) in TMD patients. The PPT was investigated in relation to headache, menstrual cycle, oral contraception, occlusal interference, and occlusal appliances. Generally, the risk of bias was low to unclear. Some structural limitations were inherent in the studies, such as small samples and short duration of the testing involved. Also, the analyzed studies lacked consistency in study design and patient management. Pressure increase values differed from 20 kPa/s to 50 kPa/s and from 0.5 kg/cm2/s to 2 kg/cm2/s. Descriptions of the PPT examination points also varied, from very precise and repeatable to a simple listing of anatomical points. The number of measurements varied from 1 to 5 at each visit. The intervals ranged from 5 seconds to 15 minutes. However, some studies confirmed that the pressure algometer is an effective tool for determining the source of orofacial pain. Conclusions: Based on the analyzed articles, the authors argue that the PPT is not an efficient approach for screening and evaluating orofacial pain. What is more, it should not be used as the only diagnostics tool for patients with orofacial pain. Importantly, however, additional factors should be considered in the future for the evaluation of the PPT, including body symmetry and posture, hormone levels and the menstrual phase in women, and the use of medications and its influence on the PPT. Further clinical trials should also be performed on the PPT, examining head and neck pain patients, with more precise study design and larger samples.


Assuntos
Dor Facial/diagnóstico , Dor Facial/terapia , Medição da Dor/instrumentação , Humanos , Terapia Ocupacional , Medição da Dor/métodos , Limiar da Dor , Pressão , Reprodutibilidade dos Testes
3.
J Oral Pathol Med ; 49(6): 454-460, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32558995

RESUMO

The International Association for the Study of Pain has released a new classification scheme for chronic pain. This classification scheme describes chronic pain as either a symptom of a disease (chronic secondary pain) or the disease itself (chronic primary pain). Chronic temporomandibular disorders have many similarities to other proposed chronic overlapping pain disorders, but are classified and managed by dental practitioners as a localized pain condition of the orofacial region. We review the literature to describe the similarities between chronic temporomandibular disorders and chronic overlapping pain disorders, and discuss how this evolving concept may affect the way that dentists approach the diagnosis and management of chronic temporomandibular disorders.


Assuntos
Dor Crônica , Dor Facial , Transtornos da Articulação Temporomandibular , Doença Crônica , Dor Crônica/complicações , Dor Crônica/diagnóstico , Dor Crônica/terapia , Odontólogos , Dor Facial/complicações , Dor Facial/diagnóstico , Dor Facial/terapia , Humanos , Papel Profissional , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/terapia
4.
J Oral Pathol Med ; 49(6): 461-469, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32585044

RESUMO

After over 80 years of much obsession as well as avoidance of the subject of temporomandibular disorders (TMDs), the dental profession is still divided over what they are and how to deal with them. Over this period, nearly every discipline in dentistry has played some role in the development of this field. Unfortunately, a significant amount of this information has been based on personal opinion, experience-based philosophies, or poorly conducted research. Furthermore, each dental specialty has been responsible for contributing to the concepts of the etiology and management of TMDs with their own professional bias; for example, orthodontists describe these problems in orthodontic terms and offer orthodontic treatments or solutions for their patients. As various treatment approaches were found to be effective at least some of the time, this has further led to misinformation and confusion within the profession. Advances in research from diverse fields, including neurophysiology, pain pathophysiology, genetics, endocrinology, behavioral sciences, and psychology, have significantly altered our understanding of TMDs and how they should be managed. The rigid mechanical and dental-based model of the past has been gradually replaced by a biopsychosocial medical model for the diagnosis and treatment of TMDs as well as other acute and chronic pain disorders. This paper discusses the evolution of our understanding of TMDs since they were first described 85 years ago. Contemporary scientific findings and their implications are presented in some detail for clinicians who wish to provide the appropriate management for their orofacial pain patients.


Assuntos
Transtornos da Articulação Temporomandibular , Dor Facial/diagnóstico , Dor Facial/etiologia , Dor Facial/terapia , Humanos , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/terapia
5.
J Oral Pathol Med ; 49(6): 590-594, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32516859

RESUMO

BACKGROUND: This study aimed to evaluate and describe the current patterns of practice pertaining to orofacial pain amongst oral medicine specialists in Australia and provide insight into the access of care available to orofacial pain patients in Australia. METHODS: A survey involving questions relevant to orofacial pain, patient and practitioner demographics was designed and disseminated via an online polling platform to all Australian Health Practitioner Regulation Agency registered oral medicine specialists. Results were collated online, and simple descriptive statistics were utilised for data analysis. RESULTS: Twenty-six oral medicine specialists were included in this study, with a survey response rate of 81.2%. All specialists considered orofacial pain practice as part of the oral medicine specialty. 96.2% assessed and managed orofacial pain patients as part of their oral medicine practice. The greatest proportion (30.8%) of oral medicine specialists were practicing in Western Australia, a state which represents 10.3% of the Australian population. All respondents reportedly diagnose temporomandibular disorders, followed by orofacial neuropathy (96.2%) and headache or neurovascular disorders (80.8%). 92.3% of specialists managed orofacial neuropathy followed by temporomandibular disorders (84.6%) and headache or neurovascular disorders (50%). CONCLUSION: This is the first study to report on patterns of orofacial pain practice amongst oral medicine specialists in Australia. Findings demonstrate that oral medicine specialists in Australia are actively engaged in the assessment and management of the orofacial pain patient. There, however, appears to be disproportionate access to care by oral medicine specialists for patients with orofacial pain across Australia.


Assuntos
Dor Facial , Manejo da Dor , Especialização , Transtornos da Articulação Temporomandibular , Austrália , Odontólogos , Dor Facial/terapia , Humanos , Padrões de Prática Médica
6.
J Oral Pathol Med ; 49(6): 470-475, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32531839

RESUMO

BACKGROUND: Temporomandibular disorders (TMD) are recognised as the most common chronic orofacial pain condition, with prevalence figures ranging from 3% to 12%. Patients referred to tertiary orofacial pain clinics for the management of TMD often experience delays in receiving treatment. The objective of the present study was to assess a group treatment programme to deliver effective earlier intervention for patients with chronic TMD. METHODS: Forty-two patients with TMD seen at the Oral Medicine Clinic, Royal Dental Hospital of Melbourne, were administered baseline validated pain questionnaires: the Graded Chronic Pain Scale and Pain Catastrophising Scale. Twenty patients subsequently received education about basic neurophysiology of pain, TMD and relaxation techniques in either a group setting or in a one-on-one session and were followed longitudinally. Administration of pain questionnaires was repeated at 4-6 weeks post-intervention. RESULTS: No evidence of difference in levels of anxiety, somatic symptoms or catastrophising was found between patients who received either group or individual intervention. Both were effective at reducing pain intensity and levels of disability. Individual intervention resulted in a greater reduction in rumination. CONCLUSION: Patients with TMD can receive effective reduction of TMD-related pain and catastrophising from either group or individual education regarding neurophysiology of pain, TMD and relaxation techniques. Group education should accelerate time to commencement of care in large referral-based settings.


Assuntos
Dor Crônica , Educação de Pacientes como Assunto , Transtornos da Articulação Temporomandibular , Doença Crônica , Dor Crônica/terapia , Dor Facial/terapia , Humanos , Medição da Dor , Transtornos da Articulação Temporomandibular/terapia
7.
J Oral Pathol Med ; 49(6): 529-537, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32531851

RESUMO

Physiotherapists can manage chronic pain patients by using technical interventions such as mobility, strengthening, manual therapy, or flexibility in a specific and functional manner, being a key component of a multidisciplinary team. Dentists are involved in the management of different chronic pain conditions such as temporomandibular disorders and sleep disorders such as obstructive sleep apnea. However, they are frequently unaware of the benefits of collaborating with physical therapists. In this review, the collaboration of physical therapists and dentists will be explored when managing orofacial pain, headaches, and sleep disorders. The physical therapist is important in the management of these disorders and also in the screening of risk factors.


Assuntos
Dor Crônica , Fisioterapeutas , Transtornos do Sono-Vigília , Dor Crônica/terapia , Odontologia , Dor Facial/terapia , Humanos , Relações Interprofissionais , Transtornos do Sono-Vigília/terapia
8.
J Oral Pathol Med ; 49(6): 476-483, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32539196

RESUMO

BACKGROUND: Central sensitization (CS) is a form of neuroplasticity characterized by changes in the neural sensitivity, responsiveness, and/or output that are not contingent on peripheral input nor activity-dependent. CS is characterized by activation of unmyelinated C-fibers resulting in a cascade of events at molecular and cellular levels which eventuate into generation of synaptic currents at rest. CS, therefore, contributes to heightened generalized pain sensitivity, further complicates the process of reaching a diagnosis, and increases the possibility of treatment failure. BODY: Trigeminal nerve is the main sensory supplier of the anterior part of the head, including the intraoral structures. Primary afferent nociceptors of the trigeminal nerve and low threshold mechanoreceptors synapse with wide dynamic range (WDR) neurons in the pons. This multifaceted network of nerve interactions which is further complicated by the modulatory circuits that can suppress or heighten the activity of WDR neurons is one of the main contributors to CS. The importance of CS in orofacial pain disorders is emphasized in the context of chronic pain development. As for all chronic pain conditions, it is crucial to consider the biopsychosocial aspects of chronic orofacial pain in managing this diverse group of conditions. This review highlights current understanding of the biopsychosocial model and central mechanisms contributing to the pathogenesis of chronic orofacial pain.


Assuntos
Dor Facial , Nociceptores , Nervo Trigêmeo , Dor Facial/fisiopatologia , Dor Facial/terapia , Humanos , Estimulação Física , Nervo Trigêmeo/fisiopatologia
10.
Brain Stimul ; 13(3): 554-561, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32289676

RESUMO

BACKGROUND: Chronic orofacial pain (COP) patients often perceive the painful face area as "swollen" without clinical signs; such self-reported illusions of the face are termed perceptual distortion (PD). The pathophysiological mechanisms underlying PD remain elusive. OBJECTIVE: To test the neuromodulatory effect of repetitive transcranial magnetic stimulation (rTMS) on PD in healthy individuals, to gain insight into the cortical mechanisms underlying PD. METHODS: PD was induced experimentally by injections of local anesthetic (LA) around the infraorbital nerve and measured as perceived size changes of the affected area. Participants were randomly allocated to inhibitory rTMS (n = 26) or sham rTMS (n = 26) group. The participants rated PD at baseline, 6 min after LA, immediately, 20 and 40 min after rTMS. The rTMS (inhibitory and sham) was applied to face (lip) representation area of primary somatosensory cortex (SI) as an intervention at 10 min after the LA, when the magnitude of PD is large. As inhibitory rTMS, continuous theta-burst stimulation paradigm (50 Hz) for 40s was employed to inhibit cortical activity. RESULTS: We demonstrated a significant decrease in the magnitude of PD immediately and 20 min after the application of inhibitory rTMS compared with sham rTMS (P < 0.006). In two control experiments, we also showed that peripheral muscle stimulation and stimulation of a cortical region other than the lip representation area had no effect on the magnitude of the PD. CONCLUSIONS: Inhibitory rTMS applied to a somatotopical-relevant cortical region modulates PD of the face in healthy individuals and could potentially have therapeutic implications for COP patients.


Assuntos
Dor Facial/terapia , Transtornos da Percepção/terapia , Distorção da Percepção , Estimulação Magnética Transcraniana/métodos , Adulto , Nervo Facial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ritmo Teta
11.
Sci Rep ; 10(1): 7195, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32346080

RESUMO

Invasive motor Cortex Stimulation (iMCS) was introduced in the 1990's for the treatment of chronic neuropathic orofacial pain (CNOP), although its effectiveness remains doubtful. However, CNOP is known to be a heterogeneous group of orofacial pain disorders, which can lead to different responses to iMCS. Therefore, this paper investigated (1) whether the effectiveness of iMCS is significantly different among different CNOP disorders and (2) whether other confounding factors can be impacting iMCS results in CNOP. A systematic review and meta-analysis using a linear mixed-model was performed. Twenty-three papers were included, totaling 140 CNOP patients. Heterogeneity of the studies showed to be 55.8%. A visual analogue scale (VAS) measured median pain relief of 66.5% (ranging from 0-100%) was found. Linear mixed-model analysis showed that patients suffering from trigeminal neuralgia responded significantly more favorable to iMCS than patients suffering from dysfunctional pain syndromes (p = 0.030). Also, patients suffering from CNOP caused by (supra)nuclear lesions responded marginally significantly better to iMCS than patients suffering from CNOP due to trigeminal nerve lesions (p = 0.049). No other confounding factors were elucidated. This meta-analysis showed that patients suffering from trigeminal neuralgia and patients suffering from (supra)nuclear lesions causing CNOP responded significantly more favorable than others on iMCS. No other confounding factors were found relevant.


Assuntos
Dor Crônica , Terapia por Estimulação Elétrica , Dor Facial , Córtex Motor/fisiopatologia , Neuralgia , Neuralgia do Trigêmeo , Dor Crônica/fisiopatologia , Dor Crônica/terapia , Dor Facial/fisiopatologia , Dor Facial/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/fisiopatologia , Neuralgia/terapia , Síndrome , Neuralgia do Trigêmeo/fisiopatologia , Neuralgia do Trigêmeo/terapia
12.
Acta Odontol Scand ; 78(4): 309-320, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31876451

RESUMO

Objective: Transcutaneous electrical nerve stimulation (TENS) may serve as non-invasive intervention for painful temporomandibular disorders (TMD) to improve jaw motor function, but its efficacy is still debated. This parallel study evaluated the effect of TENS on pain and movement patterns after repeated jaw movements in patients with painful temporomandibular joints (TMJ) and disc displacement without reduction (DDwoR), and compared with healthy controls.Material and Methods: 20 patients with TMJ pain and DDwoR and 20 age- and gender-matched healthy volunteers were randomly assigned to TENS/sham TENS (sTENS) intervention groups in a block design (10 in each group). Participants performed 20 repeated jaw movements (4 x 5 sessions), and reported pain intensity on a 0-10 Numerical Rating Scale (NRS) subsequently both before and after the intervention. Data were tested by repeated measures analysis of variance (ANOVA).Results: Significant increase of pain intensity and reduction of opening range were shown within repeated jaw movements in TMJ pain patients in contrast to healthy participants (p ≤ .001). Pain was significantly reduced during repeated open-close (p = .007), fast open-close (p = .016) and horizontal movements (p = .023), accompanied with increased opening range (p = .033) and open-close velocity (p = .019) with TENS intervention when compared with sTENS group (p > .05) in TMJ pain patients.Conclusions: This study indicated that movement-evoked pain was reduced either spontaneously or by sTENS in TMJ pain patients with DDwoR, and interestingly, that TENS could attenuate movement-evoked pain and improve jaw motor function during repeated jaw movements. The findings may have implications for TENS treatment in TMJ pain patients with DDwoR.


Assuntos
Luxações Articulares/terapia , Transtornos da Articulação Temporomandibular/terapia , Estimulação Elétrica Nervosa Transcutânea , Estudos de Casos e Controles , Dor Facial/terapia , Humanos , Articulação Temporomandibular , Resultado do Tratamento
13.
Acta Clin Croat ; 58(Suppl 1): 82-89, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741564

RESUMO

The concept of diagnostics and therapy of musculoskeletal and neuropathic diseases of the stomatognathic system, which are the subject of this paper, has been developing for decades. It can be said that in order to avoid misunderstanding, the orofacial pain as a clinical problem, in the narrower sense, involves non-odontogenic and non-malignant causes of orofacial region. In this study, the results of clinical diagnosis of the population of 557 consecutive patients with orofacial pain based on multidisciplinary diagnostics were evaluated. 15.6% of patients have given up on the participation in the study. It has been shown that the patients who dropped out of the study were significantly older (p=0.0411) than those who agreed to participate, but there was no difference in gender ratio (p=0.185) since the proportion of female patients prevailed. In an analysis of 84.4% of patients participating in the study, the elevated anxiety values were established (mean value on STAI 1 was 39.2 and STAI 2 was 41.1) and statistical significance was found in correlation between elevated anxiety and intensity of pain as shown on visual analogue scale on open mouth (p<0.0001). Compared to the age, the statistical significance was for STAI 1 (p=0.0097) but not for STAI 2 (p=0.5599). The most common form of therapy is Michigan stabilization splint: for disc displacement of temporomandibular joint (TMJ) in 38.9% of patients and in combination with physiotherapy in 18.7% of patients; for osteoarthritis of TMJ in 28.4% and in combination with physiotherapy in 26.4% of patients. The treatment with anticonvulsant drugs for trigeminal neuralgia predominates in 54.3% of patients, which is combined with acupuncture in 25.7% of patients and only acupuncture in 17.1% of patients. In this study, a multidisciplinary co-operation in initial diagnostics and differential was designed to develop subspecialist knowledge on orofacial pain.


Assuntos
Dor Facial/terapia , Osteoartrite/cirurgia , Transtornos da Articulação Temporomandibular/cirurgia , Neuralgia do Trigêmeo/terapia , Terapia por Acupuntura , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Criança , Dor Facial/etiologia , Dor Facial/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/diagnóstico , Medição da Dor , Modalidades de Fisioterapia , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/diagnóstico , Neuralgia do Trigêmeo/complicações , Neuralgia do Trigêmeo/diagnóstico , Adulto Jovem
14.
Pain Physician ; 22(5): 447-477, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31561646

RESUMO

BACKGROUND: Head and facial pain is a common and often difficult to treat disorder. Routine treatments sometimes fail to provide acceptable relief, leaving the patient searching for something else, including narcotics and surgery. Recently, neuromodulation has been expanding to provide another option. Secondary to its potentially temporary nature and relatively manageable risk profile, several reviews have suggested trialing neuromodulation prior to starting narcotics or invasive permanent surgeries. There is evidence that neuromodulation can make a difference in those patients with intractable severe craniofacial pain. OBJECTIVES: To provide a basic overview of the anatomy, epidemiology, pathophysiology and common treatments of several common head and facial disorders. Furthermore, to demonstrate the suggested mechanisms of neuromodulation and the evidence currently existing for the use of neuromodulation. METHODS: A comprehensive review was performed regarding the available literature through targeting articles reporting on the use of neuromodulation to treat pain of the head and face. RESULTS: We compiled and discuss the current evidence available in treating head and facial pain. The strongest evidence currently for neuromodulation is for occipital nerve stimulation for migraine, transcutaneous vagal nerve stimulation for migraine and cluster headache, sphenopalatine ganglion microstimulation for cluster headache, and transcutaneous supraorbital and supratrochlear nerve stimulation for migraine. In addition, there is moderate evidence for occipital nerve stimulation in treating occipital neuralgia. LIMITATIONS: Neuromodulation has been trialed and is promising in several craniofacial pain disorders; however, there remains a need for large-scale, randomized, placebo-controlled clinical trials to further evaluate the efficacy and safety of most treatments. Much of the current data relies on case reports without randomization or placebo controls. CONCLUSIONS: With advancing techniques and technology, neuromodulation can be promising in treating intractable pain of the head and face. Although more randomized controlled trials are warranted, the current literature supports the use of neuromodulation in intractable craniofacial pain. KEY WORDS: Neuromodulation, headache, facial pain, craniofacial pain, migraine, cluster headache, trigeminal neuralgia, occipital neuralgia, peripheral nerve stimulator, high cervical spinal cord stimulator, peripheral nerve field stimulator.


Assuntos
Terapia por Estimulação Elétrica/métodos , Dor Facial/terapia , Cefaleia/terapia , Manejo da Dor/métodos , Humanos , Neuralgia/terapia , Dor Intratável/terapia
15.
Rev. Hosp. Ital. B. Aires (2004) ; 39(3): 81-85, sept. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1048229

RESUMO

El dolor crónico constituye un reto terapéutico especial. Se presenta una revisión narrativa sobre el papel del tratamiento de oxigenación hiperbárica (TOHB) en el tratamiento del dolor neuropático, y sus aplicaciones en dolor crónico, síndromes neurosensitivos disfuncionales y oncodolor. El conocimiento de las indicaciones de TOHB en algiología y su aplicación en la práctica médica puede contribuir a mejorar la calidad de vida del paciente. (AU)


Chronic pain represents a special therapeutic challenge. We present a narrative review on the role of Hyperbaric Oxygen Therapy (HBOT) in the treatment of neuropathic pain, and its applications in chronic pain, dysfunctional neurosensitive syndromes and oncological pain. The knowledge of the indications of HBOT in algiology and its application in medical practice can contribute to improve the quality of life of the patient. (AU)


Assuntos
Dor Crônica/terapia , Oxigenação Hiperbárica/métodos , Membro Fantasma/terapia , Qualidade de Vida , Distrofia Simpática Reflexa/terapia , Cefaleias Vasculares/terapia , Encefalopatias/terapia , Dor Facial/terapia , Fibromialgia/terapia , Causalgia/terapia , Neuropatias Diabéticas/terapia , Edema/terapia , Neuralgia Pós-Herpética/terapia , Dor Crônica/epidemiologia , Dor do Câncer/terapia , Oxigenação Hiperbárica/tendências , Analgesia/métodos , Inflamação/terapia , Neuralgia/terapia
16.
PLoS One ; 14(8): e0221110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31415654

RESUMO

BACKGROUND: Transcranial Direct Current Stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS) have been described as promising alternatives to treat different pain syndromes. This study evaluated the effects of TMS and tDCS in the treatment of chronic orofacial pain, through a systematic review. METHODS: An electronic search was performed in major databases: MEDLINE, Scopus, Web of Science, Cochrane, Embase, LILACS, BBO, Open Gray and CINAHL. The eligibility criteria comprised randomized clinical trials (RCTs) that applied TMS or tDCS to treat chronic orofacial pain. The variables analyzed were pain, functional limitation, quality of life, tolerance to treatment, somatosensory changes, and adverse effects. The risk of bias was assessed through the Cochrane Collaboration tool, and the certainty of evidence was evaluated through GRADE. The protocol was registered in the PROSPERO database (CRD42018090774). RESULTS: The electronic search resulted in 636 studies. Thereafter, the eligibility criteria were applied and the duplicates removed, resulting in eight RCTs (four TMS and four tDCS). The findings of these studies suggest that rTMS applied to the Motor cortex (M1), the dorsolateral prefrontal cortex (DLPFC) and the secondary somatosensory cortex (S2) provide adequate orofacial pain relief. Two studies reported significant pain improvement with tDCS applied over M1 while the other two failed to demonstrate significant effects compared to placebo. CONCLUSIONS: rTMS, applied to M1, DLPFC or S2, is a promising approach for the treatment of chronic orofacial pain. Moreover, tDCS targeting M1 seems to be also effective in chronic orofacial pain treatment. The included studies used a wide variety of therapeutic protocols. In addition, most of them used small sample sizes, with a high risk of biases in their methodologies, thus producing a low quality of evidence. The results indicate that further research should be carried out with caution and with better-standardized therapeutic protocols.


Assuntos
Dor Crônica/terapia , Dor Facial/terapia , Manejo da Dor , Qualidade de Vida , Estimulação Transcraniana por Corrente Contínua , Estimulação Magnética Transcraniana , Dor Crônica/patologia , Dor Crônica/fisiopatologia , Dor Facial/patologia , Dor Facial/fisiopatologia , Humanos
17.
Neurology ; 93(12): e1138-e1147, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31434691

RESUMO

OBJECTIVE: To assess the prevalence of facial pain (V2 and/or V3) presentations among nearly 3,000 patients with headache treated in a university tertiary care center. METHODS: Between 2010 and 2018, we routinely assessed the prevalence of facial pain presentations of all patients with primary headaches. RESULTS: Of 2,912 patient datasets, 291 patients reported facial pain either as an independent or as an additional symptom. Among patients with migraine, 2.3% (44 of 1,935) reported a facial involvement, most commonly in V2. Of these, 18 patients (40.9%) experienced the pain predominantly in the face. In patients with cluster headache, 14.8% (42 of 283) reported a facial involvement, of which 31.0% perceived the pain predominantly in the face. A facial involvement was seen in 45.0% of patients with paroxysmal hemicrania (9 of 20), 21.4% of patients with hemicrania continua (9 of 42), and 20.0% of patients with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (3 of 15). In addition, we present 6 patients who reported a constant side-locked facial pain with superseded well-defined facial pain attacks of 10- to 30-minute duration that appeared several times per day. CONCLUSION: Our data suggest that a facial involvement in primary headaches is infrequent but not uncommon. A sole facial presentation of primary headache symptomatology seems to be exceptionally rare. We describe 3 different types of facial pain involvement and, in this context, distinguish patients with paroxysmal orofacial pain syndromes that have not been previously described. These patients may represent a new entity that could tentatively be called constant unilateral facial pain with added attacks.


Assuntos
Neuralgia Facial/diagnóstico , Transtornos de Enxaqueca/diagnóstico , Cefalalgias Autonômicas do Trigêmeo/diagnóstico , Adulto , Diagnóstico Diferencial , Neuralgia Facial/terapia , Dor Facial/diagnóstico , Dor Facial/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/terapia , Estudos Retrospectivos , Centros de Atenção Terciária/tendências , Cefalalgias Autonômicas do Trigêmeo/terapia
18.
Curr Pain Headache Rep ; 23(10): 74, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31388843

RESUMO

PURPOSE OF REVIEW: Trigeminal neuralgia (TN) is characterized by recurrent attacks of lancinating facial pain in the dermatomal distribution of the trigeminal nerve. TN is rare, affecting 4 to 13 people per 100,000. RECENT FINDINGS: Although there remains a debate surrounding the pathogenesis of TN, neurovascular compromise is the most currently accepted theory. Minimal stimulation caused by light touch, talking, or chewing can lead to debilitating pain and incapacitation of the patient. Pain may occur sporadically, though is primarily unilateral in onset. The diagnosis is typically determined clinically. Treatment options include medications, surgery, and complementary approaches. Anti-epileptic and tricyclic antidepressant medications are first-line treatments. Surgical management of patients with TN may be indicated in those who have either failed medical treatment with at least three medications, suffer from intolerable side-effects, or have non-remitting symptoms. Surgical treatment is categorized as either destructive or non-destructive. Deep brain and motor cortex neuro-modulatory stimulation are off label emerging techniques which may offer relief to TN that is otherwise refractory to pharmacological management and surgery. Still, sufficient data has yet to be obtained and more studies are needed.


Assuntos
Dor Facial/terapia , Neuralgia/terapia , Nervo Trigêmeo/cirurgia , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/terapia , Descompressão/métodos , Dor Facial/etiologia , Humanos , Neuralgia/diagnóstico , Resultado do Tratamento , Nervo Trigêmeo/patologia
20.
Orv Hetil ; 160(27): 1047-1056, 2019 Jul.
Artigo em Húngaro | MEDLINE | ID: mdl-31264469

RESUMO

Orofacial pain is the common name of a variety of disorders from inflammatory diseases to neuropathic pain syndromes. This condition is quite common, it may involve 7% of the whole population. Patients (and doctors) are not aware of the origin of their complaints, therefore initial management falls among the variety of healthcare professionals. The aim of our review was to summarize the current evidence of chronic orofacial pain including diagnosis, management and pitfalls. Orv Hetil. 2019; 160(27): 1047-1056.


Assuntos
Dor Crônica/diagnóstico , Dor Crônica/terapia , Dor Facial/diagnóstico , Dor Facial/terapia , Neuralgia/complicações , Medição da Dor/métodos , Dor Crônica/etiologia , Depressão , Dor Facial/etiologia , Humanos , Comunicação Interdisciplinar , Resultado do Tratamento
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