Treatment-related changes in brain activation in patients with fibromyalgia syndrome.

Little is known about the effects of successful treatment on brain function in chronic pain. This study examined changes in pain-evoked brain activation following behavioral extinction training in fibromyalgia patients. Using functional magnetic resonance imaging, brain activation to painful mechanical stimuli applied to the 2nd phalanx of the left 2nd digit (m. flexor digitorum) was assessed in 10 patients with fibromyalgia syndrome (FM) before and after behavioral extinction training. The behavioral treatment significantly reduced interference from pain in the FM patients. Mechanical pain threshold and pain tolerance increased significantly after treatment. Activation in the insula shifted bilaterally from a more anterior site before treatment to a more posterior location after treatment. The pre- to post-treatment reduction in both interference related to pain and pain severity were significantly associated with bilateral activation in pain-evoked activity in the posterior insula, the ipsilateral caudate nucleus/striatum, the contralateral lenticular nucleus, the left thalamus and the primary somatosensory cortex contralateral to the stimulated side. These data show a relation between successful behavioral treatment and higher activation bilaterally in the posterior insula and in the contralateral primary somatosensory cortex. Future studies should compare responders and non-responders for differential treatment effects and examine in more detail the mechanisms underlying these changes.

Subtle Sensory Abnormalities Detected by Quantitative Sensory Testing in Patients with Trigeminal Neuralgia.

BACKGROUND: Trigeminal neuralgia (TN) is characterized by paroxysmal pain attacks affecting the somatosensory distributions of the trigeminal nerve. It is thought to be associated with a neurovascular conflict most frequently, but pathomechanisms have not been fully elucidated. In general, no sensory deficit is found in routine clinical examination. There is limited data available, however, showing subtle subclinical sensory deficits upon extensive testing. OBJECTIVE: We used quantitative sensory testing (QST) to detect abnormalities in sensory processing in patients with TN by comparing the affected and non-affected nerve branches with their contralateral counterparts and by comparing the results of the patients with those of controls. STUDY DESIGN: Observational study. SETTING: University Hospital, Departments of Neurosurgery, Institute for Cognitive and Clinical Neuroscience. METHODS: QST was conducted on 48 patients with idiopathic TN and 27 controls matched for age and gender using the standardized protocol of the German Neuropathic Pain Network. Stimulations were performed bilaterally in the distribution of the trigeminal branches. The patients had no prior invasive treatment, and medications at the time of examination were noted. RESULTS: In patients with TN deficits in warm and cold sensory detection thresholds in the affected and also the non-affected nerve branches were found. Tactile sensation thresholds were elevated in the involved nerve branches compared to the contralateral side. LIMITATIONS: More data are needed on the correlation of such findings with the length of history of TN and with changes of the morphology of the trigeminal nerve. CONCLUSIONS: QST shows subtle sensory abnormalities in patients with TN despite not being detected in routine clinical examination. Our data may provide a basis for further research on the development of TN and also on improvement after treatment. KEY WORDS: Quantitative sensory testing, trigeminal neuralgia, facial pain, neuropathic pain, microvascular decompression, cranial nerve.

A German version of the GOHAI.

OBJECTIVES: Translation, reliability analysis and validation of a German version of the Geriatric/General Oral Health Assessment Index (GOHAI) was the aim of this study. METHODS: Translation was performed by a forward-backward process. Validity was assessed as convergent validity in comparison with another self-perceived assessment of oral health (OHIP-14) and as group validity (n = 218; mean age 73 years). Reliability was proved in terms of internal consistency, inter-item and item-scale correlations, and stability (test-retest procedure; n = 36; mean age 77 years). The responsiveness to change in oral health status was assessed by pre- and post-treatment comparison (n = 21; mean age 63 years). RESULTS: A German version of the GOHAI is presented. Convergent validity was sufficient (r = -0.76 compared with OHIP-14); group validity could be demonstrated for self-perceived need for treatment, chewing problems, number of own teeth, caries lesions present and dental status. The internal consistency was high (Cronbach's alpha = 0.92) as were inter-item and item-scale correlations, for which good homogeneity of the index was apparent. The test-retest correlation for the summary score was r = 0.84, single item correlations ranged from r = 0.36 to r = 0.89. The GOHAI sum score increased significantly after patients received new dentures, indicating responsiveness of the GOHAI to clinical change in the expected direction. CONCLUSIONS: The German version of the GOHAI had sufficient reliability, validity and responsiveness to be used as measure of oral health-related quality of life in cross-sectional and longitudinal studies of the elderly.

[Clinical assessment of oral health between physician and dentist--a pilot study on inter-examiner reliability]. / Wie verlässlich ist die klinische Erhebung von Mundgesundheitsparametern durch Arzte bei geriatrischen Patienten? : Eine Pilotstudie zur Ubereinstimmung zwischen den Untersuchungsergebnissen eines Arztes und eines Zahnarztes.

OBJECTIVE: Very little is known about the ability of physicians to assess oral health of geriatric patients. The aim of this pilot study was to assess the in ter-examiner reliability in assessment of oral health for a dentist and a physician, and to evaluate the influence of training in dental findings for the physician on inter- examiner reliability. METHODS: Inter-examiner reliability between a physician and a dentist was tested in a primary geriatric hospital with 126 participants 60 years old or more (mean 77 years; 32% men) using the Revised Oral Assessment Guide (ROAG) and additional items relating to caries and dentures (14 items). Calculated were kappa-coefficients, and percentage agreement between the examiners before (n = 50) and after (n = 51) training for the physician in dentistry (n = 25 for the common training session). RESULTS: Before the training both kappa-values and percentage agreement were not acceptable in the different categories. After the training, with the exception of the categories swallow and tongue, the reliability of all items was moderate or good. The number of occasions on which the physician underestimated the clinical finding compared to the dentist - indicating a clinical finding was overlooked - decreased for every item; for retention of denture and decayed teeth this decrease was significant. CONCLUSION: Screening for oral health performed by a physician was insufficient regarding the different clinical aspects. Training in the use of an oral health assessment tool improved the reliability of the screening. Because of the low number of examiners the results should be interpreted as a pilot investigation on this new topic.

Oral health-related quality of life and somatization in the elderly.

OBJECTIVE: Somatization disorders are frequent in the elderly, and previous studies have revealed that psychological factors affect the outcome of measurement of oral health-related quality of life (OHRQoL). The objective of this study was, therefore, to investigate the correlation between OHRQoL and somatization. METHODS: One-hundred and twenty-five participants aged 60 years or older (mean age 76.6 years; 40 males) from a primary geriatric medical hospital participated in this cross-sectional study. OHRQoL was assessed by using the Oral Health Impact Profile (OHIP), somatization by using the somatization subscale of the Symptom Check List (SCL-90-R). To obtain dental data we performed a clinical dental examination. RESULTS: In bivariate analyses the most consistent correlation with somatization was found for overall OHIP sum score and the subscales physical pain and functional limitation (r > 0.4). Participants with high somatization scores had high OHIP sum scores. In multivariate analysis somatization led to additional explanation of the variance of the OHIP sum score and of all OHIP subscales. CONCLUSIONS: There is consistent correlation between OHRQoL and somatization. When evaluating OHRQoL in the elderly (using the OHIP) further evaluation of somatization should be considered for thorough interpretation of the results.

Correlations between self-ratings of denture function and oral health-related quality of life in different age groups.

This study aimed to assess the correlation between self-rated denture function and oral health-related quality of life (OHRQoL) in different age groups. Subjects' OHRQoL was measured using the Oral Health Impact Profile, and self-ratings of denture function were assessed on a Likert-type scale for patients with fixed and removable partial dentures in 3 age groups (N = 253). For subjects with fixed partial dentures, all correlations were significant for the younger patients but not for higher age groups, whereas the opposite was true for subjects with removable partial dentures. The importance of self-perception of denture function in OHRQoL is different in various groups of patients, depending on age and dental status.