Face Pain

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Karen G Raphael - One of the best experts on this subject based on the ideXlab platform.

  • stress evoked muscle activity in women with and without chronic myofascial Face Pain
    Journal of Oral Rehabilitation, 2021
    Co-Authors: Malvin N Janal, Frank Lobbezoo, Karen S Quigley, Karen G Raphael
    Abstract:

    Background Amplified muscle activity in reaction to daily life stressors might explain chronic Pain in temporomandibular disorder (TMD). Objectives To assess whether patients with myofascial TMD Pain (MFP) react to standardized stressors with greater masticatory muscle activity than demographically-matched controls. Methods 124 female MFP patients and 6346 demographically matched and Pain-free controls rated distress while performing a series of standardized stress-reactivity tasks (viz., cold pressor test, mental arithmetic test, speech stressor test, and reaction time/startle response test) as well as a vanilla baseline control task. Blood pressure was measured before and after each task, and electromyographic (EMG) activity was continuously recorded over the jaw-closing muscles and several non-masticatory muscles during each task. Linear mixed model analyses were used to test the hypothesis that case status, stress-reactivity task, and muscle recording site influenced EMG activity. Results Stress induction was successful, as evidenced by distress ratings and blood pressure measurements that were significantly elevated during performance of the stress tasks. Participants reported that some of the tasks were stressful in a way that resembled stressors experienced in their daily lives. Elevated muscle activity could be confirmed only for the reaction time/startle response task, where mean EMG activity was elevated more in cases than in controls, specifically in the jaw-closing muscles. Conclusion These data could not provide clear support for the theory that psychological stressors produce a differential increase in masticatory muscle activity in MFP patients than Pain-free controls.

  • interepisode sleep bruxism intervals and myofascial Face Pain
    Sleep, 2017
    Co-Authors: Konstantin Muzalev, Malvin N Janal, Frank Lobbezoo, Karen G Raphael
    Abstract:

    Study Objectives: Sleep bruxism (SB) is considered as a possible etiological factor for temporomandibular disorder (TMD) Pain. However, polysomnographic (PSG) studies, which are current "gold standard" diagnostic approach to SB, failed to prove an association between SB and TMD. A possible explanation could be that PSG studies have considered only limited characteristics of SB activity: the number of SB events per hour and, sometimes, the total duration of SB per night. According to the sports sciences literature, lack of adequate rest time between muscle activities leads to muscle overloading and Pain. Therefore, the aim of this study was to determine whether the intervals between bruxism events differ between patients with and without TMD Pain. Methods: Two groups of female volunteers were recruited: myofascial TMD Pain group (n=124) and non-TMD control group (n=46). From these groups, we selected 86 (69%) case participants and 37 (80%) controls who had at least two SB episodes per night based on PSG recordings. A linear mixed model was used to compare case and control groups over the repeated observations of interepisode intervals. Results: The duration of interepisode intervals was statistically similar in the case (mean [standard deviation {SD}] 1137.7 [1975.8] seconds)] and control (mean [SD] 1192.0 [1972.0] seconds) groups. There were also a similar number of SB episodes per hour and a total duration of SB episodes in both groups. Conclusions: The current data fail to support the idea that TMD Pain can be explained by increasing number of SB episodes per hour of sleep or decreasing the time between SB events.

  • the role of tooth grinding in the maintenance of myofascial Face Pain a test of alternate models
    Pain Medicine, 2007
    Co-Authors: Malvin N Janal, Karen G Raphael, Jack J Klausner, Mark F Teaford
    Abstract:

    Objective. While mechanisms of myofascial Face Pain are poorly understood, bruxism has been implicated in the maintenance of this Painful disorder. This study evaluates whether evidence of one aspect of bruxism, tooth-grinding, is positively associated with Pain severity, as predicted by a psychophysiological model, or negatively associated, as predicted by an adaptation model of Face Pain. Patients. Participant s were 51 women who met Research Diagnostic Criteria for the myofascial subtype of temporomandibular disorder. Outcome Measures. Tooth-grinding was quantified by changes in microwear features of the molar teeth over 2 weeks. Palpated Pain severity was quantified on an 11-point scale in response to palpation of the skin overlying the masseter and temporalis muscles bilaterally. Other measures included validated scales of spontaneous Pain severity, stress, distress, and psychological symptoms. Association was quantified as Pearson correlation coefficients. Results. Data showed an inverse correlation ( r = −0.37, P < 0.05) between palpated Pain severity and the index of tooth wear, supporting the adaptation model. This correlation provided a weighted average of a strong effect ( r = −0.80, P < 0.01) seen in those women reporting Pain only the right side of their Face with an effect that approximated zero in those reporting bilateral Pain. Tooth wear measures were negatively associated with ratings of Pain severity only over the right masseter. Discussion. While these data do not address the role of clenching, they cast serious doubt on the theory that myofascial Face Pain is maintained by tooth-grinding.

  • is bruxism severity a predictor of oral splint efficacy in patients with myofascial Face Pain
    Journal of Oral Rehabilitation, 2003
    Co-Authors: Karen G Raphael, Joseph J Marbach, Jack J Klausner, Mark F Teaford, D K Fischoff
    Abstract:

    Both the efficacy and mechanism of any effect of oral splint therapy for patients with temporomandibular disorders (TMDs) are a matter of controversy. To address these issues, this study tested the hypothesis that oral splints produce the most marked Pain relief for those TMD patients with myofascial Face Pain (MFP) who also brux (i.e. grind or clench) more than other MFP patients. In a 6-week randomized controlled clinical trial, 52 women with MFP were randomly assigned to receive either a full-coverage hard acrylic splint or a palatal-only splint. Bruxism was assessed both by self-report and by an objective assessment of molar microwear changes over a 2-week period prior to the start of the trial. Tested across multiple outcome measures, results indicated that those receiving the full-coverage splint had marginally better improvement on some Pain-related measures than those receiving the palatal splint, but severity of bruxism did not moderate the therapeutic effect of the full-coverage splint. These findings strongly argue against the belief that oral splints reduce MFP by reducing bruxism and raise questions about the importance of bruxism in the maintenance of MFP.

  • widespread Pain and the effectiveness of oral splints in myofascial Face Pain
    Journal of the American Dental Association, 2001
    Co-Authors: Karen G Raphael, Joseph J Marbach
    Abstract:

    ABSTRACT Background The research literature reaches inconsistent conclusions about the efficacy of oral splints for treating myofascial Face Pain. This investigation hypothesizes that their effectiveness varies as a function of the presence or absence of widespread Pain. Methods In a randomized, controlled clinical trial, 63 women with myofascial Face Pain were assigned to use of either an active, maxillary, flat-plane, hard acrylic splint or a palatal splint that did not interfere with occlusion. Participants also were classified according to the presence or absence of widespread Pain throughout the body. After six weeks, groups were compared regarding Pain on palpation, self-reported Pain and functional outcome. Results Overall, the findings showed a modest tendency for subjects receiving the active vs. the palatal splint to exhibit improvement on self-reported Pain and functional outcome. On further division of the sample into subjects with local vs. widespread Pain, the general pattern showed that patients with widespread Pain who received an active splint did not experience improvement, while patients with local Pain who received the active splint did. Conclusions The presence or absence of widespread Pain may help to define the specific circumstances under which oral splints should be prescribed for patients with myofascial Face Pain. Clinical Implications Clinicians should screen patients with myofascial Face Pain for the presence of widespread Pain, since this comorbid symptom pattern may be a contraindication for the use of oral splints.

Joseph J Marbach - One of the best experts on this subject based on the ideXlab platform.

  • is bruxism severity a predictor of oral splint efficacy in patients with myofascial Face Pain
    Journal of Oral Rehabilitation, 2003
    Co-Authors: Karen G Raphael, Joseph J Marbach, Jack J Klausner, Mark F Teaford, D K Fischoff
    Abstract:

    Both the efficacy and mechanism of any effect of oral splint therapy for patients with temporomandibular disorders (TMDs) are a matter of controversy. To address these issues, this study tested the hypothesis that oral splints produce the most marked Pain relief for those TMD patients with myofascial Face Pain (MFP) who also brux (i.e. grind or clench) more than other MFP patients. In a 6-week randomized controlled clinical trial, 52 women with MFP were randomly assigned to receive either a full-coverage hard acrylic splint or a palatal-only splint. Bruxism was assessed both by self-report and by an objective assessment of molar microwear changes over a 2-week period prior to the start of the trial. Tested across multiple outcome measures, results indicated that those receiving the full-coverage splint had marginally better improvement on some Pain-related measures than those receiving the palatal splint, but severity of bruxism did not moderate the therapeutic effect of the full-coverage splint. These findings strongly argue against the belief that oral splints reduce MFP by reducing bruxism and raise questions about the importance of bruxism in the maintenance of MFP.

  • widespread Pain and the effectiveness of oral splints in myofascial Face Pain
    Journal of the American Dental Association, 2001
    Co-Authors: Karen G Raphael, Joseph J Marbach
    Abstract:

    ABSTRACT Background The research literature reaches inconsistent conclusions about the efficacy of oral splints for treating myofascial Face Pain. This investigation hypothesizes that their effectiveness varies as a function of the presence or absence of widespread Pain. Methods In a randomized, controlled clinical trial, 63 women with myofascial Face Pain were assigned to use of either an active, maxillary, flat-plane, hard acrylic splint or a palatal splint that did not interfere with occlusion. Participants also were classified according to the presence or absence of widespread Pain throughout the body. After six weeks, groups were compared regarding Pain on palpation, self-reported Pain and functional outcome. Results Overall, the findings showed a modest tendency for subjects receiving the active vs. the palatal splint to exhibit improvement on self-reported Pain and functional outcome. On further division of the sample into subjects with local vs. widespread Pain, the general pattern showed that patients with widespread Pain who received an active splint did not experience improvement, while patients with local Pain who received the active splint did. Conclusions The presence or absence of widespread Pain may help to define the specific circumstances under which oral splints should be prescribed for patients with myofascial Face Pain. Clinical Implications Clinicians should screen patients with myofascial Face Pain for the presence of widespread Pain, since this comorbid symptom pattern may be a contraindication for the use of oral splints.

  • myofascial Face Pain clinical characteristics of those with regional vs widespread Pain
    Journal of the American Dental Association, 2000
    Co-Authors: Karen G Raphael, Joseph J Marbach, Jack J Klausner
    Abstract:

    ABSTRACT Background The authors conducted a study to determine whether there are differences in salient clinical characteristics between patients who have both myofascial Face Pain, or MFP, and comorbid fibromyalgia, or FM, and patients who have MFP but not FM. Methods The authors enrolled in the study 162 female subjects who had histories of MFP. In physical examinations at the time of initial consultation, they recorded facial Pain signs and symptoms. At the research interview follow-up (seven years postconsultation), participants were screened for a lifetime history of FM and other health problems. In addition, psychiatric interviewers conducted the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Third Edition–Revised, to assess each patient's history of depression and other psychiatric disorders. Results Of the 162 participants, 38 (23.5 percent) reported a history of FM. At the time of treatment for MFP, both the FM and non-FM groups had similar signs and symptoms of MFP. At the time of the research interview follow-up, participants with FM histories were significantly less likely than those without FM histories to report that they were free of MFP. On recall, those with FM histories reported experiencing more symptoms of MFP. Those with FM histories also were more likely to have had major depression and to report somatization symptoms. Finally, those who had FM more commonly had a history of facial Pain's interference with social and occupational functioning and had more severe Pain than did those without FM. Conclusions Patients who have MFP and a history of widespread Pain suggestive of FM are likely to have more persistent and debilitating MFP and to have higher rates of depression and somatization symptoms than those who have no history of widespread Pain.

  • why is depression comorbid with chronic myofascial Face Pain a family study test of alternative hypotheses
    Pain, 1999
    Co-Authors: Bruce P Dohrenwend, Karen G Raphael, Joseph J Marbach, Rollin M Gallagher
    Abstract:

    A number of explanations have been proposed to account for findings that rates of depression are elevated in persons with chronic, non-malignant Pain disorders (CNPDs); for example, that CNPDs are variants of depression (e.g. 'masked depression'), that the stress of living with CNPDs contribute to the onset of depression ('diathesis-stress'), or that the correlation of CNPDs and depression is a methodological artifact of studying treatment-seeking samples. These alternative hypotheses are tested for one specific CNPD, chronic myofascial Face Pain, using a family study methodology. The procedure was to conduct direct psychiatric interviews with 106 patients with a history of carefully diagnosed myofascial Face Pain, 118 acquaintance controls without personal histories of myofascial Face Pain, and a random sample of adult first degree relatives of these case and control probands. The probands were further subdivided into four roughly equal samples consisting of cases with and without personal histories of major depressive disorder (MDD), and controls with and without personal histories of MDD. Dates of initial onsets of myofascial Face Pain and MDD in patient probands were obtained from interviews and records. The main results were that, compared to control probands without personal histories of MDD, MDD and depressive spectrum disorders (DSD) were elevated in the first degree relatives of control probands with personal histories of early onset MDD, but not in the first degree relatives of myofascial Face Pain probands with or without personal histories of early or late onset MDD. This outcome is consistent with the hypothesis that living with chronic myofascial Face Pain contributes to elevated rates of depression. It is inconsistent with the alternative hypotheses that this CNPD is a variant of depression or that the elevated MDD rates are simply an artifact of selection into treatment. The implications of these results and additional results consistent with them are discussed.

  • the examination of myofascial Face Pain and its relationship to psychological distress among women
    Health Psychology, 1995
    Co-Authors: Alex J Zautra, Karen G Raphael, Joseph J Marbach, Bruce P Dohrenwend, Mary Clare Lennon, David A Kenny
    Abstract:

    In this study, 110 female myofascial Face Pain patients were assessed monthly for 10 months on measures of Pain, distress, and stressful life events. D. A. Kenny and A. J. Zautra's (1995) structural equation model for examining the separate trait, state, and error components of the variables was used to analyze the data. Both Pain and distress had sizable trait variance, and the trait components were correlated. The 2 variables also showed sizable state variance, and the states of Pain covaried with states of distress. A significant time-lagged relationship between the 2 variables was found: Increases in distress led to elevations in Pain 1 month later. Stressful life events arising from major social roles were also associated with greater distress, but not Pain. Illness events unrelated to the Pain syndrome were associated with both Pain and distress.

James E Heavner - One of the best experts on this subject based on the ideXlab platform.

  • sphenopalatine ganglion pulsed radiofrequency treatment in 30 patients suffering from chronic Face and head Pain
    Pain Practice, 2005
    Co-Authors: Erin Z Bayer, Gabor B Racz, Day Miles, James E Heavner
    Abstract:

    This study evaluated the efficacy of sphenopalatine ganglion pulsed radiofrequency (SPG-PRF) treatment in patients suffering from chronic head and Face Pain. Thirty patients were observed from 4 to 52 months after PRF treatment. The primary efficacy measures were the reduction in oral medication use, including opioids, time-to-next-treatment modality for presenting symptoms, duration of Pain relief, and the presence of residual symptoms. Secondary objectives included the evaluation of adverse effects and complications. All data were derived from patient charts, phone conversations, and clinical follow-up visits. Fourteen percent of respondents reported no Pain relief, 21% had complete Pain relief, and 65% of the patients reported mild to moderate Pain relief from SPG-PRF treatment. Sixty-five percent of the respondents reported mild to moderate reduction in oral opioids. None of the patients developed significant infection, bleeding, hematoma formation, dysesthesia, or numbness of palate, maxilla, or posterior pharynx. A large-scale study of SPG-PRF for the treatment of Face and head Pain has not been previously reported. Our results suggest that a prospective, randomized, controlled trial study to confirm efficacy and safety of this novel treatment for chronic head and Face Pain is justified.

Ivan Garza - One of the best experts on this subject based on the ideXlab platform.

Day Miles - One of the best experts on this subject based on the ideXlab platform.

  • sphenopalatine ganglion pulsed radiofrequency treatment in 30 patients suffering from chronic Face and head Pain
    Pain Practice, 2005
    Co-Authors: Erin Z Bayer, Gabor B Racz, Day Miles, James E Heavner
    Abstract:

    This study evaluated the efficacy of sphenopalatine ganglion pulsed radiofrequency (SPG-PRF) treatment in patients suffering from chronic head and Face Pain. Thirty patients were observed from 4 to 52 months after PRF treatment. The primary efficacy measures were the reduction in oral medication use, including opioids, time-to-next-treatment modality for presenting symptoms, duration of Pain relief, and the presence of residual symptoms. Secondary objectives included the evaluation of adverse effects and complications. All data were derived from patient charts, phone conversations, and clinical follow-up visits. Fourteen percent of respondents reported no Pain relief, 21% had complete Pain relief, and 65% of the patients reported mild to moderate Pain relief from SPG-PRF treatment. Sixty-five percent of the respondents reported mild to moderate reduction in oral opioids. None of the patients developed significant infection, bleeding, hematoma formation, dysesthesia, or numbness of palate, maxilla, or posterior pharynx. A large-scale study of SPG-PRF for the treatment of Face and head Pain has not been previously reported. Our results suggest that a prospective, randomized, controlled trial study to confirm efficacy and safety of this novel treatment for chronic head and Face Pain is justified.