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Couvade is a phenomenon, where the expectant father or another relative experiences somatic and/or psychiatric symptoms during a woman's pregnancy. Although epidemiological studies report a frequency of couvade symptoms between 11 and 36% during all pregnancies, psychotic couvade cases are very rare with few case reports. The authors report 2 cases of psychotic couvade and give a psychodynamic interpretation of the cases. They emphasize the important role of ego defect and double identification in the development of the cases. Couvade is a phenomenon, where the expectant father or another relative experiences somatic and/or psychiatric symptoms during a woman's pregnancy. The term couvade was first coined by Tylor in 1865. Somatic symptoms can include indigestion or colic, gastritic symptoms, food cravings, nausea and vomiting, increased or decreased appetite, diarrhea, toothache, headache, itch, muscle tremors, nosebleed or other pains. Abdominal bloating and pseudocyesis have also been reported. Although the psychiatric symptoms most often observed are depression, anxiety, insomnia, irritability, tension and hypochondria there are some reports on psychotic couvade too. In our article we present 2 cases of psychotic couvade.
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PMID:Psychotic couvade: 2 case reports. 886 58

Although Lyme disease has spread rapidly and it is difficult to diagnose, a review of the dental literature does not reveal many references to this illness. Dental practitioners must be aware of the systemic effects of this often multiorgan disorder. Its clinical manifestations may include facial and dental pain, facial nerve palsy, headache, temporomandibular joint pain, and masticatory muscle pain. The effects precipitated when performing dental procedures on a patient with Lyme disease must also be considered. This study discusses the epidemiology and diagnosis of Lyme disease, its prevention, and factors to consider when making a differential diagnosis. Dental care of the patient with Lyme disease and currently available treatments also are considered. Three case reports are presented.
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PMID:Lyme disease: considerations for dentistry. 899 19

The major purpose of this study was to determine if 31 patients with fibromyalgia syndrome (FS) reported different pain intensity and Health Locus of Control (HLC) scores than 30 patients with rheumatoid arthritis (RA). Another purpose was to determine the relationship among experienced actual pain (present, usual, worse, least), recalled prior episodes of pain (worse toothache, headache, and stomach ache), HLC orientation, age and the duration of the actual pain. Visual Analogue Scales were used to measure pain intensity. The Health Locus of Control Scale was used to determine external/internal orientation. The results showed that the FS patients reported significantly more intense actual pain, recalled pain for worse toothache and headache, and were more externally oriented than the RA patients. Present pain intensity was significantly correlated to actual intensity ratings, but not to reported earlier experienced pain, except for worse stomach ache in the RA group. The findings' implications for treatment and education are discussed.
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PMID:Pain intensity and health locus of control: a comparison of patients with fibromyalgia syndrome and rheumatoid arthritis. 900 34

The analgesic effectiveness and safety of oral tramadol were compared with standard analgesics using a meta-analysis of individual patient data from randomised controlled trials in patients with moderate or severe pain after surgery or dental extraction. Calculation of %maxTOTPAR from individual patient data, and the use of > 50%maxTOTPAR defined clinically acceptable pain relief. Number-needed-to-treat (NNT) for one patient to have > 50%maxTOTPAR compared with placebo was used to examine the effectiveness of different single oral doses of tramadol and comparator drugs. Eighteen randomised, double-blind, parallel-group single-dose trials with 3453 patients using categorical pain relief scales allowed the calculation of %maxTOTPAR. The use of > 50%maxTOTPAR was a sensitive measure to discriminate between analgesics. Tramadol and comparator drugs gave significantly more analgesia than placebo. In postsurgical pain tramadol 50, 100 and 150 mg had NNTs for > 50%maxTOTPAR of 7.1 (95% confidence intervals 4.6-18), 4.8 (3.4-8.2) and 2.4 (2.0-3.1), comparable with aspirin 650 mg plus codeine 60 mg (NNT 3.6 (2.5-6.3)) and acetaminophen 650 mg plus propoxyphene 100 mg (NNT 4.0 (3.0-5.7)). With the same dose of drug postsurgical patients had more pain relief than those having dental surgery. Tramadol showed a dose-response for analgesia in both postsurgical and dental pain patients. With the same dose of drug postsurgical pain patients had fewer adverse events than those having dental surgery. Adverse events (headache, nausea, vomiting, dizziness, somnolence) with tramadol 50 mg and 100 mg had a similar incidence to comparator drugs. There was a dose response with tramadol, tending towards higher incidences at higher doses. Single-patient meta-analysis using more than half pain relief provides a sensitive description of the analgesic properties of a drug, and NNT calculations allow comparisons to be made with standard analgesics. Absolute ranking of analgesic performance should be done separately for postsurgical and dental pain.
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PMID:Single-patient data meta-analysis of 3453 postoperative patients: oral tramadol versus placebo, codeine and combination analgesics. 908 3

Headache, facial pain and toothache are poorly localized and irradiate in distant areas. Thus, toothache often causes facial pain and headache, but, in turn, it can also be mimicked by several forms of these disorders, in particular by a myoarthropathy of the masticatory system, a migraine, a tension-type headache, a neuropatic pain and a trigeminal neuralgia. The atypical odontalgia is a nonodontogenic form of toothache that is difficult to diagnose; therefore, it leads to a number of invasive dental procedures which normally worsen the pain condition. The atypical odontalgia can often be solely diagnosed by means of a diagnostic block. Headache and facial pain can also be caused by a myoarthropathy of the masticatory system. This disorder is often misdiagnosed, because the signs and symptoms are not pathognomonic, and they are frequently present also in healthy individuals. The disorder has a good prognosis, the therapy is generally simple and follows the treatment principles for chronic musculoskeletal disorders. The burning-mouth syndrome is an other poorly understood form of intraoral pain that occurs primarily in postmenopausal females. Several etiologic factors have been described, but treatment based on one or more of these factors is often ineffective. Spontaneous remission occurs in about half of the patients after several years.
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PMID:[Headache and teeth]. 913 11

Dentists are trained to provide treatment for patients with straightforward problems that respond to routine therapy and do not recur. However, patients may present to dentists and complain solely of physical symptoms such as toothache, headache, and facial pain: only after much inappropriate treatment these symptoms are revealed to be due to emotional disturbance. The dentist may spend hours investigating such patients, in some of whom dental pathology may be present, but the symptoms and ensuing disability cannot be satisfactorily explained as a result. There are other patients who are preoccupied by physical symptoms or by their appearance. In others, anxiety may manifest itself as a phobia, or a dysmorphic concern about certain aspects of their appearance. This article reviews the role of liaison psychiatry and psychology in dentistry.
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PMID:Liaison psychiatry and psychology in dentistry. 939 63

Pain is a major public health problem. The management of orofacial pain may be a difficult challenge to the medical and dental professions. Ideally, severe cases of this type of pain should be treated by a team drawn from several disciplines such as neurology, otolaryngology, dentistry and psychiatry. Trigeminal neuralgia patients develop brief, very severe unilateral pain, usually radiating from the upper or lower jaw toward the ear, and confined to the distribution of the trigeminal nerve. The pain may be triggered by chewing, shaving or exposure to cold wind. Most patients respond to carbamazepine, with phenytoin or baclofen as an alternative. Intractable pain may require surgical treatment. Horton's syndrome (cluster headache) is always unilateral and is often associated with unilateral lacrimation and rhinorrhoea. The pain is extreme, and its typical localisation the eye, forehead, temple, jaws, or teeth. Treatment with ergotamine and sumatriptan has been used with some success, calcium blockers (e.g., verapamil) being used as prophylaxis. Atypical facial pain is a continuous ache with intermittent episodes, localised to non-muscular, non-joint facial areas. The pain may be unilateral or bilateral, and may persist for many years. Typically, these patients consult a variety of specialists, such as dentists and otolaryngologists. Surgical procedures such as tooth extraction or sinus surgery, even if skillfully executed, exacerbate the condition, are are thus contraindicated. If the patient does not respond to reassurance, antidepressants may be tried. In sinusitis, the pain location is dependent upon which paranasal sinus is affected. Routine diagnostic nasal endoscopy and coronal plane computed tomography enable subtle pathological changes that are related to chronic pain to be identified. If medical treatment fails to afford relief, surgery should be considered. Pain, limited range of jaw motion, and joint noises are the common characteristics of temporomandibular disorders. Treatment usually consists of non-surgical means such as splints, occlusal equilibration, and non-steroidal anti-inflammatory drugs. Surgical treatment is indicated in a few carefully selected cases. Most dental pain is attributable to caries or periodontal disease. When pus is present, drainage affords excellent pain relief. Acute pericoronitis involving mandibular third molars responds to irrigation, removal of maxillary third molar trauma, and--in cases of serious infection--antimicrobial therapy. Early recognition of a case of chronic pain improves the chances of successful management, and avoids frustration and disillusion both to patient and doctor.
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PMID:[Neurologist, otolaryngologist...? Which specialist should treat facial pain?]. 963 Jul 98

Third-party payers typically use patients' discharge diagnoses to determine "appropriate" Emergency Department (ED) usage. This analysis compared the resource intensity involved in ED evaluation for "inappropriate" and all other ED visits. In this retrospective database review, 11 discharge diagnoses (DX11) (chronic nasopharyngitis; chronic sinusitis; chronic pharyngitis; rhinitis; constipation; head cold; hemorrhoids; toothache; flu; headache; and tension headache) were identified by a third party payor as being "inappropriate" for ED evaluation. The chief complaints of all patients seen in 1994 and 1995 with one of the DX11 were identified along with their E & M billing level, ED length of stay (LOS), and the frequency of consultation. In this urban, university trauma center, 1994 and 1995 visits totaled 120,402. Eighty-two different chief complaints were associated with a final diagnosis of DX11; 79% of all ED patients presented with one of the chief complaints (AllCC). Four percent of patients with DX11 were admitted, and the AllCC group had comparable resource utilization to the entire ED population. Patients' presenting complaints are incapable of predicting diagnosis or disposition. Retrospective denial of payment by discharge diagnosis is inappropriate.
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PMID:Retrospective denial of emergency department payments is inappropriate. 995 Mar 81

Rofecoxib selectively inhibits cyclo-oxygenase-2 in a dose-dependent manner in humans. No significant inhibition of cyclo-oxygenase-1 is observed with rofecoxib up to doses of 1000 mg. In 4 large double-blind randomised trials performed in patients with osteoarthritis, rofecoxib 12.5 and 25 mg/day significantly improved physical functioning, assessed using the Western Ontario and McMasters Universities Osteoarthritis Index and patient or investigator global assessment, compared with placebo. In addition, rofecoxib showed similar clinical efficacy to that observed with diclofenac 50 mg 3 times daily, ibuprofen 800 mg 3 times daily and nabumetone 1500 mg once daily. Rofecoxib is also an effective analgesic in patients with primary dysmenorrhoea or postoperative dental pain and demonstrates similar analgesic efficacy to that of naproxen sodium and ibuprofen. Rofecoxib is generally well tolerated. The most common adverse events associated with rofecoxib are diarrhoea, headache, nausea and upper respiratory tract infection. There was a significantly lower incidence of upper-gastrointestinal adverse events (perforations, ulcers and bleeds) in patients with osteoarthritis receiving rofecoxib 12.5, 25 or 50 mg/day than in those receiving ibuprofen, diclofenac or nabumetone.
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PMID:Rofecoxib. 1049 77

Recently, leukotrienes have been implicated in the mediation of bronchoconstriction and inflammatory changes in asthma. Leukotriene levels have also been shown to be elevated in patients with asthma as well as in those with sinonasal polyposis and sinusitis. The leukotriene synthesis inhibitor zileuton and the leukotriene receptor antagonist zafirlukast have been shown to produce subjective and objective improvements in patients with mild to moderate asthma. Given these findings, we evaluated the efficacy of these two medications in controlling sinonasal polyposis and their associated symptoms. We treated 40 patients diagnosed with sinonasal polyposis and sinusitis with either zileuton or zafirlukast. No other change was made in their standard therapy. Outcome measures included subjective interviews and questionnaire responses, as well as office endoscopic examinations and chart reviews. At study's end, 36 patients were available for evaluation. Twenty-six had taken zafirlukast, five had taken zileuton, and five others had switched from zafirlukast to zileuton. Overall, 26 patients (72%) experienced subjective improvement in their symptomatology after starting their medication. Statistically significant improvement was noted with respect to headache, facial pain and pressure, ear discomfort, dentalgia, purulent nasal discharge, postnasal drip, nasal congestion and obstruction, olfaction, and fever. An objective alleviation, or at least stabilization, of sinonasal polyposis was seen in 50% of the patients. Four patients (11%) discontinued their medication because of side effects. We conclude that antileukotrienes might play a significant role in controlling polyposis and symptoms secondary to sinonasal disease, and they might be a viable alternative to long-term oral steroid therapy and repeated surgical debridement.
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PMID:Acute effects of antileukotrienes on sinonasal polyposis and sinusitis. 1066 87


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