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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Conservative methods should be a basic treatment principle in CMD. In spite of similar signs and symptoms, the etiology may vary and treatment should, if possible, be directed towards the cause, but the management may often just be mitigating. Counselling may be crucial. Occlusal appliances of different design obviously influence the muscular activity significantly but equilibration may include a strong placebo effect. While relaxation is incompletely investigated, biofeedback seem possibly effective. The application of physical medicine procedures is almost entirely empirically based. Experience from other areas also motivates pharmacotherapy in CMD while intra-articular injections seem reasonably well founded. Investigations of pain-alleviating methods like TENS and acupuncture, though sometimes promising, are often uncontrolled. Manipulation, even if effective, may not necessarily be a "disc recapturing" manoeuvre. The results of conservative treatment for joint clicking seem unpredictable and long-term results of treatment with repositioning splints are not encouraging. A need for well-controlled, randomised clinical studies in diagnostic subgroups and controls has been expressed. Although most patients with CMD can be successfully treated with different conservative methods, often with remarkably similar results, other options must be considered for some.
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PMID:Conservative treatment methods in craniomandibular disorder. 148 Nov 29

In 15 patients with central pain (thalamic pain) after stroke, CT, PET scan and intraoperative thalamic microrecordings were performed. The results are considered together to evaluate a possible role of thalamic intralaminar nuclei in the genesis of central pain, especially of superficial pain. In the non-thalamic lesion group (deep pain dominant), thalamic background neural activity (BNA) was relatively high in Vim but low in CL. Conversely, in the thalamic lesion group (superficial pain dominant), thalamic BNA was higher in CL than in Vim, and markedly decreased in VC. In this group, regional cerebral oxygen consumption (rCMRO2) was relatively maintained, and regional oxygen extraction ratio (raOEF) and the relative value of regional cerebral glucose utilization (CMRGL), compared to rCMRO2, was increased in the cerebral cortex around the central sulcus. The genesis of superficial pain is discussed.
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PMID:Pathophysiology of central (thalamic) pain: a possible role of the intralaminar nuclei in superficial pain. 179 53

A sample of 637 persons was interviewed and examined clinically for signs and symptoms of CMD. Five percent reported daily headaches, and recurrent headaches were more frequently (P less than 0.001) reported by women (28%) than men (15%). Women more often (P greater than 0.001) had headaches upon awaking and in the afternoon. Face, eyes, throat, and neck were the most common locations of pain (20%). Women (18%) more often (P less than 0.05) reported CM symptoms than men (10%), and 16% of the women and 9% of the men considered themselves to be in need of treatment. About 20% reported oral parafunctions (clenching/grinding/biting). The most frequent clinical finding was TMJ sounds (58%). Both clicking and crepitation were more frequent in women (P less than 0.01). Palpation tenderness in the jaw muscles was most frequently found in the lateral pterygoid (34%) and temporal muscle (27%). Women generally had more tenderness and muscles tender to palpation. Mean maximal opening capacity was significantly larger in men. Only 12% of the sample were found to be free of signs of mandibular dysfunction. As signs and symptoms of CMD were common findings, routine dental examination should always include functional examination of the stomatognathic system to evaluate the need of treatment.
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PMID:Craniomandibular disorders in an urban Swedish population. 209 91

One hundred two tinnitus patients were examined to determine the prevalence of signs and symptoms of CMD. The examination comprised determination of the anamnestic and clinical dysfunction indices according to Helkimo; assessment of the dentition, occlusal factors, and signs of parafunctions; and accomplishment of a tension test. Patients also answered a questionnaire concerning the presence and frequency of CMD symptoms and headaches, as well as influence on tinnitus by mandibular movements, by pressure applied to the TMJ, or by dental therapy. Frequent headaches and fatigue/tenderness in jaw muscles were more prevalent in tinnitus patients than in epidemiologic samples, as was the prevalence of clinical findings of pain on palpation of masticatory muscles, impaired mandibular mobility, and signs of parafunctions. About one-third of the patients reported influence on tinnitus by mandibular movements and/or pressure applied to the TMJs. A theoretic model of causal connections between tinnitus and signs and symptoms of CMD in some tinnitus patients is suggested.
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PMID:Prevalence of signs and symptoms of craniomandibular disorders in tinnitus patients. 209 94

The stomatognathic system was examined in 100 chronic recurrent headache patients, and the asymmetry in clinical and radiographic findings was studied. A clinically recorded facial asymmetry was found more frequently in patients with a definite CMD pain (P less than 0.001), in patients with mainly a unilateral headache (P less than 0.01), and in patients with a head injury in the history (P less than 0.05). The radiographically determined asymmetry in condylar height in these headache patients was high. More condylar asymmetry was found in migraine patients than in patients with tension headache (P less than 0.05). Asymmetric findings in the hard-tissue condition of the temporomandibular joint were more prevalent in patients with a definite CMD pain and in those with mainly bilateral headaches.
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PMID:Craniomandibular asymmetry in headache patients. 209 97

Fifty patients with recurrent headache who had been referred to a neurologist were randomly invited for an examination of their stomatognathic system. The prevalence and distribution of the findings in many ways resemble the clinical findings in CMD patients. In 66% of the patients, a myogenous or arthrogenous origin of CMD pain could be detected. Headache occurred more bilaterally, but unilateral findings were more common at the functional examination. The results did not show any statistical differences between the sexes.
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PMID:Craniomandibular disorders in headache patients. 260 99

An hypothesis that migraine is the experience of a protective vascular response to cerebral information overload has been explored to a limited extent by examining the association between laterality of the attack and verbal and spatial performances under standard symptom-free conditions. The study was restricted to individuals with unilateral symptoms always presenting on the same side. It emerged that those with classical migraine do not always have prodromata referable to the same side as the pain. Indeed, in the present study, prodromata were almost exclusively referable to the left (dominant) cerebral hemisphere. A subgroup of those with speech disturbances as a feature of the prodromal symptoms was also found to have relatively impaired language abilities on routine testing. It is this finding that lends some support to the hypothesis. The findings also invite the refining proposition that information overload, as defined in the hypothesis, is almost always borne by the dominant (verbal) hemisphere in our species. Such overload might concurrently or sequentially also overtax a suggested limited right hemisphere language capacity, in terms of the hypothesis, accounting for the right-sided pain sometimes presenting in these cases. Otherwise, pain appears to be predominantly left-sided or midline. Perhaps the frequency of this particular syndrome is an indictment of the limitations of language as a basis for communication, as well as reflecting the possibility that most of our stressful transactions and their cerebral processing use a verbal substrate. The results also reveal the need for agreement on rules for classification of laterality in migraine.
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PMID:Cerebral hemisphere function and migraine. 263 18

Three hundred patients were questioned regarding frequency of headache pain. One hundred forty-one patients were seeking treatment at the University of Kentucky College of Dentistry TMJ Clinic for CMD. A comparison group of 159 was selected from persons being screened for routine dental needs. The following findings regarding incidence and frequency of headache pain were observed: 1. The incidence of headache pain was twice as high in the CMD group than in the comparison group (p less than .001). 2. Of the persons in each group reporting the occurrence of headaches, the frequency of headaches in the CMD group was significantly higher (44%) than in the comparison group (p less than .001). Thirty-three patients with headache pain were treated for a 4-week period with occlusal splint therapy. Patients were questioned regarding the number of headaches per week they had before and after occlusal splint therapy. The following results were observed: 1. Twenty-one (63.6%) patients showed a decrease in the frequency of their headaches. 2. Ten (30.3%) patients showed complete remission of headaches. 3. No patient showed an increase in the frequency of headaches. 4. As a group the average number of headaches per week before treatment was 5.06; after occlusal splint therapy the average number of headaches per week was 2.15 (p less than .001).
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PMID:Craniomandibular disorders and headaches. 657 39

A case of "effort thrombosis" of the subclavian vein which occurred in a young woman with severe thrombotic risk factors is reported. The manifestations of this syndrome are summarized, and recent concepts regarding the management of subclavian vein obstruction are discussed. The 33 year old woman was admitted with a 3 day history of rapidly increasing pain and swelling of her right upper extremity and right breast. She recalled no previous trauma but did indicate that her vocation required frequent exertion of her right (dominant) arm. The involved extremity exhibited easy fatigability with intermittent "tingling numbness" of the hand. She had been taking oral contraceptives (OCs) for 4 years. On admission she was smoking 2-3 packs of cigarettes daily with a 15 year smoking history. She had essential hypertension of 14 years duration which was treated with a thiazide diuretic. On physical examination, the patient's right breast was found to be twice the size of the left and exhibited tenderness, peau d'orange appearance, and superficial venous prominence. The right upper extremity exhibited venous prominence and mottled cyanosis and was edematous with an upper arm circumference that was 2.5 cm greater than the left. The involved axilla was tender, with no palpable venous "cord" or enlarged lymph nodes. Adson's maneuver was negative. Noninvasive impedance plethysmography showed no evidence of obstruction to venous outflow in the upper or lower extremities, but venography taken with the arms abducted to 45 degrees showed complete thrombotic obstruction of the right subclavian vein (shown in a figure). At first the patient was treated conservatively with bedrest, arm elevation, discontinuation of OCs, and heparinization. She became asymptomatic during the ensuing week, but a repeat venogram after 7 days of heparin therapy displayed complete obstruction of the right subclavian vein. The patient was discharged on warfarin sodium therapy which was continued for 5 months, during which time antithrombin 3 levels rose to 100% activity. During the year following hospitalization, the patient has experienced monthly episodes of mild aching in her right arm, unaccompanied by swelling or discoloration, following exertion of the extremity. Due to the fact that the etiology of effort thrombosis is now considered to be related to thoracic outlet compression, more emphasis is being placed on the use of phlebography to demonstrate compression points along the subclavian vein. Conservative management with anticoagulants continues to be the mainstay of therapy, but surgical treatment with early thrombectomy promises to decrease the chronic morbidity so common to this condition.
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PMID:"Effort thrombosis" of the subclavian vein associated with oral contraceptives. 731 65

EMG spectral shifts of anterior temporal and medial masseter muscles were evaluated. Mean power frequency (MPF) shift during fatigue and recovery of 46 healthy subjects and 46 patients with craniomandibular disorder were recorded at the beginning and the end of fatiguing clenching, then 3, 8, 13 and 18 min following the fatiguing clenching. The reference clenching force was 80% of each subject's maximal voluntary contraction (MVC). Recording was stopped when subjects felt pain or discomfort. Significance was found between the healthy group (N) and the diseases group (CMD) in the three following points: (i) the mean of MPF values of the masseter muscles at the end of fatiguing clenching; (ii) the recovery pattern of the temporal muscles; and (iii) MPF shift induced by fatiguing clenching. Our results therefore suggest that MPF reflects several aspects of craniomandibular disorders. Thus, measuring fatigue and recovery MPF could be useful in the screening of CMD.
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PMID:Mean power frequency shift during fatigue and recovery in patients with craniomandibular disorders. 772 48


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