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

The purpose of this study was to evaluate whether non-expert examiners could reliably use the physical assessment methods described in the Research Diagnostic Criteria for temporomandibular disorders (RDC/TMD). Screening examinations were performed on patients with self-reported TMD symptoms by two examiners using techniques specified in Axis I of RDC/TMD diagnostic criteria. Both examinations and diagnostic categorization were carried out independently and blindly; reliability of the examiners was tested with appropriate parametric and non-parametric techniques. Assignment of diagnostic categories based on examination data showed levels of reliability ranging from acceptable to good. Concordance for diagnostic signs was good for determining opening click, closing click, and coarse crepitus, while concordance for determining protrusive click and joint space pain categories was poor. Using the examination and diagnosis procedures specified in the RDC/TMD, conscientious nonexpert examiners can assign diagnostic labels to the major subcategories of TMD with a satisfactory level of reliability.
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PMID:Inter-examiner reliability of physical assessment methods for assessing temporomandibular disorders. 1563 75

Sex differences in the cellular responses to morphine were examined in an animal model of temporomandibular joint (TMJ) pain. TMJ-responsive neurons were recorded in the superficial laminae at the trigeminal subnucleus caudalis/upper cervical cord (Vc/C(2)) junction region, the initial site of synaptic integration for TMJ afferents, in male and cycling female rats under barbiturate anesthesia. Unit activity was evoked by local injection of bradykinin into the TMJ capsule at 30 min intervals and the effects of morphine sulfate (0.03-3 mg/kg, i.v.) were assessed by a cumulative dose regimen. Morphine caused a dose-related inhibition of bradykinin-evoked unit activity in males and diestrous females in a naloxone-reversible manner, while evoked unit activity in proestrous females was not reduced. The apparent sex hormone-related aspect of morphine analgesia was selective for evoked unit activity, since the spontaneous activity of TMJ units was reduced similarly in all groups, while the convergent cutaneous receptive field area of TMJ units did not change in any group. These results were consistent with the hypothesis that sex hormone status interacts with pain control systems to modify neural activity at the level of the Vc/C(2) junction region relevant for TMD pain.
Pain 2005 Mar
PMID:Differential modulation of TMJ neurons in superficial laminae of trigeminal subnucleus caudalis/upper cervical cord junction region of male and cycling female rats by morphine. 1573 46

The objective was to study the utility of the graded chronic pain (GCP) scale of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the purpose of recognizing TMD pain profiles in primary health care. The GCP scale was used to gather data from 93 consecutive TMD patients seeking treatment in a primary health care setting. The GCP data were compared with pain profiles assessed by scales similar to the more complicated multidimensional pain inventory (MPI). The scales used were able to produce the similar 'dysfunctional profiles' in the TMD patients as the original MPI scale in the sample of chronic pain patients. Also, the original MPI profiles of 'adaptive copers' and 'interpersonally distressed' were produced with distinctive features. The GCP grades distributed almost identically among the subgroups produced by the pain profiles. Most grade I patients were classified as adaptive copers (82--86%), most grade II patients were interpersonally distressed (59%) and all except one of the grade III patients were classified as dysfunctional (83%). The results seem to support the main assumption of our study that the GCP scale is a simple screening tool suitable for identifying primary care TMD patients with various types of pain profiles.
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PMID:Searching for an assessment instrument to determine temporomandibular disorder pain profiles for the purposes of primary health care. 1604 13

This case report relates the association between a rare neuralgiform syndrome (SUNCT) and masticatory myofascial pain (TMD); two different diseases with different diagnosis criteria and treatments. SUNCT syndrome was treated with a balloon microcompression procedure of the trigeminal ganglion, and the myofascial pain with injections and physical therapy. The patient was without pain at a twelve-month follow-up evaluation.
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PMID:SUNCT syndrome associated with temporomandibular disorders: a case report. 1708 60

A within-patient change in pain score after treatment is statistically 'reliable' when it exceeds the smallest detectable difference (SDD). The aims of the present study were to: (i) determine SDDs for VAS-scores of pain intensity, for sufficiently long test-retest intervals to include most biological fluctuations, (ii) examine whether SDD is invariant to baseline score, and (iii) discuss the value of reliable change (RC) for detecting clinically important difference (CID) or as a possible indicator of successful treatment. SDDs were determined using duplicate data from 118 patients with myogenous Temporomandibular disorders: (1) VAS-scores of pain intensity from the masticatory system in a pre-treatment diary, and (2) VAS-scores of pain intensity from the hand (cold-pressor test). RC was determined in VAS-scores from a pre- and post-treatment questionnaire. The long-term SDD was 49mm. A regression analysis on duplicate VAS-scores showed that SDD was largely invariant to the baseline level. Because RC (change>SDD) exceeded CID, it might serve as an indicator of successful treatment. However, only 17% of the patients showed RC after treatment, mainly because the baseline was smaller than SDD in 67% of the patients thus making detection of any treatment effect impossible. For patients with possible detection (33%), the frequency of RC was 51%. If the detection threshold would be avoided by provoking pain in patients with a low baseline, a long-term RC in VAS-scores might occur in about half of all myogenous TMD patients and might then serve as an indicator of cases of treatment success.
Eur J Pain 2007 Aug
PMID:Long-term reliable change of pain scores in individual myogenous TMD patients. 1711 82

The objective of the study is to assess the prevalence of myofascial pain in a threshold country and to isolate occlusal risk factors. One hundred and seventy-one randomized selected women were examined by a trained examiner in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) examination procedure. Subscales of the SCL 90-R, graded chronic pain status, and anamnestic questionnaires were also used. Logistic regression was performed to compute the odds ratios for six common occlusal features with regard to the presence of myofascial pain, in accordance with the RDC/TMD criteria. Fifteen subjects (15 / 151 = 9.93%) suffered from myofascial pain. Results from logistic regression analysis showed that non-occlusion (posterior teeth, at least one side) and open bite increased the risk of myofascial pain. The prevalence of myofascial pain in this study is comparable with that in another study, in a highly industrialized environment, in which the RDC/TMD was used. The role of occlusion in a non-patient population seems to be restricted to serious alterations of normality. This article presents the prevalence of myofascial pain and its association with occlusal factors. This issue will help the clinicians to assess the influence of occlusion in myofascial pain patients and to send the patient to the appropriate specialist.
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PMID:The prevalence of myofascial pain and its association with occlusal factors in a threshold country non-patient population. 1741 Mar 85

Several electronic instruments have been developed as adjuncts to objectively record the dysfunctional features of temporomandibular disorders and to study the effectiveness of various treatment interventions. The aim of this review was to assess the value and contribution of clinical electromyographic research in the understanding of asymptomatic and dysfunctional muscle function and the therapeutic effects of interocclusal appliances. For this purpose MedLine and PubMed searches were conducted with the following main keywords alone and in various combinations: electromyography, muscles of mastication, masseter, temporalis, temporomandibular, TMD, utility, validity, repeatability, rest, postural, vertical dimension, occlusal, splint, treatment. The review includes critical evaluation, discussion and conclusions regarding electromyographic studies in asymptomatic and dysfunctional muscles, rest position, occlusal parameters and interocclusal appliances, as well as a critical summary and proposals for further research. Much of earlier critique of many electromyographic studies still applies regarding comparative sample selections, research designs, analyses and conclusions. The areas not well-understood include normal biological variation, capacity for adaptation, fluctuations regarding the clinical course and multidimensional features of temporomandibular disorders and long-term follow-up data, especially in studies that evaluate the effectiveness of therapeutic measures. Considering the required improvements in technical and research designs features and critical appraisal electromyographic research could have value as an adjunct research tool to study features of craniofacial muscle-related dysfunction. Until electromyographic measures are correlated with other multidimensional, especially subjective and pain-related methods, the clinical use of this method for diagnostic purposes of temporomandibular disorders remains in doubt, and is not at present recommended.
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PMID:Review of clinical EMG studies related to muscle and occlusal factors in healthy and TMD subjects. 1920 67

The relationships between temporomandibular joint (TMJ) disorders and cervical structure dysfunctions have already been demonstrated. The aim of the present study was to investigate functional and structural alterations of the head and neck of 17 individuals with TMJ disorders (TMD group), compared with a control group of 17 asymptomatic subjects in a cross-sectional design. The outcome variables included pain on palpation of the sternocleidomastoideus, superior trapezius and subocciptal muscles, as well as radiographic measures of alignment of the cervical spine and positioning of the hyoid bone. Cervical alignment, determined by measures of the cervical curvature angle, was investigated by the Cobb method. Independent Student t-tests were used to investigate differences between groups for all outcome variables (alpha < 0.05). The results demonstrated that individuals with TMJ disorders, when compared with asymptomatic subjects, presented higher levels of perception of pain in all cervical muscles (P < 0.0001). No significant differences were found between groups for the cervical alignment measures. In the TMD group, the position of the hyoid bone in relation to the cervical spine did not appear to be different from the control group.
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PMID:Cervical spine alignment and hyoid bone positioning with temporomandibular disorders. 1782 89

At the USC Orofacial Pain/Oral Medicine Center, 1,049 new patients seen from September 2003 to September 2005 were sorted according to their primary diagnosis. Two-thirds were female and 19.7% were over 64 years of age. The most prevalent diseases were categorized and compared with a similar study published 15 years ago. The seven categories included osseous disease (3.3%), mucogingival disease (17.8%), salivary/lymphatic disease (3.3%), TMD (46.3%); neuropathic pain/headache disorders (13.1%), motor/sleep disorders (9.1%), and miscellaneous (not included in above categories) (7.1%). The 35 most frequent diagnoses were sorted by the mean age of our patients and the male-female ratio was also determined. The oldest patients had burning mouth syndrome (68.1 +/- 14.7) and the youngest had internal derangements of the temporomandibular joints (27.9 +/- 14.0). These data could be used to provide information on the scope of oral medicine practice, to help practitioners create age-appropriate differential diagnoses, and to help dental school curriculum committees and graduate program directors assess their curricula to ensure they are including the full range of oral conditions in their programs.
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PMID:Oral conditions of 1,049 patients referred to a university-based oral medicine and orofacial pain center. 1799 Apr 78

The purpose of the study was to examine whether patients' psychosocial profiles differ depending on if the location of pain is in the masticatory muscles, the temporomandibular joint, or both. Eligible participants were 491 consecutive patients examined according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD). Among these a total of 225 adult TMD patients had at least one pain-related TMD diagnosis and were therefore included in this study and completed the multidimensional pain inventory (MPI). Patients diagnosed with myogenous pain only (n = 103), patients with joint pain only (n = 56), and patients with both (n = 66) were compared with respect to depression, somatization, jaw disability, pain intensity and chronicity, and MPI scores and profiles. The MPI profiles were analyzed using a multivariate analysis of variance and Hotelling's T(2) test. Although patients with joint pain were significantly more impaired in jaw function, no significant differences in depression, in somatization or in the 11 scales of the MPI were observed. The location of pain in TMD patients is not a major factor for the prediction of psychosocial profiles. Therefore, clinical TMD diagnoses alone form an insufficient basis for tailored behavioural or psychological management.
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PMID:Psychosocial profiles of diagnostic subgroups of temporomandibular disorder patients. 1847 Dec 42


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