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Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with chronic orofacial pain must be treated with methods different from those used with patients with acute pain. If different methods are not used, the characteristics of chronic pain may become firmly entrenched. Dentists should be aware of the various methods of treatment for this separate pain entity.
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PMID:Recognition and treatment of patients with chronic orofacial pain. 29 56

The diagnosis and assessment of patients suffering from chronic, persistent orofacial pain of nonspecific origin can be difficult because of the interactions between psychological and somatic signs. Patients with chronic pain are treated differently from those with acute pain and often fail to respond to the usual acute pain model. This article discusses the practical assessment and drug treatment of chronic orofacial pain of nonspecific origin.
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PMID:Assessment of patients suffering from chronic orofacial pain of nonspecific origin. 209 84

The pain relieving effect of vibratory stimulation was studied in 731 patients suffering from acute pain (135 patients) or chronic pain (596 patients). Most of the patients had previously undergone treatments of various kinds without sufficient pain relief. The effect of vibratory stimulation was assessed before, during and after stimulation using different rating scales. About 70% of the patients reported reduction of pain during vibratory stimulation. In many patients there was a clear relation between the degree of reduction of pain and the intensity of pain before the beginning of stimulation. In general, relief of pain by more than 50% during stimulation was obtained in the patients who reported light, light to moderate, or moderate pain. The patients with moderate to severe, or severe pain before stimulation generally reported a reduction of pain of 50% or less. The best pain reducing site was found to be either the area of pain or close to it, the antagonistic muscle or a trigger point near the painful area. In most patients suffering from musculoskeletal pain the best pain reducing effect was obtained when the vibratory stimulation was applied with moderate pressure (at which contact was achieved with underlying bone) at a frequency of 50-150 Hz. To obtain a maximal duration of pain relief the stimulation had to be applied for 30-45 minutes. Many of the patients experienced pain relief lasting for more than 3 hours. It may be noticed that in many patients the pain relief lasted for 12 hours or more. There was a good correlation between the degree of pain relief and its duration. In the patients who experienced a pain reduction of 50% or less the pain relief generally lasted for less than 6 hours while in the patients who experienced pain relief of more than 50% it lasted for more than 6 hours. In comparison with high or low frequency TENS, vibratory stimulation was found to be as effective and in some patients even more effective in reducing chronic musculoskeletal or orofacial pain. The effect of 20 Hz, 100 Hz and 200 Hz vibratory stimulation, high frequency TENS, low frequency TENS and "placebo" vibratory stimulation was examined in various chronic musculoskeletal pain syndromes. 82% of the patients experienced a relief of pain with any of the above mentioned methods; 47% of the patients experienced a reduction of pain with vibratory stimulation or TENS stimulation.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Vibratory stimulation for the alleviation of chronic pain. 660 24

We examined the analgesic effect of racemic ketamine and its 2 enantiomers in 16 female patients (age: 20-29 years) suffering acute pain after oral surgery and in 7 female patients (age: 42-79 years) suffering chronic neuropathic orofacial pain. All 3 forms of ketamine consistently relieved postoperative pain, (S)-ketamine being 4 times more potent than (R)-ketamine. The analgesic effect was maximal 5 min after i.m. injection and lasted for about 30 min. The 7 patients with neuropathic pain received ketamine at one or several occasions. Four patients (age: 54-79 years) who had suffered pain for more than 5 years did not experience an analgesic effect, whereas 3 patients (age: 42-53 years) who had suffered pain for less than 3 years reported pain relief lasting from 24 h to 3 days. The individual type of response did not depend on the form of ketamine used. The mental side effects were qualitatively similar for the 3 forms of ketamine. Relative to the analgesic effect (S)-ketamine caused more disturbing side effects than did (R)-ketamine. The mean serum concentration of each form of ketamine at the time of maximal effect was close to the approximate Kd value for PCP site occupancy by that particular form. This is in concert with the hypothesis that the effect of ketamine on acute nociceptive pain is due to N-methyl-D-aspartate (NMDA) receptor inhibition and adds to the evidence that NMDA receptors are important for the perception of acute, nociceptive pain in humans.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of ketamine, an NMDA receptor inhibitor, in acute and chronic orofacial pain. 765 31

A review of the records and follow-up of 106 patients who had been referred to pain management clinics in Auckland between January 1990 and October 1992 because of chronic, protracted, orofacial pain, showed that more than half gained lasting benefit. This is consistent with the experience of other interdisciplinary pain clinics dealing with various chronic pain disorders, where previous and often multiple treatments have proved unsuccessful. The patients who made good progress tended to be those motivated to take charge of, and responsibility for, their own rehabilitation. Those patients still seeking a "cure", or who felt it was not up to them to take an active part in the management of their pain problem, tended to make poor or no progress. Of concern was the number of instances of misdiagnosis seen, resulting in inappropriate and, on occasion, harmful treatments. On average, the patients had consulted three general or specialist dental or medical practitioners before referral. Chronic pain problems usually require considerable time and a multidisciplinary environment for accurate diagnoses, and a carefully planned management programme. Often, neither are readily available to the busy general practitioner, whose training and experience is directed toward the treatment of acute pain. As a result, patients with chronic pain often end up treated with methods more appropriate for acute pain, which may entrench and compound the pain problem and lead to permanent disability. Recognition and referral of the patient with chronic pain at an early stage can improve the chances of successful management, and avoid frustration and disillusionment of both the practitioner and the patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:An evaluation of the diagnosis, treatment, and outcome of patients with chronic orofacial pain. 805 17

The non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used classes of drugs for the management of acute and chronic pain in dentistry. Their therapeutic efficacy and toxicity are well-documented and provide evidence that NSAIDs generally provide an acceptable therapeutic ratio of pain relief with fewer adverse effects than the opioid-mild analgesic combination drugs that they have largely replaced for most dental applications. The great many studies done with the oral surgery model of acute pain indicate that a single dose of an NSAID is more effective than combinations of aspirin or acetaminophen plus an opioid, with fewer side-effects, thus making it preferable for ambulatory patients. The combination of an NSAID with an opioid generally results in marginal analgesic activity but with an increased incidence of side-effects, which limits its use to patients in whom the NSAID alone results in inadequate analgesia. The selective COX-2 inhibitors hold promise for clinical efficacy with less toxicity from chronic administration and may prove advantageous for the relief of chronic orofacial pain. The use of repeated doses of NSAIDs for chronic orofacial pain should be re-evaluated in light of a lack of documented efficacy and the potential for serious gastrointestinal and renal toxicity with repeated dosing.
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PMID:Therapeutic uses of non-steroidal anti-inflammatory drugs in dentistry. 1160 4

Acute and chronic orofacial pain continues to be poorly understood and managed. The National Health and Medical Research Council of Australia (NHMRC) 1999 report on acute pain management promotes the development of evidence based clinical practice guidelines aimed at improving both the quality of health care and health outcomes in medical and dental practice in Australia. Nerve signals arising from sites of tissue or nerve injury lead to long term changes in the central nervous system and the amplification and persistence of pain. These nociceptor activity-induced neuronal changes known as central sensitization, have important clinical implications in the development of new approaches to the management of persistent pain. These findings and implications are discussed in relationship to poorly managed and understood conditions such as oral dysaesthesia, burning mouth syndrome, atypical facial pain/atypical odontalgia, peripheral nerve injury, deafferentation and phantom tooth syndrome.
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PMID:Chronicity of orofacial pain. 1170 38

In this review, the modulatory effects of tooth and implant loading, orofacial pain, and psychological factors on somatosensory and jaw-motor function in humans are assessed. Experimental studies on the control of jaw actions have revealed that patients with prostheses supported by osseointegrated implants show an impairment of fine motor control of the mandible. One possibility is that this may be related to the loss of afferent information from periodontal ligament mechanoreceptors, which results in considerably higher and more variable forces to hold and manipulate food between the teeth. However, psychophysical investigations have shown that patients still perceive mechanical stimuli exerted on osseointegrated implants in the jawbone. The use of somatosensory evoked potentials may revealed what specific receptor groups are responsible for this so-called osseoperception phenomenon. Orofacial pain is another modulator of trigeminal system functioning. Experimental jaw muscle pain has several effects on the somatosensory and motor function of the masticatory system, all of them serving to warn the individual about the ongoing damaging of tissues. Finally, the influence of mental state on the sensory and motor functions of the trigeminal system will be addressed. While some animal studies suggest that psychological stress can reduce acute pain, less speculative are the findings in human subjects that the anticipation of receiving a painful stimulus or undertaking difficult mental tasks can modulate jaw reflexes, including those evoked by mechanical stimuli applied to the teeth. Since such stimuli occur regularly during normal oral activities, the study of the resulting motor effects may yield clinically meaningful results in the context of other variables that modulate mandibular function.
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PMID:Topical review: modulation of trigeminal sensory input in humans: mechanisms and clinical implications. 1188 63

The majority of people afflicted with orofacial pain have acute pain that resolves quickly, but some are left with chronic and disabling pain. Therapy must be provided to deal with the nociception, behavior, and suffering. Appropriate behavioral evaluation may be required prior to developing a treatment plan. The treatment should then be carefully outlined and presented in a treatment-planning visit and may include physical, pharmacologic, and behavioral aspects.
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PMID:Current concepts in chronic pain management. 1283 36

Pain is a complex, multidimensional experience encompassing sensory-discriminative, cognitive, emotional and motivational dimensions. These dimensions in the orofacial region have particular expression since the face and mouth have special biological, emotional and psychological meaning to each individual. Orofacial pain is frequent. Epidemiological studies reveal a high prevalence of severe pain in syndromes such as temporomandibular disorders (TMD), burning mouth syndrome and toothaches, as well as an important role of psychosocial influences, contributing to the persistence of these syndromes. Many of the difficulties experienced by clinicians with the diagnosis and management of acute and chronic orofacial pain stem from a lack of recognition and understanding of these complex conditions, the various intricate bio-psycho-social interactions and the neurobiology behind the chronicisation of acute pain. This text strives to review the important advances and insights into the peripheral processes by which noxious stimuli activates or modulates nociceptive afferent input into the brainstem, the neural pathways in the brainstem and higher levels of the trigeminal (V) somatosensory system and the mechanisms involved in the plasticity of nociceptive transmission. We shall link this knowledge to clinical correlates and suggest a therapeutic approach in acute orofacial pain, in the attempt to avoid the development of chronic pain.
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PMID:[Mechanisms by which acute orofacial pain becomes chronic]. 1680 82


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