Painful temporomandibular disorders (TMD) and comorbidities in primary care : associations with pain-related disability

Objective: We studied whether primary care temporomandibular disorder (TMD) patients reporting different levels of pain-related disability differ in terms of comorbid pains, general health conditions and quality of life. Material and methods: Consecutive TMD pain patients (n = 399) seeking treatment in primary care completed a questionnaire on comorbid pains and their interference and the Finnish version of the RAND-36-item quality of life questionnaire. Medical diagnoses confirmed by doctors were recorded. The patients were classified according to the Graded Chronic Pain Scale (GCPS) of the Research Diagnostic Criteria for TMD (RDC/TMD). The patients were classified: no disability group (0 disability points), low disability group (1-2 disability points) and high disability group (3-6 disability points). Results: Compared to patients in the no-disability group, patients in the high- and low-disability groups reported more comorbid pain conditions (p <.001), and experienced these as more intense and interfering more with daily life (p <.05). Patients in the high-disability group reported more general health-related medical diagnoses than patients in the no-disability group (p <.05). Furthermore, patients with low or high pain-related disability indicated poorer quality of life in all RAND-36 subscales than those with no disability (p <.05). Conclusions: The findings suggest that GCPS-related disability scoring can be used as a simple screening instrument to identify TMD patients with different degrees of health burdens.Peer reviewe

Terveys- ja hyvinvointivaikutukset - lähtötason tilanne 2009-2010: työllisyys, terveys ja hyvinvointi : Paltamon työllistämismallin arviointitutkimus 2009-2013

Työtä kaikille -kokeiluhank

Efficacy and tolerability in patients with chronic facial pain of two consecutive treatment periods of rTMS applied over the facial motor cortex, using protocols differing in stimulation frequency, duration, and train pattern

Abstract Objective: We conducted an open-label cross-over study assessing the global effect of two high-frequency protocols of electric-field navigated repetitive transcranial magnetic stimulation (rTMS) targeted to functional facial motor cortex and comparing their efficacy and tolerability in patients with chronic facial pain. Outcome predictors were also assessed. Methods: We randomized twenty consecutive patients with chronic facial pain (post-traumatic trigeminal neuropathic pain, n=14; persistent idiopathic facial pain, n=4; secondary trigeminal neuralgia, n=2) to receive two distinct 5-day rTMS interventions (10Hz, 2400 pulses and 20Hz, 3600 pulses) separated by six weeks. The target area was assessed by mapping of lower face representation. The primary endpoint was the change in weekly mean of pain intensity (numeric rating scale, NRS) between the baseline and therapy week (1st week), and follow-up weeks (2nd and 3rd weeks) for each rTMS intervention. Response was defined using a combination scale including the patient’s global impression of change and continuance with maintenance treatment. Results: Overall, pain intensity NRS decreased from 7.4 at baseline to 5.9 ten weeks later, after the second rTMS intervention (p=0.009). The repetition of the treatment had a significant effect (F=4.983, p=0.043) indicating that the NRS scores are lower during the second four weeks period. Eight (40%) patients were responders, 4 (20%) exhibited a modest effect, 4 (20%) displayed no effect, and 4 (20%) experienced worsening of pain. High disability and high pain intensity (&gt;7) predicted a better outcome (p=0.043 and p=0.045). Female gender, shorter duration of pain and low Beck Anxiety Inventory scores showed a trend towards a better outcome (p=0.052, 0.060 and 0.055, respectively). Conclusions: High-frequency rTMS targeted to face M1 alleviates treatment resistant chronic facial pain. Repeated treatment improves the analgesic effect. A protocol with higher frequency (above 10Hz), longer session duration (more than 20 minutes) and higher number of pulses (above 2400 pulses/session) did not improve the outcome. The results support early consideration of rTMS