Orofacial Pain Classification Diagnostic Tool

This diagnostic tool was created to assist dental professionals in diagnosing orofacial pain conditions including trigeminal neuralgias, neuropathic pain, and idiopathic pain. The goal is for practitioners of all experience levels to be able to quickly and accurately diagnose these conditions

The association of self-injurious behaviour and suicide attempts with recurrent idiopathic pain in adolescents: evidence from a population-based study

Background: While several population-based studies report that pain is independently associated with higher rates of self-destructive behaviour (suicidal ideation, suicide attempts, and self-injurious behaviour) in adults, studies in adolescents are rare and limited to specific chronic pain conditions. The aim of this study was to investigate the link between self-reported idiopathic pain and the prevalence and frequency of self-injury (SI) and suicide attempts in adolescents. Methods: Data from a cross-sectional, school-based sample was derived to assess SI, suicide attempts, recurrent pain symptoms and various areas of emotional and behavioural problems via a self-report booklet including the Youth Self-Report (YSR). Adolescents were assigned to two groups (presence of pain vs. no pain) for analysis. Data from 5,504 students of 116 schools in a region of South Western Germany was available. A series of unadjusted and adjusted multinomial logistic regression models were performed to address the association of pain, SI, and suicide attempts. Results: 929 (16.88%) respondents reported recurrent pain in one of three areas of pain symptoms assessed (general pain, headache, and abdominal pain). Adolescents who reported pain also reported greater psychopathological distress on all sub-scales of the YSR. The presence of pain was significantly associated with an increased risk ratio (RR) for SI (1–3 incidences in the past year: RR: 2.96; >3 incidences: RR: 6.04) and suicide attempts (one attempt: RR: 3.63; multiple attempts: RR: 5.4) in unadjusted analysis. Similarly, increased RR was observed when adjusting for sociodemographic variables. While controlling for psychopathology attenuated this association, it remained significant (RRs: 1.4–1.8). Sub-sequent sensitivity analysis revealed different RR by location and frequency of pain symptoms. Conclusions: Adolescents with recurrent idiopathic pain are more likely to report previous incidents of SI and suicide attempts. This association is likely mediated by the presence of psychopathological distress as consequence of recurrent idiopathic pain. However, the observed variance in dependent variables is only partially explained by emotional and behavioural problems. Clinicians should be aware of these associations and interview adolescents with recurrent symptoms of pain for the presence of self-harm, past suicide attempts and current suicidal thoughts. Future studies addressing the neurobiology underpinnings of an increased likelihood for self-injurious behaviour and suicide attempts in adolescents with recurrent idiopathic pain are necessary

Psychological and Family Variables Associated with the Treatment of Pediatric Idiopathic Pain

The present study examined variability in treatment outcomes of children with idiopathic chronic pain. Specifically, the biopsychosocial model was used as a framework to consider the way that symptoms of depression and anxiety as well as parent response to pain contributed to the change in a child’s confidence in participating in daily activities following treatment in an inpatient chronic pain treatment program

Psihološki i psihijatrijski čimbenici temporomandibularnog poremećaja

Temporomandibular disorders (TMD) is an umbrella term covering a series of pathologic conditions which can have similar signs and symptoms and which lead to an imbalance in the normal functioning of stomatognatic system. Temporomandibular disorders are defined as a group of orofacial disorders with pain in the preauricular area, jaw joints (TMJ) or masticating muscles with limitations in range and deviations of lower jaw’s movement as well as TMJ sounds during mastication. When the pathophysiologic factor is known, the pain is conventionally classified as “specific” and when it is unknown it is called “nonspecific”, psychogenic, idiopathic, conversive or euphemistic atypical pain. Nonspecific pain of the TMD is very often a symptom of a psychiatric disorder, for example depression with somatic symptoms, hypochondria, psychosis or is classified in the group of somatoform psychiatric disorders according to contemporary classification systems, e.g. the American Psychiatric Association’s DSM-IV (7) and the International Classification of Diseases (ICD-10). TMD affects 12% of overall population. Psychological-psychiatric problems prevail among patients with TMD, anxious-depressive disorder is found in 50%, while depression in 32.1% of patients. Patients with psychiatric problems are 4.5 times more prone to TMD than individuals without psychiatric problems and vice versa. TMD is connected with numerous etiologic factors, which renders early and precise diagnosis as well as efficient therapy more difficult. Five main factors are usually listed as connected to TMD: trauma, occlusion, habits (parafunctional activities, such as chewing a piece of gum, chewing on one side, teeth clenching, bruxism), deep pain stimulus, psychological problems connected with emotional stress, and psychiatric disorders. Psychological and psychiatric factors of TMD are the focus of this paper. Treating nonspecific, psychogenic pain disorders is not possible without a holistic, integrative, interdisciplinary team approach of psychiatrists, psychologists, physiologists, neurologists and sometimes even neurosurgeons. Cognitive-behavioral psychotherapy is prevalent as well as techniques of alleviating anxiety and stress (autogenic training), physiologic therapy, EMG biofeedback methods and psychopharmacotherapy.Temporomandibularni poremećaj (TMP) skupni je naziv za niz patoloških stanja koja mogu imati slične znakove i simptome, a dovode do poremećaja normalne funkcije stomatognatog sustava. Temporomandibularni poremećaji definiraju se kao skupina orofacijalnih poremećaja s boli u preaurikularnom području, čeljusnim zglobovima (TMZ) ili žvačnim mišićima s ograničenjima u rasponu i devijacijama kretnji donje čeljusti te zvukovima TMZ-ova tijekom žvakanja. Kada je poznat patofiziološki uzročni čimbenik TMP-a s boli, konvencionalno se klasificira kao “specifičan”, a kada patofiziološki uzročni čimbenik nije poznat, kao “nespecifičan”, psihogen, idiopatski, konverzivan ili eufemistički atipičan. Nespecifična bol pri TMP-u često je simptom nekog psihijatrijskog poremećaja kao što je depresija sa somatskim simptomima, hipohondrija, psihoza ili se pak svrstava u skupinu somatoformnih psihijatrijskih poremećaja prema suvremenim klasifikacijskim sustavima kao što su Dijagnostički i statistički priručnik (DSM-IV) američkog psihijatrijskog društva i Međunarodna klasifikacija bolesti i srodnih zdravstvenih problema MKB-10. TMP zahvaća 12% cjelokupne populacije. Psihološko-psihijatrijski problemi prevladavaju među bolesnicima s TMP-om, anksiozno-depresivni poremećaj pronađen je u 50%, a depresija u 32.1% bolesnika. Pacijenti sa psihijatrijskim problemima skloniji su 4.5 puta TMP-u nego osobe bez psihičkih problema i obrnuto. TMP je povezan s brojnim etiološkim čimbenicima, što otežava ranu i preciznu dijagnostiku i učinkovitu terapiju. Obično se navodi pet glavnih čimbenika povezanih s TMP-om: trauma, okluzija, navike (parafunkcijske aktivnosti, kao što su žvakanje žvakaće gume, žvakanje na jednu stranu, stiskanje zubi, bruksizam), duboki bolni podražaj, psihološki problemi povezani s emocionalnim stresom i psihijatrijski poremećaji. U ovom radu pozornost je usmjerena na psihološke i psihijatrijske čimbenike TMP-a. Liječenje nespecifičnih, psihogenih bolnih poremećaja TMZ-a nije moguće bez holističkog, integrativnog, interdisciplinarnog, timskog pristupa psihijatra, psihologa, fizijatra, neurologa, a ponekad i neurokirurga. Prevladava kognitivno-bihevioralna psihoterapija, tehnike ublažavanja anksioznosti i stresa (autogeni trening), fizikalna terapija, EMG biofeedback metode i psihofarmakoterapija

Lack of interchangeability between visual analogue and verbal rating pain scales: a cross sectional description of pain etiology groups

BACKGROUND: Rating scales like the visual analogue scale, VAS, and the verbal rating scale, VRS, are often used for pain assessments both in clinical work and in research, despite the lack of a gold standard. Interchangeability of recorded pain intensity captured in the two scales has been discussed earlier, but not in conjunction with taking the influence of pain etiology into consideration. METHODS: In this cross-sectional study, patients with their pain classified according to its etiology (chronic/idiopathic, nociceptive and neuropathic pain) were consecutively recruited for self-assessment of their actual pain intensity using a continuous VAS, 0–100, and a discrete five-category VRS. The data were analyzed with a non-parametric statistical method, suitable for comparison of scales with different numbers of response alternatives. RESULTS: An overlapping of the VAS records relative the VRS categories was seen in all pain groups. Cut-off positions for the VAS records related to the VRS categories were found lower in patients with nociceptive pain relative patients suffering from chronic/idiopathic and neuropathic pain. When comparing the VAS records transformed into an equidistant five-category scale with the VRS records, systematic disagreements between the scales was shown in all groups. Furthermore, in the test-retest a low percentage of the patients agreed to the same pain level on the VAS while the opposite hold for the VRS. CONCLUSION: The pain intensity assessments on VAS and VRS are in this study, not interchangeable due to overlap of pain records between the two scales, systematic disagreements when comparing the two scales and a low percentage intra-scale agreement. Furthermore, the lower VAS cut-off positions relative the VRS labels indicate different meaning of the rated pain intensity depending on pain etiology. It is also indicated that the scales have non-linear properties and that the two scales probably have different interpretation. Our findings are in favor of using the VRS in pain intensity assessments but if still the VAS is preferred, the VAS data should be analyzed as continuous using statistical methods suitable for ordinal data. Furthermore, our findings indicate a risk to over or under estimate the patient's perceived pain when interpreting condensed VAS data

Somatization and psychological distress among women with vulvar vestibulitis syndrome

ObjectiveTo investigate the distribution of psychological characteristics and pain reporting among women with vulvar vestibulitis syndrome (VVS).MethodsIn this exploratory study, 109 women with VVS completed a battery of questionnaires to assess pain with intercourse and psychological characteristics (e.g. somatization, anxiety, distress). The distribution of these characteristics was compared, first with a conventional binary classification schema (primary and secondary) and subsequently with a 3â category schema (primary, latent primary, secondary).ResultsSeverity of pain with intercourse did not differ among the subgroups using either classification schema. Women with primary VVS consistently showed higher levels of somatization, anxiety, and distress compared with those with secondary VVS. Using a 3â tiered classification system, we found no difference between latent primary diagnosis and the other 2 groups (primary and secondary).ConclusionThis study highlights the critical need for research on subtype definition and the role of psychological factors in VVS.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135448/1/ijgo38.pd

End-stage head and neck cancer: coping mechanism

Coping mechanisms are patients’ means of adapting to stressful situations and involve psychological and physical changes in behavior. Patients adapt to head and neck cancer in a variety of ways. Head and neck cancers are extremely debilitating, especially in advanced stages of the disease or in end-of-life situations. While an oncology team needs to address the needs of all oncology patients, the advanced terminal patients require special attention. Most of these patients do not cope well with their situation and have a tendency to cease social interactions. Pain is the most frequentlyexperienced medical disability in patients having an end-stage illness experience, and thus an important medical endeavor is to afford dignity to the dying patient facingan incurable disease. In such cases, the medical community should never refuse therapy or to assist a dying patient.In some instances, the patient and family may derive benefit from their religious beliefs

Potential protein biomarkers for burning mouth syndrome discovered by quantitative proteomics.

Burning mouth syndrome (BMS) is a chronic pain disorder characterized by severe burning sensation in normal looking oral mucosa. Diagnosis of BMS remains to be a challenge to oral healthcare professionals because the method for definite diagnosis is still uncertain. In this study, a quantitative saliva proteomic analysis was performed in order to identify target proteins in BMS patients' saliva that may be used as biomarkers for simple, non-invasive detection of the disease. By using isobaric tags for relative and absolute quantitation labeling and liquid chromatography-tandem mass spectrometry to quantify 1130 saliva proteins between BMS patients and healthy control subjects, we found that 50 proteins were significantly changed in the BMS patients when compared to the healthy control subjects ( p ≤ 0.05, 39 up-regulated and 11 down-regulated). Four candidates, alpha-enolase, interleukin-18 (IL-18), kallikrein-13 (KLK13), and cathepsin G, were selected for further validation. Based on enzyme-linked immunosorbent assay measurements, three potential biomarkers, alpha-enolase, IL-18, and KLK13, were successfully validated. The fold changes for alpha-enolase, IL-18, and KLK13 were determined as 3.6, 2.9, and 2.2 (burning mouth syndrome vs. control), and corresponding receiver operating characteristic values were determined as 0.78, 0.83, and 0.68, respectively. Our findings indicate that testing of the identified protein biomarkers in saliva might be a valuable clinical tool for BMS detection. Further validation studies of the identified biomarkers or additional candidate biomarkers are needed to achieve a multi-marker prediction model for improved detection of BMS with high sensitivity and specificity