Journal of Oral & Facial Pain and Headache, 02/2016

Aims: To assess thermal pain perception in patients with burning mouth syndrome (BMS) and lingual nerve injury (LNI) by using a quantitative sensory testing (QST) protocol. Methods: QST was used to assess cool, warm, cold pain, and heat pain thresholds in healthy control subjects (n = 17) and in patients with BMS (n = 22) and LNI (n = 47). Capsaicin (10 μg/mL) and ethyl chloride-evoked hypersensitivities at the anterior two-thirds of the tongue were measured using a visual analog scale. Data were analyzed using Microsoft Excel with descriptive statistics, scatter graphs, and two-tailed Student t tests with 95% confidence interval and 5% level of significance. Results: Patients with BMS significantly reported the most pain at rest (P .001) and capsaicin hypersensitivity (P .01). Despite this increased sensitivity to capsaicin and significantly lower warm threshold than the control subjects (P .05), these patients did not show heat pain hyperalgesia. There was increased sensitivity to ethyl chloride and cold pain hyperalgesia in patients with BMS (P .05) compared with reduced or no sensation of cold or heat pain in patients with LNI. Conclusions: This study has demonstrated that the assessment of capsaicin and ethyl chloride- evoked sensitivities as well as the use of QST to assess thermosensitivity are useful approaches for detecting hyperalgesia or hypoalgesia to heat and cold in patients with BMS and LNI. Schlagwörter: burning mouth syndrome, hyperalgesia, hypoalgesia, lingual nerve injury, quantitative sensory testing

Aims: To test if patients with masticatory myofascial pain, local myalgia, centrally mediated myalgia, disc displacement, capsulitis/synovitis, or continuous neuropathic pain differed in self-reported satisfaction with life. The study also tested if satisfaction with life was similarly predicted by measures of physical, emotional, and social functioning across disorders. Methods: Satisfaction with life, fatigue, affective distress, social support, and pain data were extracted from the medical records of 343 patients seeking treatment for chronic orofacial pain. Patients were grouped by primary diagnosis assigned following their initial appointment. Satisfaction with life was compared between disorders, with and without pain intensity entered as a covariate. Disorder-specific linear regression models using physical, emotional, and social predictors of satisfaction with life were computed. Results: Patients with centrally mediated myalgia reported significantly lower satisfaction with life than did patients with any of the other five disorders. Inclusion of pain intensity as a covariate weakened but did not eliminate the effect. Satisfaction with life was predicted by measures of physical, emotional, and social functioning, but these associations were not consistent across disorders. Conclusions: Results suggest that reduced satisfaction with life in patients with centrally mediated myalgia is not due only to pain intensity. There may be other factors that predispose people to both reduced satisfaction with life and centrally mediated myalgia. Furthermore, the results suggest that satisfaction with life is differentially influenced by physical, emotional, and social functioning in different orofacial pain disorders. Schlagwörter: affective distress, fatigue, orofacial pain, pain intensity, satisfaction with life

Aims: To determine if retrospective self-report of oral parafunctional behaviors potentially relevant to pain conditions is valid, by comparing oral parafunctional behaviors via a self-report instrument (Oral Behaviors Checklist [OBC]) with in-field reports of oral parafunction. Methods: Individuals with a range of oral parafunctional behaviors, as identified by the OBC, were recruited, and 22 completed the field study. Using the Ecological Momentary Assessment paradigm, each subject was randomly prompted about eight times per day, for a target of 7 days, via portable handheld computer to report current behaviors among 11 queried items. Before and after the field study, a paper version of the OBC was administered. Separately, 74 individuals participated in a test-retest study of the paper OBC. Analyses included regression, correlation, intraclass correlation coefficient (ICC) and area under the receiving operating curve (AUC). Results: Pre- and postfield study administration of the OBC exhibited substantial reliability (ICC = 0.65), indicating no reactivity during the intervening in-field data collection. Reliability across in-field days was low, indicating high variability in which behavior occurred on which day. Nonobservable behaviors were reported more frequently than observable behaviors. Self-report via OBC was linear with in-field data collection methods (R2 values ranged from 0.1 to 0.7; most values were within 0.3 to 0.4). The predictive value of the self-report total score was AUC (0.88) relative to the in-field study score. Separate test-retest reliability of the OBC was almost perfect (ICC = 0.88). Conclusions: The OBC is a reliable and valid way to predict behaviors in the natural environment and will be useful for further pain research. Schlagwörter: behavior, pain, parafunction, self-report, TMD

Aims: To evaluate the possible association between the nociceptive blink reflex (nBR) and various pain-related psychological measures: the Anxiety Sensitivity Index-3 (ASI-3), the Fear of Pain Questionnaire III (FPQ-III), the Pain Vigilance and Awareness Questionnaire (PVAQ), the Somatosensory Amplification Scale (SSAS), the Pain Catastrophizing Scale (PCS), and the Situational Pain Catastrophizing Scale (S-PCS). Methods: The nBR was evaluated in 21 healthy participants. It was elicited by a nociceptive-specific electrode placed over the entry zone of the right supraorbital nerve, infraorbital nerve, and mental nerve, as well as the left infraorbital nerve. The outcomes were (1) nBR measurements: (a) individual electrical sensory threshold (I0) and pain threshold (IP); (b) root mean square (RMS), area under the curve (AUC), and onset latencies of R2 responses; (c) stimulus-evoked pain on a 0 to 10 numeric rating scale (NRS); and (2) the ASI-3, the FPQ-III, the PVAQ, the SSAS, the PCS, and the S-PCS. Pearson correlation coefficient was used to evaluate the association between the means of nBR measurements from all sites and the questionnaires The significance level was set up after a Bonferroni correction (adjusted α = .8%). Results: There was no correlation for any pair of variables at the adjusted significance level (P > .008). There was only a single significant correlation at the standard significance level (P .05), where the pain intensity (NRS) at 50% of IP presented a positive and small to moderate correlation with the PCS (r = 0.43, P = .04). Conclusion: It appears that the nBR and its associated psychophysical measures are not associated with psychological factors in healthy participants. Schlagwörter: nociceptive blink reflex, pain catastrophizing, pain-related anxiety, pain vigilance, somatosensory amplification

Aims: To explore adolescents' explanations of their temporomandibular disorder (TMD) pain, their pain management strategies for TMD pain, and their treatmentseeking behavior. Methods: One-on-one interviews were conducted with 21 adolescents aged 15 to 19 years who had TMD pain and followed a semistructured interview guide. Subjects were strategically selected from patients referred to an orofacial pain clinic. All participants had been examined and received a pain diagnosis based on the Research Diagnostic Criteria for TMD. The interviews focused on the adolescents' experiences of TMD pain, their strategies for handling pain, and how they seek care. The interviews were recorded, transcribed verbatim, and analyzed using qualitative manifest content analysis. Results: Qualitative manifest content analysis revealed two categories: (1) selfconstructed explanations, with three subcategories (situation-based explanatory model, physical/biologic model, and psychological explanatory model); and (2) pain management strategies, with four subcategories (social support, treatment, relaxation/rest, and psychological strategies). Adolescents used physical activities and psychological and pharmacologic treatment to manage pain. Reasons for seeking treatment were to be cured, to obtain an explanation for their pain, and because their symptoms bother others. Conclusion: Adolescents living with TMD pain develop self-constructed explanations and pain management strategies. With access to these descriptions, dentists can be better prepared to have a dialogue with their adolescent patients about their own explanations of pain, the nature of pain, and in which situations the pain appears. Dentists can also explore adolescent patients' pain management strategies and perhaps also suggest new treatment strategies at an earlier stage. Schlagwörter: adolescents, content analysis, interview, TMD pain, treatment

Aims: To investigate the possible relationship between the orthodontic treatment of Class II malocclusion and the development of temporomandibular disorders (TMD). Methods: A total of 40 patients was evaluated at four time points: the day before the start of treatment employing bilateral Class II elastics (baseline), as well as at 24 hours, 1 week, and 1 month after the start of treatment. The development of TMD pain complaints in the orofacial region and changes in the range of mouth opening were assessed at these times. Shapiro-Wilk, McNemar, and Friedman tests with 5% significance level were used to analyze the data. Results: The treatment produced pain of a transitory, moderate intensity, but there was no significant change from baseline after 1 month. There were no restrictions in the range of jaw motion or any evidence of limitations in mouth opening. Conclusion: Orthodontic treatment with bilateral Class II elastics does not cause significant orofacial pain or undesirable changes in the range of mouth opening. Furthermore, this modality of orthodontic treatment was not responsible for inducing TMD. Schlagwörter: Class II malocclusion, intermaxillary elastics, orofacial pain, orthodontic treatment, temporomandibular disorders

Aims: To validate the Chinese version of the Identification of Migraine screener (ID-Migraine), assess migraine prevalence, identify potential associated factors, and assess the impact of migraine on quality of life in a community in Harbin, PR China. Methods: A community-based, cross-sectional study was conducted in the Songbei district of Harbin. After excluding the people who did not usually reside in the community, 2,588 adults were invited to participate in the study. Eligible participants underwent a physical examination before completing a questionnaire addressing demographics, medical history, and other features. Additionally, the ID-Migraine was validated by using International Classification of Headache Disorders-3 criteria, with 94 participants screening positive and 100 participants screening negative for migraine as diagnosed through a telephone interview. The diagnostic accuracy of ID-Migraine was evaluated by sensitivity and specificity, and a multivariate logistic regression model was used to determine the association between migraine and associated factors. Results: A total of 1,143 subjects completed the questionnaire (response rate 44.2%). The prevalence of migraine was 8.9%, with a male to female prevalence ratio of 1:3.30 (3.7% versus 12.2%; P .001). The sensitivity (90.6%; 95% confidence interval [CI] = 75.0% to 97.9%) and specificity (71.4%; 95% CI = 60.0% to 81.2%) of the ID-Migraine were satisfactory. Multivariate logistic regression analyses suggested female sex, depression, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), ischemic stroke (IS), and hypertension were positively associated with migraine, whereas age and education level were negatively associated with migraine. Migraine was shown to significantly impact quality of life. Conclusion: Migraine is a highly prevalent disease that can significantly affect quality of life. Age, sex, education level, depression, CHD, COPD, IS, and hypertension were all associated with migraine. Schlagwörter: associated factors, ID-Migraine, migraine, prevalence, quality of life

Aims: To investigate the association between circulating Chlamydia pneumoniae (C pneumoniae) immunoglobulin G (IgG) antibody and migraine in Indian patients. Methods: A total of 300 migraine patients and 150 age-matched and sex-matched controls were recruited from the Department of Neurology at Yashoda Hospital in Hyderabad, India, during the study period between August 2011 and July 2013. All patients and controls were assessed for the presence of the C pneumoniae IgG antibody and also C-reactive protein (CRP) as well as for depression, which was assessed by the Hamilton Depression Rating Scale (HDRS). Results: Of the patients with migraine, 69% were female and the mean age ± standard deviation (SD) was 45.8 ± 4.8 years (range 18 to 62 years). The C pneumoniae IgG antibody was present in 151 of the patients (50.3%; P .0001), CRP in 180 (60%; P .0001), depression in 270 (90%; P .0001), and history of sleep disturbances in 70 (23.3%; P .0001); all measurements were significantly higher in migraine patients compared with controls. After adjustment for multiple logistic regression analyses, C pneumoniae IgG antibody positivity (odds ratio [OR] 2.6; 95% confidence interval [CI] = 1.3 to 3.7), CRP positivity (OR 6.2; 95% CI = 3.3 to 11.6), mild depression (OR 16.9; 95% CI = 6.5 to 39.4), and history of sleep disturbance (OR 2.1; 95% CI = 1.1 to 3.1) were independently associated with migraine. Conclusion: This study showed that the presence of C pneumoniae IgG antibody was independently associated with migraine in Indian patients. Schlagwörter: C pneumoniae positive, C-reactive protein, history of sleep disturbance, Indian population, migraine

Aims: To assess dental students' achieved competencies and perceived satisfaction with their temporomandibular disorders (TMD) and orofacial pain education and to compare these with the results of their final examination in TMD and orofacial pain. Methods: Dental students from two consecutive classes (2011/2012 and 2012/2013) at the Department of Orofacial Pain and Jaw Function at the dental school in Malmö, Sweden completed two self-evaluations, one at the beginning of semester seven and one at the end of semester eight. The questionnaire that they were given concerned achieved competencies and satisfaction with education in TMD and orofacial pain. Items focused on anatomy, physiology, and clinical training. Students estimated their competence and satisfaction on a numeric rating scale and described their idea of treating TMD and orofacial pain patients on a verbal rating scale. Outcome variables were tested with paired samples t test for differences over time and independent samples t test for between-class comparisons; both were adjusted for multiple testing with Bonferroni correction. Results: Significant improvement in all items was observed for achieved competencies and satisfaction in both classes between semester seven and semester eight (P .05). No differences in competencies or satisfaction occurred between classes at the end of the clinical course in semester eight (P > .05). Conclusion: This study has shown that expansion in undergraduate TMD and orofacial pain education at the dental school in Malmö has allowed all students to develop the same level of competence, independent of prior experience. The study also pointed out that continuous evaluation and enhancement of TMD and orofacial pain education in undergraduate dental education is beneficial. Schlagwörter: education, problem-based learning, professional competence, temporomandibular joint disorders

Aims: To compare the feasibility and accuracy of three injection techniques for entering the superior joint space of the swine temporomandibular joint (TMJ). Methods: Nine swine were used for this study, in which 500 μL of colored dye was injected into both TMJs of each swine. Three injection techniques were used: the posterior injection (PI), the anterosuperior injection (ASI), and the lateral injection (LI) techniques. Each injection technique was performed on six TMJs. Swine were sacrificed immediately after injection and the swine head was dissected in order to observe the dye distribution. Injection was considered successful if no dye could be observed outside the superior joint space. Results: The PI technique was successful in all six TMJs (success rate: 100%), the LI technique in three out of six TMJs (success rate: 50%), and the ASI technique in two out of six TMJs (success rate: 33%); the differences were statistically significant (chi-square test, P .05). Conclusion: The PI technique was more accurate than the LI or ASI techniques in accessing the swine superior TMJ space. Schlagwörter: animal model, injection techniques, joint space, swine, temporomandibular joint