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Psychogenic Factors in Benign Chronic Orofacial Pain
Published in Eli Ilana, Oral Psychophysiology, 2020
A detailed discussion of the various conditions of chronic orofacial pain is beyond the scope of this chapter. Instead, the chapter deals with some of the most common conditions of chronic benign orofacial pain of psychogenic origin and with the emotional and behavioral aspects of several pain states with a known pathophysiological mechanism. To do this, the classification strategy of Dworkin and Burgess4 is used.
Orofacial Pain
Published in Andrea Kohn Maikovich-Fong, Handbook of Psychosocial Interventions for Chronic Pain, 2019
John E. Schmidt, James M. Hawkins
“Orofacial pain” is defined as pain and dysfunction affecting motor and sensory transmission in the trigeminal nerve system and refers to pain associated with the hard and soft tissues of the head, face, and neck (de Leeuw & Klasser, 2013). Headache and tooth pain are the most common OFP conditions, while masticatory myalgia (chewing muscle pain), temporomandibular disorder (TMJ) pain, trigeminal neuropathy, and cervical myofascial pain referring to the head and face are other conditions frequently managed in an OFP clinic.
Persistent Idiopathic Facial Pain
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
A retrospective analysis of data collected on 493 consecutive patients who presented to a university orofacial pain clinic was rather enlightening and stressed the importance of careful clinical evaluation and diagnosis (2). In this study a diagnosis of atypical facial pain was made if patients had persistent orofacial pain for more than six months for which previous treatments had been unsuccessful and the diagnosis was unknown on referral to the clinic. Of the 493 patient charts reviewed, 35 (7%) met these criteria. Using the American Academy of Orofacial Pain diagnostic criteria (3), all but one (97%) actually did have diagnosable physical problems and sometimes multiple overlapping physical diagnoses causing the pain. Over half (19 of 35 or 54%) were found to have myofascial pain due to trigger points as the primary cause or significant contributing factor to the pain. Eleven (31%) had periodontal ligament sensitivity, eight had referred pain from dental pulpitis, three had neuropathic pain, and one each had burning mouth from oral candidiasis, burning tongue from an oral habit, pericoronitis, sinus pathology, or an incomplete tooth fracture. A review by Clark suggested that the differential diagnosis in these patients should also include a focal neuropathic pain disorder when no local source of infectious, inflammatory, or other pathology can be found (4).
The association between myofascial orofacial pain with and without referral and widespread pain
Published in Acta Odontologica Scandinavica, 2022
Anna Lövgren, Corine M. Visscher, Frank Lobbezoo, Negin Yekkalam, Simon Vallin, Anders Wänman, Birgitta Häggman-Henrikson
In accordance with the DC/TMD and following the International Classification of Orofacial Pain, ICOP [25], myofascial orofacial pain was considered present when the following criteria were fulfilled: self-reported pain within the last 30 days, pain modified by function, and pain confirmed to the masseter or temporal muscles by the examiner together with familiar pain confirmed during jaw movement or muscle palpation during the clinical examination. In a second step, pain referral was considered present in the case of concurrent referred pain outside the muscle border during a 5-second muscle palpation. Based upon these criteria, all individuals were categorized into three groups; no myofascial pain (controls), myofascial pain without referral or myofascial pain with referral, respectively.
Diagnostic accuracy of three screening questions (3Q/TMD) in relation to the DC/TMD in a specialized orofacial pain clinic
Published in Acta Odontologica Scandinavica, 2018
Anna Lövgren, Hasti Parvaneh, Frank Lobbezoo, Birgitta Häggman-Henrikson, Anders Wänman, Corine Mirjam Visscher
The present study population has shown an expected high proportion of TMD diagnoses (44% had a pain-related TMD and 33% showed an intra-articular TMD) as well as a high variety of other chronic pain conditions. The data for this study were extracted from routine patient files and based on this, we evaluated the diagnostic accuracy. The test-retest reliability of the screening tool in adults has not been established yet. Further research is needed to evaluate the reproducibility of the 3Q/TMD. Due to the selection of patients from a specialized clinic sample, where most patients will have symptoms, the number of 3Q-negative individuals was rather small. In order to increase the control group, patients from other specialized clinics from ACTA could have been included. This, however, would have interfered with the usual care as provided in the other specialized clinics, as a standardized DC/TMD examination is not part of their routine. Furthermore, the composition of patient groups within different specialist clinics can vary widely, depending on the focus in the clinic, which will affect the external validity of the results. Taken together, the results may be generalized to comparable specialist clinic settings, where mainly patients with orofacial pain and dysfunction are referred to.
The effect of supervised exercise on localized TMD pain and TMD pain associated with generalized pain
Published in Acta Odontologica Scandinavica, 2018
Birgitta Häggman-Henrikson, Birgitta Wiesinger, Anders Wänman
Patients with TMD pain report a higher prevalence of pain in the neck region [21,22] and vice versa [23]. In addition to this overlap between pain in the jaw–face and neck regions, a relationship has been demonstrated between orofacial pain and spinal pain [24]. This relationship was shown to be reciprocal in that pain in one region increases the risk of developing pain in the other region [25,26]. In addition to local and regional pain, a proportion of patients with TMD may also develop widespread generalized pain. This spread of pain has been suggested to be related to central sensitization. Some suggested factors associated with a higher risk to develop widespread pain are female gender, pain intensity and duration, catastrophizing and concomitant jaw and neck pain [27,28].