Patient Education and Self-Care for the Management of Jaw Pain upon Awakening: A Randomized Controlled Clinical Trial Comparing the Effectiveness of Adding Pharmacologic Treatment with Cyclobenzaprine or Tizanidine

Aims: To compare the effectiveness of adding cyclobenzaprine, tizanidine, or placebo to patient education and a self-care management program for patients with myofascial pain and specifically presenting with jaw pain upon awakening. Methods: Forty-five patients with a diagnosis of myofascial pain based on the guidelines of the American Academy of Orofacial Pain participated in this 3-week study. The subjects were randomly assigned into one of three groups: placebo group, TZA group (tizanidine 4 mg), or CYC group (cyclobenzaprine 10 mg). Patients were evaluated for changes in pain intensity, frequency, and duration by using the modified Severity Symptoms Index and changes in sleep quality with the use of the Pittsburgh Sleep Quality Index. Data were analyzed by ANOVA and post-hoc or nonparametric statistical tests as appropriate. Results: All three groups had a reduction in pain symptoms and improvement of sleep quality based on a comparison of pretreatment and treatment scores. However, no significant differences among the groups were observed at the posttreatment evaluation. Conclusion: The use of tizanidine or cyclobenzaprine in addition to self-care management and patient education was not more effective than placebo for the management of patients with myofascial jaw pain upon awakening.

Do people with recurrent back pain constrain spinal motion during seated horizontal and downward reaching?

Background: Although the effect of symptomatic back pain on functional movement has been investigated, changes to spinal movement patterns in essentially pain-free people with a history of recurrent back pain are largely unreported. Reaching activities, important for everyday and occupational function, often present problems to such people, but have not been considered in this population. The purpose of this study was to compare the amplitude and timing of spinal and hip motions during two, seated reaching activities in people with and without a history of recurrent low back pain (RLBP).Methods: Spinal and hip motions during reaching downward and across the body, in both directions, were tracked using electromagnetic sensors. Analyses were conducted to explore the amplitudes, velocities and timings of 3D segmental movements and to compare controls with subjects with recurrent, but asymptomatic lumbar or lumbosacral pain.Findings: We detected significant differences in the amplitude and timing of movement in the lower thoracic region, with the RLBP group restricting movement and demonstrating compensatory increased motion at the hip. The lumbar region displayed no significant between-group differences. The order in which the spinal segments achieved peak velocity in cross-reaching was reversed in RLBP compared to controls, with lumbar motion leading in controls and lagging in RLBP.Interpretation: Subjects with a history of RLBP show a number of altered kinematic features during reaching activities which are not related to the presence or intensity of pain, but which suggest adaptive changes to movement control. (C) 2013 Elsevier Ltd. All rights reserved.

IB4(+) and TRPV1(+) sensory neurons mediate pain but not proliferation in a mouse model of squamous cell carcinoma

Background: Cancer pain severely limits function and significantly reduces quality of life. Subtypes of sensory neurons involved in cancer pain and proliferation are not clear.Methods: We produced a cancer model by inoculating human oral squamous cell carcinoma (SCC) cells into the hind paw of athymic mice. We quantified mechanical and thermal nociception using the paw withdrawal assays. Neurotoxins isolectin B4-saporin (IB4-SAP), or capsaicin was injected intrathecally to selectively ablate IB4(+) neurons or TRPV1(+) neurons, respectively. JNJ-17203212, a TRPV1 antagonist, was also injected intrathecally. TRPV1 protein expression in the spinal cord was quantified with western blot. Paw volume was measured by a plethysmometer and was used as an index for tumor size. Ki-67 immunostaining in mouse paw sections was performed to evaluate cancer proliferation in situ.Results: We showed that mice with SCC exhibited both mechanical and thermal hypersensitivity. Selective ablation of IB4(+) neurons by IB4-SAP decreased mechanical allodynia in mice with SCC. Selective ablation of TRPV1(+) neurons by intrathecal capsaicin injection, or TRPV1 antagonism by JNJ-17203212 in the IB4-SAP treated mice completely reversed SCC-induced thermal hyperalgesia, without affecting mechanical allodynia. Furthermore, TRPV1 protein expression was increased in the spinal cord of SCC mice compared to normal mice. Neither removal of IB4(+) or TRPV1(+) neurons affected SCC proliferation.Conclusions: We show in a mouse model that IB4(+) neurons play an important role in cancer-induced mechanical allodynia, while TRPV1 mediates cancer-induced thermal hyperalgesia. Characterization of the sensory fiber subtypes responsible for cancer pain could lead to the development of targeted therapeutics.

Comparison of pain threshold and duration of pain perception in men and women of different ages

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Prevalence and severity of orofacial pain in pregnant women

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Envenomation by caterpillars (erucism): proposal for simple pain relief treatment

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Discriminant analysis of neuromuscular variables in chronic low back pain

Background: Investigation and discrimination of neuromuscular variables related to the complex aetiology of low back pain could contribute to clarifying the factors associated with symptoms. Objective: Analysing the discriminative power of neuromuscular variables in low back pain. Methods: This study compared muscle endurance, proprioception and isometric trunk assessments between women with low back pain (LBP, n=14) and a control group (CG, n=14). Multivariate analysis of variance and discriminant analysis of the data were performed. Results: The muscle endurance time (s) was shorter in the LBP group than in the CG (p=0.004) with values of 85.81 (37.79) and 134.25 (43.88), respectively. The peak torque (Nm/kg) for trunk extension was 2.48 (0.69) in the LBP group and 3.56 (0.88) in the GG (p=0.001); for trunk flexion, the mean torque was 1.49 (0.40) in the LBP group and 1.85 (0.39) in the CG (p=0.023). The repositioning error (degrees) before the endurance test was 2.66 (1.36) in the LBP group and 2.41 (1.46) in the CG (p=0.664), and after the endurance test, it was 2.95 (1.94) in the LBP group and 2.00 (1.16) in the CG (p=0.06). Furthermore, the variables showed discrimination between the groups (p=0.007), with 78.6% of the individuals with low back pain correctly classified in the LBP group. In turn, variables related to muscle activation showed no difference in discrimination between the groups (p=0.369). Conclusion: Based on these findings, the clinical management of low back pain should consist of both resistance and strength training, particularly in the extensor muscles.

Self-reported moderate-to-vigorous leisure time physical activity predicts less pain and disability over 12 months in chronic and persistent low back pain

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Validation of the UNESP-Botucatu unidimensional composite pain scale for assessing postoperative pain in cattle

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Alternative approach to the management of postoperative pain after pediatric surgical procedures

This paper reports two clinical cases in which the application of low-level laser therapy (LLLT) enhanced the postoperative symptoms after pediatric surgical procedures. Background: The uses of novel technologies allow more comfort to the patients and ensure a rapid procedure, and LLLT application has shown a positive effect in the prevention of discomfort after invasive procedures. Case description: Low-level laser therapy protocol was applied after surgical removal of supernumerary tooth and frenectomy resulting in less swallow and pain with no need of medication intake. Conclusion: The laser application was well accepted by both children and parents and showed a clinical efficiency in the follow-up examinations beyond the satisfactory quality of wound healing. Clinical significance: The LLLT approach is an excellent adjuvant therapy resource for delivery an optimal postoperative after surgical procedures in children.

Relationship between levels of neuropeptide Substance P in periodontal disease and chronic pain: a literature review

The aim of the current review was to investigate the relationship between levels of neuropeptide Substance P in periodontal disease and chronic pain. Substance P is a neuropeptide that is directly related with pain. In periodontal disease, it is expressed during the inflammatory process, and is one of the factors responsible for bone resorption. Studies have shown that Substance P levels are highest in the gingival crevicular fluid from sites with active periodontal disease and bone loss. The persistence of these substances could be sufficient to stimulate neurogenic inflammation in susceptible tissues, and cause pain. The scientific literature shows that Substance P expressed during periodontal disease can be a risk factor for patients with systemic inflammatory pathologies, such as chronic arthritis or rheumatoid arthritis. Additional research is needed to confirm the participation of this substance in the origin of some types of chronic pain.

Factors associated with temporomandibular disorders pain in adolescents

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Long-term follow-up in sacroiliac joint pain patients treated with radiofrequency ablative therapy

Sacroiliac joint (SIJ) pain is responsible for up to 40% of all cases of lumbar back pain. Objective Report the long-term efficacy of radiofrequency denervation for sacroiliac joint pain at six, twelve and eighteen months. Method Third-two adults’ patients with sacroiliac join pain diagnosis were included for a prospective study. Primary outcome measure was pain intensity on the Numeric Rating Scale (NRS). Secondary outcome measure was Patient Global Impression of Change Scale (PGIC). Results Short-term pain relief was observed, with the mean NRS pain score decreasing from 7.7 ± 1.8 at baseline to 2.8 ± 1.2 at one month and to 3.1 ± 1.9 at six months post-procedure (p < 0.001). Long-term pain relief was sustained at twelve and eighteen months post-procedure, with NRS pain remaining at 3.4 ± 2.1 and 4.0 ± 2.7, respectively. Conclusion Radiofrequency denervation of the SIJ can significantly reduce pain in selected patients with sacroiliac syndrome.

Prevalence of low back pain and associated factors in adults from a middle-size Brazilian city

Objective: To determine the prevalence of low back pain and some related variables among adults of both genders. Methods: Was conduct a cross-sectional study of population-based in the urban area of Presidente Prudente, São Paulo. The sample consisted of 743 adult residents for over two years in this city. Low back pain, quality of sleep and physical activity were collected through face to face interview at the residence of respondents. Was used the chi-square test to analyze the association between variables, later was created tree multivariate models with hierarchical inclusion of confounding factors. Results: The prevalence of low back pain reported last year was 50.2% (95% CI: 46.6, 53.8), and the last week 32.3% (95% CI: 28.9, 35.6). Was association among low back pain and females (p-value = 0.031), older age, lower education, altered sleep and overweight, the adjusted model found that people over the age of 45 years (45 to 59.9 years, OR = 13.1 [1.72-98.5] and ≥ 60 years, OR = 9.10 [1.15-71.7]), with some alteration of sleep (OR = 3.21 [1.84-5.61]) and obese (OR = 2.33 [1:26 to 4:33]) seems to be a risk group for low back pain. Conclusion: The prevalence of low back pain is high and obese people aged over 45 years, with any sleep disturbance are a group at higher risk for low back pain.

Relationship between therapeutic alliance and deep abdominal muscle recruitment in nonspecific low back pain sufferers

Chronic low back pain is a difficult condition to be treated. As some patients respond positively to treatment and others do not present any improvements, one can think there are others conditional factors that need to be elucidated. By means of this study, we sought to investigate the association between the occurrence of the formation of a positive relationship between patient and therapist, assessed by the therapeutic alliance inventory, and the adequate recruitment of the deep abdominal muscles, as well as to verify the effect of a protocol intervention based on motor control exercises on levels of pain and disability. The recruitment of the transverse abdominal and internal oblique muscles was examined by ultrasound imaging in 12 subjects with nonspecific chronic low back pain before and after implementation of a protocol for motor control exercises, with subsequent application of the therapeutic alliance inventory questionnaire. No association was found between the level of therapist/patient alliance and muscle recruitment. The proposed protocol was effective in reducing the levels of pain and disability; however, recruitment of transverse abdominal and internal oblique muscles showed no significant changes in the end of the intervention. Based on these findings, we verified that the therapeutic alliance has no association with muscle recruitment in the short term. However, although there were no changes in muscle recruitment after the intervention program, the level of pain and disability was reduced.