Chronic Facial Pain Research Articles

Personality, coping and atypical facial pain. Case reports

BACKGROUND AND OBJECTIVES: Idiopathic facial pain is a chronic condition with unknown etiology and pathophysiology. Its diagnostic criteria depend on the exclusion of any somatic cause of orofacial pain. Several studies have investigated anxiety and depression, but there is a lack of publications about personality. The objective of this study was to describe three cases of patients with idiopathic facial pain that had their temperament and character evaluated in order to verify the relation between the findings with pain behavior and pain characteristics. The instruments used were a free interview and the Temperament and Character Inventory. CASE REPORTS: Case 1 was proactive and had high scores of cooperativity and self-transcendence correspondent to the well-coping behavior. On the other side, cases 2 and 3 showed similarities about their harm avoidance, novelty seeking and poor coping, correspondent to a self-protective insecure personality. CONCLUSION: These cases show the importance of personality assessment in order to determine coping strategies in complex chronic facial pain such as idiopathic facial pain.

Personality, coping and atypical facial pain. Case reports

ABSTRACT BACKGROUND AND OBJECTIVES: Idiopathic facial pain is a chronic condition with unknown etiology and pathophysiology. Its diagnostic criteria depend on the exclusion of any somatic cause of orofacial pain. Several studies have investigated anxiety and depression, but there is a lack of publications about personality. The objective of this study was to describe three cases of patients with idiopathic facial pain that had their temperament and character evaluated in order to verify the relation between the findings with pain behavior and pain characteristics. The instruments used were a free interview and the Temperament and Character Inventory. CASE REPORTS: Case 1 was proactive and had high scores of cooperativity and self-transcendence correspondent to the well-coping behavior. On the other side, cases 2 and 3 showed similarities about their harm avoidance, novelty seeking and poor coping, correspondent to a self-protective insecure personality. CONCLUSION: These cases show the importance of personality assessment in order to determine coping strategies in complex chronic facial pain such as idiopathic facial pain.

Affective Circuitry Alterations in Patients with Trigeminal Neuralgia.

Trigeminal neuralgia (TN) is a severe chronic neuropathic facial pain disorder. Affect-related behavioral and structural brain changes have been noted across chronic pain disorders, but have not been well-studied in TN. We examined the potential impact of TN (37 patients: 23 with right-sided TN, 14 with left-sided TN), compared to age- and sex-matched healthy controls, on three major white matter tracts responsible for carrying affect-related signals—i.e., cingulum, fornix, and medial forebrain bundle. Diffusion magnetic resonance imaging (dMRI), deterministic multi-tensor tractography for tract modeling, and a model-driven region-of-interest approach was used. We also used volumetric gray matter analysis on key targets of these pathways (i.e., hippocampus, cingulate cortex subregions, nucleus accumbens, and ventral diencephalon). Hypotheses included: (1) successful modeling of tracts; (2) altered white matter microstructure of the cingulum and medial forebrain bundle (via changes in dMRI metrics such as fractional anisotropy, and mean, axial, and radial diffusivities) compared to controls; (3) no alterations in the control region of the fornix; (4) corresponding decreases in gray matter volumes. Results showed (1) all 325 tracts were successfully modeled, although 11 were partially complete; (2) The cingulum and medial forebrain bundle (MFB) were altered in those with TN, with dMRI metric changes in the middle (p = 0.001) and posterior cingulum (p < 0.0001), and the MFB near the ventral tegmental area (MFB-VTA) (p = 0.001). The posterior cingulum and MFB-VTA also showed unilateral differences between right- and left-sided TN patients; (3) No differences were noted at any fornix subdivision; (4) decreased volumes were noted for the hippocampus, posterior cingulate, nucleus accumbens, and ventral diencephalon. Together, these results support the notion of selectively altered affective circuits in patients with TN, which may be related to the experience of negative affect and the increased comorbidity of mood and anxiety disorders in this population.

O12 RTMS therapy on M1 modifies the facial motor map in chronic neuropathic pain

Objectives Despite the poorly known mechanism of action, high-frequency rTMS targeted somatotopically to M1, is beneficial to treat therapy-resistant chronic neuropathic pain in about half of the patients. According to previous literature hand motor representation area is diminished in chronic pain. We hypothesized that face motor map is altered in chronic pain and will be restored after rTMS treatment. Another aim was to find the different patterns of plastic cortical reshaping. Methods 13 patients with severe unilateral, chronic atypical facial pain were examined before therapy (2 five-day rTMS treatment courses (2400 or 3600 pulses daily), separated by 6 weeks), and 4–5 days after the last treatment session. Motor mapping was performed at 105% rMT of the mentalis muscle using a grid (2 stimuli per square) to determine the extent of representation area on the hemisphere contralateral to painful side. Mapping was analyzed for hotspot, center-of-gravity (CoG) and representation area, calculated using spline-interpolation method. Patient scored the effect of treatment using patient global impression of change (PGIC). Results The hotspots and CoGs were located in anatomically expected areas. In group level, the rTMS did not cause any shift in mediolateral or anteroposterior axis, or affect the extent of representation areas. However, there were several patients in whom the area significantly largened or became more compact/dense after the treatment. Noteworthly, the motor map of facial muscles was surprisingly small in four patients, whereof three scored high benefit. Discussion The face motor maps in patients with chronic facial pain are variable in size. There was a trend of rTMS increasing the motor map. In some patients the face motor map was clearly diminished and mainly, these patients responded to treatment well. This may be related to enhanced cortical plasticity. Conclusion nTMS motor mapping is a feasible method to study neuronal plasticity in chronic pain and enlighten the effects of rTMS. However, larger amount of patient is needed to draw conclusions about patterns of cortical plasticity. Significance Motor map area may be a biomarker for treatment response in chronic facial pain.

Serious gaming during multidisciplinary rehabilitation for patients with complex chronic pain or fatigue complaints: study protocol for a controlled trial and process evaluation

IntroductionMany individuals suffer from chronic pain or functional somatic syndromes and face boundaries for diminishing functional limitations by means of biopsychosocial interventions. Serious gaming could complement multidisciplinary interventions through enjoyment...

Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain.

Chronic or neuropathic trigeminal facial pain can be challenging to treat. Neurosurgical procedures should be applied when conservative treatment fails. Neuromodulation techniques for chronic facial pain include deep brain stimulation and motor cortex stimulation, which are complex to perform. Subcutaneous nerve field stimulation is certified for chronic back pain and is the least invasive form of neuromodulation. We applied this technique to treat chronic and neuropathic trigeminal pain as an individual therapy concept. First, trial stimulation is performed. Subcutaneous leads are placed in the painful trigeminal dermatome under local anesthesia. The leads are connected to an external neurostimulator that applies constant stimulation. Patients undergo a 12 day outpatient trial to assess the effect of the stimulation. Electrodes are removed after the trial. If the patient reports pain reduction of at least 50% in intensity and/or attack frequency, a reduction in medication or increase in quality of life, permanent implantation is scheduled. New electrodes are implanted under general anesthesia and are subcutaneously tunneled to an infraclavicular internal pulse generator. Patients are able to turn stimulation on and off and to increase or decrease the stimulation amplitude as needed. This technique represents a minimal invasive alternative to other more invasive means of neuromodulation for trigeminal pain such as motor cortex stimulation or deep brain stimulation.

Persistent idiopathic facial pain.

Background Persistent idiopathic facial pain (PIFP) is a chronic disorder recurring daily for more than two hours per day over more than three months, in the absence of clinical neurological deficit. PIFP is the current terminology for Atypical Facial Pain and is characterized by daily or near daily pain that is initially confined but may subsequently spread. Pain cannot be attributed to any pathological process, although traumatic neuropathic mechanisms are suspected. When present intraorally, PIFP has been termed 'Atypical Odontalgia', and this entity is discussed in a separate article in this special issue. PIFP is often a difficult but important differential diagnosis among chronic facial pain syndromes. Aim To summarize current knowledge on diagnostic criteria, differential diagnosis, pathophysiology and management of PIFP. Methods We present a narrative review reporting current literature and personal experience. Additionally, we discuss and differentiate the common differential diagnoses associated with PIFP including traumatic trigeminal neuropathies, regional myofascial pain, atypical neurovascular pains and atypical trigeminal neuropathic pains. Results and conclusion The underlying pathophysiology in PIFP is still enigmatic, however neuropathic mechanisms may be relevant. PIFP needs interdisciplinary collaboration to rule out and manage secondary causes, psychiatric comorbidities and other facial pain syndromes, particularly trigeminal neuralgia. Burden of disease and psychiatric comorbidity screening is recommended at an early stage of disease, and should be addressed in the management plan. Future research is needed to establish clear diagnostic criteria and treatment strategies based on clinical findings and individual pathophysiology.

Classification: The key to understanding facial pain.

It is indisputable that the global scientific advances in headache research, be it bench or bedside, have benefited enormously from the operational diagnostic criteria published in 1988. Today, this classification system is indispensable. The reason for this success is a low inter-rater variability. In general, orofacial pain conditions are less well characterised - with the noticeable exemption of temporomandibular disorder pain. Tremendous work has been put into changing this, and significant progress has been achieved - in particular, in terms of the clinical implications and overriding conceptual models for oro-facial pain. Scientific classifications have only one goal: To provide a scientific agreement about the main features of an object of research and a scientific consensus regarding the name. The main significance is not the fact that a good classification offers a detailed and accurate image of the reality. If we want to overcome the obstacles of different competing classification systems, we need to overcome specialisation borders. The key to success is to understand that such a definition does not mirror all possible clinical facets of a given pain condition but is simply a convention - that is, a consensus on a word used for a pain condition. Simply speaking, a classification creates a common language to be used by more than one profession. It will be crucial to define any given pain condition as precisely and rigid as possible, in order to ensure a homogenous population. Only this ensures a low inter-rater variability, which consequently allows combining and comparing research on a population across different professional settings. This is not easy for chronic facial pain without verifiable morphological cause or structural lesions, as these syndromes are often rather featureless. The new IASP classification of chronic pain is a big step forward to a better characterisation of such conditions, and will trigger future work on a new and operationalised classification of oro-facial pain.

P013 rTMS therapy on M1 modifies the motor map in chronic neuropathic facial pain – A pilot study

Repetitive TMS (rTMS) targeted to primary motor cortex (M1) has been proven effective in treating pharmacoresistant chronic neuropathic pain. However, the mechanisms of action of rTMS are so far unknown. Better efficacy has been shown when rTMS is targeted to adjacent cortical area (Lefaucheur et al., 2006), though somatotopic targeting is also commonly used. Previously, smaller hand motor representation area of the painful side has been shown in chronic pain (Krause et al., 2006). We hypothesized that the motor map plasticity would be changed after two 5-days rTMS treatment sessions separated by 6 weeks. Therapy was targeted to the somatotopic facial M1 using neuronavigated TMS. Three patients with severe unilateral, chronic atypical facial pain were enrolled in the study. High-frequency rTMS (10 Hz or 20 Hz, 2400 or 3600 pulses per session, 90% of the resting motor threshold, rMT) was targeted to functional motor representation area of the mentalis muscle. Hotspots and rMTs were determined for face and hand on both hemispheres. Silent period duration was measured on the hand muscle. Mapping was performed at 105% of the rMT of the mentalis muscle to determine the center-of-gravity (CoG) on the hemisphere contralateral to painful side. A grid with 5 mm spacing was used and two stimuli were applied per square. rTMS sessions did not significantly change the hand or face rMTs on either hemisphere. In all three patients, the representation area of the mentalis muscle has expanded in anterior-posterior direction. Correspondingly, the CoG of the mentalis muscle moved posteriorly (Fig. 1). Silent period duration was increased in the third patient showing the largest shift of the CoG. Patients 2 and 3 benefitted from the treatmentDownload : Download high-res image (302KB)Download : Download full-size image. These preliminary results suggest that rTMS induces changes in the motor map plasticity measurable 4–11 days after last rTMS session. Plastic changes may be related to normalized corticospinal inhibition.

P064 rTMS in the treatment of orofacial pain

Introduction In our previous experiments 10 Hz and 20 Hz rTMS stimulations were used for the treatment of different types of orofacial pain. All patienst had drug resistant orofacial unilateral neurogenic pain with duration greater than one year. It was found out that 20 Hz rTMS stimulation is more effective than 10 Hz stimulation. In this experiment we tested the theta burst stimulation as another possible tool for pain treatment. Patients 23 patients with 20 Hz, 36 patients with 10 Hz stimulation and 19 patients with theta burst with chronic orofacial pain participated in the study with pharmacotherapy resistant chronic facial pain (trigeminal neuralgia, atypical orofacial pain, post-herpetic neuralgia, dental pain), aged 33–65 years (mean age = 50.7 yrs), with pain duration of at least 6 months. Methods We stimulated motorcortex area corresponding to the hand on painfull side. They underwent quantitative sensory testing before and after the stimulation. The intensity of pain was evaluated in all patients before, during and after rTMS or shame stimulation by means of a visual analogue scale (VAS). Thermal and tactile sensory thresholds and allodynia as a consequence of orofacial pain were measured. The intensity of pain was evaluated in all patients before, during and after rTMS or shame stimulation by means of a visual analogue scale (VAS 0–10). Thermal sensory thresholds and allodynia as a consequences of a neuropathic pain syndrome were measured. Tactile sensory thresholds were measured by using monofilaments (von-Frey) increasing thickness on the affected and nonaffected side. Results By using VAS measurement the theta burst stimulation was more effective than the shame stimulation. The effect of theta burst stimulations was still observed 14 days after the stimulation. Conclusion During the measurement of thermic sensitivity, theta burst stimulation was not significantly improved. The measurement of tactile stimulation was significantly effective after real burst stimulation if compared with shame stimulation. Repetitive transcranial stimulation (rTMS) is non-invasive neuromodulatory technigue that allows safe and painless stimulation of the brain cortex. High frequency rTMS theta burst stimulation was more effective in the chronic orofacial pain and could represent another possibility for the treatment of different types of orofacial pain.

P53 and VEGF expression in human temporomandibular joint discs with internal derangement correlate with degeneration

Aim: Temporomandibular joint (TMJ) disorders are one of the most relevant causes of chronic facial pain and disability. During histopathological conditions biomolecular mechanisms occur inducing histologic changes of the tissue itself. Human Tumor Protein p53 and Vascular Endothelial Growth Factor are related with cell-cycle control, angiogenesis and both play a central role during inflammation. The purpose of the present research was to investigate the immunoexpression and immunolocalization of Human Tumor Protein p53 and Vascular Endothelial Growth Factor in temporomandibular joint discs of individuals with internal derangement with anterior disc displacement in order to gain insights into the apoptotic and angiogenetic processes in the three bands of articular discs with or without reduction and compare them to the histological degeneration score. Methods: Paraffin samples of eighteen displaced temporomandibular joint and four control discs were analyzed by immunohistochemistry for the above evaluations. Results: Data showed a strong Human Tumor Protein p53 and Vascular Endothelial Growth Factor immunoexpression in the anterior and intermediate disc areas and a weak immunoexpression in posterior area of anterior disc displacement with reduction patients while anterior disc displacement without reduction patients demonstrated a weak Human Tumor Protein p53 and Vascular Endothelial Growth Factor immunolabelling in the anterior and intermediate areas and a strong immunoexpression in posterior band. These immunoexpressions correlated with histological degeneration score. Conclusions: According to our results it can be assumed in that when the more histopathological changes in the disc are releaved, major levels of p53 and VEGF are produced.

High risk of temporomandibular disorder in irritable bowel syndrome: Is there a correlation with greater illness severity?

To investigate the prevalence and the risk of temporomandibular disorders (TMDs) in patients with irritable bowel syndrome (IBS) (including each subtype: constipation, diarrhoea, and mixed) compared to the general population. Between January 2014 and December 2015 we enrolled consecutively adult patients diagnosed with IBS at the outpatient clinic of the University of Salerno and healthy controls (HC) without IBS. At enrollment, we analyzed all patients for the presence of TMDs according to the Research Diagnostic Criteria for TMD. We enrolled 91 IBS patients (23 IBS-D, 30 IBS-C and 38 IBS-M) and 57 HC in the study. We found a higher risk of having TMD (OR = 3.41, 95%CI: 1.66-7.01) compared to the HC. The risk of having TMD was independent of IBS-subtype. Multiple regression analysis showed that facial pain was positively related to abdominal pain and higher level of depression. IBS patients had a more than three times greater risk of TMD compared to HC. The risk of having TMD was similar in different IBS subtypes. IBS patients that also fulfilled criteria for TMD seem to share along with chronic facial and abdominal pain a significant co-occurrence with psychiatric disorders and female preponderance.

Predicting pain relief: Use of pre-surgical trigeminal nerve diffusion metrics in trigeminal neuralgia.

Trigeminal neuralgia (TN) is a chronic neuropathic facial pain disorder that commonly responds to surgery. A proportion of patients, however, do not benefit and suffer ongoing pain. There are currently no imaging tools that permit the prediction of treatment response. To address this paucity, we used diffusion tensor imaging (DTI) to determine whether pre-surgical trigeminal nerve microstructural diffusivities can prognosticate response to TN treatment.In 31 TN patients and 16 healthy controls, multi-tensor tractography was used to extract DTI-derived metrics—axial (AD), radial (RD), mean diffusivity (MD), and fractional anisotropy (FA)—from the cisternal segment, root entry zone and pontine segment of trigeminal nerves for false discovery rate-corrected Student's t-tests. Ipsilateral diffusivities were bootstrap resampled to visualize group-level diffusivity thresholds of long-term response. To obtain an individual-level statistical classifier of surgical response, we conducted discriminant function analysis (DFA) with the type of surgery chosen alongside ipsilateral measurements and ipsilateral/contralateral ratios of AD and RD from all regions of interest as prediction variables.Abnormal diffusivity in the trigeminal pontine fibers, demonstrated by increased AD, highlighted non-responders (n = 14) compared to controls. Bootstrap resampling revealed three ipsilateral diffusivity thresholds of response—pontine AD, MD, cisternal FA—separating 85% of non-responders from responders. DFA produced an 83.9% (71.0% using leave-one-out-cross-validation) accurate prognosticator of response that successfully identified 12/14 non-responders.Our study demonstrates that pre-surgical DTI metrics can serve as a highly predictive, individualized tool to prognosticate surgical response. We further highlight abnormal pontine segment diffusivities as key features of treatment non-response and confirm the axiom that central pain does not commonly benefit from peripheral treatments.

Comorbidities of chronic facial pain and obstructive sleep apnea.

This article explains the high comorbidity of craniofacial pain (chronic face pain, temporomandibular disorders, and primary headaches) with obstructive sleep breathing disorders and obstructive sleep apnea (OSA). It is recommended that physicians treating OSA should be aware of the concurrent chronic pain that affects the quality of sleep, and also dentists treating chronic pain be aware of a sleep breathing origin so that proper reciprocal referrals be made for optimal patient treatment outcome. These comorbid relationships are not limited to adults. The most recent literature demonstrates that children diagnosed with primary headaches are highly comorbid with OSA and frequently have chronic facial pain complaints. It is recommended that patients who seek care for the symptoms of sleep-related breathing disorders (OSA), or patients seeking care for chronic head and face pain be screened with intake forms that include questions of both to insure optimal treatment outcomes for either chief complaint.

Association of stress and depression with chronic facial pain: A case-control study based on the Northern Finland 1966 Birth Cohort

Objective: The aim was to study the association between stress level and chronic facial pain, while controlling for the effect of depression on this association, during a three-year follow-up in a general population-based birth cohort.Methods: In the general population-based Northern Finland 1966 Birth Cohort, information about stress level, depression and facial pain were collected using questionnaires at the age of 31 years. Stress level was measured using the Work Ability Index. Depression was assessed using the 13-item depression subscale in the Hopkins Symptom Checklist-25. Three years later, a subsample of 52 subjects (42 women) with chronic facial pain and 52 pain-free controls (42 women) was formed.Results: Of the subjects having high stress level at baseline, 73.3% had chronic facial pain, and 26.7% were pain-free three years later. The univariate logistic regression analysis showed that high stress level at 31 years increased the risk for chronic facial pain (crude OR 6.1, 95%, CI 1.3–28.7) three years later. When including depression in a multivariate model, depression associated statistically significantly with chronic facial pain (adjusted OR 2.5, 95%, CI 1.0–5.8), whereas stress level did not (adjusted OR 2.3, 95%, CI 0.6–8.4).Conclusion: High stress level is connected with increased risk for chronic facial pain. This association seems to mediate through depression.

NCCN News2016 NCCN Nursing Program Addresses Information Needs for Oncology Nurses2016 NCCN Fellows Recognition Program Explores New Horizons in Quality Cancer CareFor Breast Cancer, When to Screen or Not to Screen? That is the Question Plaguing the Minds of US Women—and Their CliniciansIn the Face of Chronic Pain, Clinicians Seek Best Practices for Management while Evading Opioid Abuse

NCCN News2016 NCCN Nursing Program Addresses Information Needs for Oncology Nurses2016 NCCN Fellows Recognition Program Explores New Horizons in Quality Cancer CareFor Breast Cancer, When to Screen or Not to Screen? That is the Question Plaguing the Minds of US Women—and Their CliniciansIn the Face of Chronic Pain, Clinicians Seek Best Practices for Management while Evading Opioid Abuse

Editorial: Natural Products in Oral Health.

Oral health is a state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity [1]. This definition by the World Health Organization, though not comprehensive or exhaustive, gives us the gamut of oral health. However, dental caries and periodontal disease steal the limelight under the umbrella of oral health [2]. Most governments which spend significant amounts on health concentrate on the control of dental caries followed by periodontal disease [1]. Though preventive measures and control of risk factors form the major form of public health intervention, there is a definite role for pharmaceutical or active agents in management of oral health. One of the limitations identified in the wide array of active agents on oral diseases has been their exclusive focus on targeting pathogenic organisms. However, the host plays a very significant role in the occurrence of diseases. Identification of other agents especially from natural products has become exciting due to the possibility of addressing host issues as well as pathogenic organisms. Traditional medicines of various origins focus on the use of natural products in various forms to bring equilibrium to the disturbed human body and thus eliminating the ‘toxins’ responsible for the ailments [3, 4]. This time tested intervention for diseases though not always scientifically verified opens to us a large window of opportunity for managing the present day illnesses. Periodontal diseases which primarily include gingivitis and periodontitis are caused by the bacterial biofilm but mediated and modified by the host [5]. Studies on natural products for periodontal diseases have led to commercially available medication especially for gingivitis [5, 6]. Natural products have many properties which can have an effect on the immune and inflammatory process during disease progression apart from inhibiting pathogenic bacteria [7, 8]. Developments in drug delivery including nanoforms open up myriad opportunities for developing therapies including locally deliverable agents against periodontal diseases [5, 9]. Dental caries is a bacterial initiated demineralization of the hard tissue structures of the tooth. Plant based extracts and their derivatives have been explored for the anti-cariogenic effects [10, 11]. New research has shown the potential of natural products in remineralising tooth surfaces affected by dental caries [12]. The potential of local sustained delivery of active agents for protecting tooth surface is also being explored [13]. The other important potential for the use of natural products is in oral mucosal diseases. Effect of plant based products on oral mucositis including as a result of cancer therapies has been an important focus of research [14]. The polyphenols from plant based products have been very effective for their anti-inflammatory and healing effects [15]. Nanotechnology has helped in the sustained delivery as well in maintaining a higher bioavailability of the active drug [16]. The special issue on natural products and oral health will create more interest among the researchers and clinicians to view naturally derived therapies as an effective way to manage oral diseases. Commercial exploration towards better patient utilization of these therapies based on natural products should be promoted. Nanotechnology for better formulation of drugs will definitely give the much needed boost towards these goals.

The “Being Hopeful in the Face of Chronic Pain” Program: A Counseling Program for People Experiencing Chronic Pain

Chronic pain is a condition defined by its intractable nature, with a host of negative impacts on the lives of sufferers, including a deficit of positive emotions. This article presents an innovative group therapy program for chronic pain patients entitled Being Hopeful in the Face of Chronic Pain. Theoretical background for the creation of the group is presented, along with empirical evidence to support the efficacy of the program. The 6-week group program is described in sufficient detail for practitioners to adapt it for use, delineating the specific activities undertaken in each session. Implications for chronic pain treatment are discussed.

Pain. Part 7: Trigeminal Neuralgia.

Trigeminal neuralgia (TN) is also known as 'tic douloureux' (in French, 'painful twitch'). It is a rare chronic facial pain syndrome, characterized by severe, brief, stabbing, 'electric shock-like 'recurrent pain attacks felt in one or more divisions of trigeminal nerve innervation areas. So intense is the elicited pain that TN has a significant effect on a sufferer's quality of life, rendering many patients unable to consider a future with the ongoing threat of recurrent pain. The aim of this article is to discuss the diagnosis and management of this disabling facial pain condition. CPD/Clinical Relevance: As general medical practitioners may struggle differentiating TN from toothache, primary care dentists have an important role in excluding odontogenic cause of pain, diagnosing TN and referring patients to a facial pain clinic for further investigations and multidisciplinary team management.

Psychological appraisal in temporomandibular disorders: A cross-sectional study

Aims and Objectives: The objective of this study was to investigate the prevalence of stress and depression within temporomandibular disorder (TMD) patient subgroups with chronic facial pain (cfp) and healthy controls and to assess possible relationships among the different subgroups. It also evaluated the correlation among pain, stress, and depression scores. Materials and Methods: A total number of 120 patients, 60 cases and 60 controls aged 20-40 years were included in the study. The study group after clinical examination was assigned into subgroups depending on the Research Diagnostic Criteria for TMD (RDC/TMD). Age- and sex-matched patients with no complaints of TMD formed the control group. Both the groups were administered the Beck's inventory of depression (BDI) and stress symptom rating scale (SSRS) questionnaires. Pain intensity was measured by the visual analogue scale. All the scores were statistically analyzed. Results: Depression and stress scores were seen more in the myofascial pain group. Depression was prevalent in 53.3% and stress in 60% of the study group. Positive correlation was seen among pain scores, depression, and stress scores ( P Conclusion: The findings are consistent with previous research indicating a link among depression, stress, and TMD. Screening for such symptoms should be an integral part of the evaluation for effective cognitive behavioural therapy.