Craniofacial Pain Research Articles

Abdominal Acupuncture for Non-Responding TMD Patients: a Retrospective Observational Study in General Practice

Pain related to Temporomandibular Disorders (TMD) is severe, negatively affecting patients' quality of life, and often resistant to conventional treatments. Abdominal Acupuncture (AA) is known to be particularly effective for pain, especially chronic and musculoskeletal pain, but it is still poorly studied and never investigated in TMD patients. To analyze the efficacy of AA for the treatment of patients with subacute and chronic pain related to TMD and non-responding to previous conventional therapies (occlusal splint, medications, physical therapy). Twenty-eight patients, 24 F and four M (mean age 49.36 years), were recruited from January 2019-February 2021. All patients underwent AA treatment: two sessions per week for four weeks, for a total of eight sessions. At the beginning of therapy (T0) and at the end of the cycle (T1) the following data were evaluated: maximum mouth opening (MMO); cranio-facial pain related to TMD (verbal numeric scale, VNS); pain interference with normal activities and quality of life of patients (Brief Pain Inventory, BPI); oral functioning (Oral Behavior Checklist, OBC); impression of treatment effectiveness (Patients' Global Impression of Improvement, PGI-I Scale). Statistical comparison of data before and after the AA treatment was performed by Wilcoxon's signed-rank test (significance level p < 0.05). The MMO values were significantly improved after one cycle of AA (p = 0.0002). In addition, TMD-related pain had a statistically significant decline following AA treatment (all p < 0.001). Patients' general activity and quality of life (BPI) were described as improved following a course of AA, with statistically significant values for all aspects considered (all p < 0.05). Abdominal acupuncture resulted in effective treatment of subacute/chronic-resistant pain related to TMD, capable of improving mandibular function and facial pain, and reduced the interference of pain affecting patients' quality of life.

Clinical features and ICHD headache diagnoses for patients with prominent craniofacial pain referred by a rhinologist to headache specialists (P11-12.003)

<h3>Objective:</h3> To describe the clinical features and final headache diagnoses of patients with prominent craniofacial pain who were referred by a rhinologist to a headache specialist. <h3>Background:</h3> Many patients with craniofacial pain are misdiagnosed with “sinus headache” and are often referred to otolaryngologists for evaluation of sinus disease. However, the benefit of collaboration between rhinologists and headache specialists for evaluation of patients with putative sinus headache has not been studied. <h3>Design/Methods:</h3> We conducted a single-center retrospective case series of patients who saw a rhinologist for craniofacial pain and were subsequently referred to a headache specialist for presumed non-sinogenic craniofacial pain between January 2016 and March 2019. SNOT-22 (Sino-Nasal Outcome Test-22 questionnaire) score, ICHD (International Classification of Headache Disorders) diagnosis, patient characteristics, endoscopy results, and headache characteristics were assessed. <h3>Results:</h3> Of 98 patients, 73 (74.5%) were female, the mean age was 50.9 years, and the mean SNOT-22 score was 48.6. Nasal endoscopy performed in the rhinology clinic revealed normal results in 90 (92.7 %) patients, edema was noted in 4 (5.2%) patients, and mucopurulence in 2 (2%) patients. Most patients described their pain as frontal or frontal-maxillary, dull or throbbing, and moderate to severe. Migraine (episodic and chronic) was the most common final diagnosis in 48 (49.0 %) patients, and the second most common diagnosis was tension-type headache in 17 (17.3%) patients. <h3>Conclusions:</h3> Patients referred from a rhinologist to a headache specialist for non-sinogenic craniofacial pain are likely to have a final diagnosis of a primary headache disorder, specifically migraine or tension-type headache, rather than a true sinus-related disorder. Collaboration between specialists may improve diagnostic accuracy and outcomes for patients with craniofacial pain that may be confused for sinus headache. <b>Disclosure:</b> Dr. Alayyas has nothing to disclose. Ms. Singh has nothing to disclose. Mr. Saleem has nothing to disclose. John Craig has received personal compensation in the range of $0-$499 for serving as a Consultant for Optinose USA, Inc. Dr. Ali has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Ebsco.

Assessment of the painDETECT questionnaire as a tool for screening and treatment evaluation in trigeminal neuralgia

Introduction: Although trigeminal neuralgia (TN) is diagnosed clinically and most cases can be easily identified, misdiagnoses are frequent and lead to delayed treatment. Therefore, we evaluated the painDETECT questionnaire, an established tool for detecting neuropathic pain components, as a screening tool in TN. Methods: We conducted a retrospective chart review of all patients who had presented to our neuro-surgical outpatient department complaining of craniofacial pain between January 2019 and August 2021. The patients were categorized as likely having TN (TN group) or likely having pain of a different etiology (non-TN). Patients with other neuropathic facial pain syndromes or those in whom TN could not be diagnosed nor ruled out with sufficient confidence were excluded. The painDETECT scores were compared, along with other outcome parameters. Results: We identified 52 patients with craniofacial pain. After exclusion of 14 patients, 25 patients were included in the TN group and 13 in the non-TN group. The mean painDETECT score was 17.0±4.7 and 12.7±6.1, respectively (p=0.02). The positive predictive value for TN at a cutoff value of 19 points was 80%, the negative predictive value was 39%. In patients who underwent surgery, the correlation between the postoperative painDETECT score and the postoperative numeric rating scale score was 0.73 (p=0.01). Discussion: The painDETECT questionnaire is of limited use as a screening tool for possible TN. It can be utilized to track treatment outcomes if data collection beyond daily clinical use is desired.

137 Successful Management of Refractory Craniofacial Pain With Peripheral Nerve Field Stimulation: An International Case Series

INTRODUCTION: Craniofacial pain syndromes (CPS) encompass various debilitating pain etiologies including trigeminal neuralgia, migraine, cluster headaches, atypical facial pain and post-herpetic neuralgia. Although medical management is initially indicated, most patients with CPS eventually require surgical intervention. METHODS: This is a retrospective chart review of adults with refractory CPS who underwent PNFS. Implantation areas included the greater occipital nerve and CNV branches. Outcomes include pain severity measured with Barrow Pain Scale (BPS), functional status pre- and post-operatively, complications secondary to PNFS, and time to re-intervention. RESULTS: Seventeen patients underwent PNFS implantation for: atypical TN (48%), migraine (18%), post-herpetic neuralgia (12%), other CPS (17%). Baseline BPS pain score was 5/5 for all patients. At 2 weeks post-PNFS 88% of patients (N = 16) reported BPS score of 1/5. At 1-month post-PNFS 77% of patients (N = 17) had BPS score 2/5 or less; at 6 months follow-up, 77% of patients (N = 14) had BPS score 2/5 or less; and at 12-month follow-up, 63% of patients (N = 11) reported BPS score 2/5 or less. Patients with good outcomes had no further pain-related hospital admissions. The most sustained results were achieved amongst patients with post-herpetic neuralgia. Complications included infection in 2 patients, and refractory pain in 3 patients requiring re-intervention at 10 months post-PNFS on average. CONCLUSIONS: This case series demonstrates the utility of PNFS for CPS refractory to traditional medical and surgical management. All patients reported significant pain relief with improvement of function early in the post-operative period. Different etiologies of CPS and PNFS technology may partially explain the variability in long-term outcomes. PNFS technology is continuously optimizing pulse settings and technical characteristics and may be an adequate intervention for refractory CPS.

Diagnosis Gangguan Sendi Temporomandibular pada Kasus Kehilangan Gigi dengan Metode DC/TMD

Background: Temporomandibular joint disorder (TMD) is characterized by craniofacial pain involving the jaw joint, masticatory muscles, or muscles that innervate the head and neck. The causes of TMD are multifactorial, including tooth loss and bad habits. The new DC/TMD protocol is a TMD examination protocol that is highly recommended for use as a clinical and research protocol for dentists. Objective: This study aims to determine the prevalence of TMD diagnosis results using the DC/TMD method, to determine the types of TMD diseases experienced and their relationship to the status of tooth loss in students. Method: The study used a cross-sectional analytical design with samples that met the inclusion criteria of 150 students aged 19-25 years who were taken by total sampling. The research subjects were asked to agree and sign an informed consent in advance by the researcher. Data were obtained from the results of anamnesis and physical examination with a diagnosis of TMD using the DC/TMD protocol based on the International RDC/TMD Consortium Network which has been translated into Indonesian. The examination data were processed using SPSS statistical software with univariate and bivariate tests. Results: 48% of students had tooth loss, 62% of students were diagnosed with TMD, and the results of the relationship analysis using the chi-square test showed that there was a significant relationship between tooth loss and TMD (p-value = 0.024; p

Rhino-cerebral mucormycosis storm during COVID-19 pandemic: A retrospective study at urban tertiary care center

Introduction: The imminent threat has emerged in the form of COVID-19-associated opportunistic infections in India. Mucormycosis has been increasingly described in patients with severe COVID-19 disease. We attempted to study the epidemiological factors, clinical presentation, and outcome in such patients which have not been well described. Materials and Methods: A total of 47 patients diagnosed with mucormycosis infection in tissue sections of patients with a history of COVID-19 disease were included in the study. A detailed clinical history including radiological and microbiological findings was retrieved from the case sheets. Histopathology slides were reviewed and correlated with clinical findings. Results: The males were commonly affected than females. The most common age group for females was slightly more than males. Out of 47 patients of mucormycosis, 37 (78.72%) have associated diseases. The 29 were known patients of diabetes mellitus, of which 16 patients had also associated hypertension. Thirty-nine patients received steroids during the hospital stay. Treatment with steroids and hyperglycemia were the most common risk factor for mucormycosis in post-COVID-19 disease. Discussion: Apart from severe COVID-19 disease, treatment with steroids, and hyperglycemia, other possible factors for mucormycosis include immune dysregulation and hyperferritinemia. Early diagnosis and treatment are the keys for the reduction of morbidity and mortality. Early diagnosis of mucormycosis requires expertise and interdisciplinary co-ordination. Craniofacial pain in patients with a history of severe COVID-19 disease, a diagnosis of mucormycosis must be suspected. Conclusion: Early diagnosis of mucormycosis.

Beliefs and concerns about pain were associated with craniofacial pain experienced within 24 hours: cross-sectional study

Beliefs and concerns about pain were associated with craniofacial pain experienced within 24 hours: cross-sectional study

Distúrbios do sono estão associados à dor temporal matinal e à dor na mandíbula em adultos e idosos: um estudo de base populacional

Objective Purpose: To assess the influence of sleep disorders on temporal and jaw pain in the morning in adults and elderly people. Methods: Population-based study with representative individuals aged 18 years or over. Individuals were selected using a multistage sampling procedure. The outcomes of morning jaw pain and morning temporal pain were assessed. Sleep bruxism, obstructive sleep apnea, and sleep quality were evaluated as exposure variables. Adjusted analysis was conducted using Poisson regression. All analysis was sex stratified. Results: 820 individuals were studied. Female with sleep bruxism were 1.37 times more likely to have morning temporal pain (p=0.041). Male and female with bruxism had a prevalence 160% and 97%, respectively, higher of morning jaw pain (male: p=0.003; female: p&lt;0.001). Women with obstructive sleep apnea were 1.52 times more likely to have morning temporal pain (p=0.023). Men with poor sleep quality had a prevalence 190% higher of morning temporal pain (p=0.005). Conclusion: Morning craniofacial pain is more frequent in individuals with sleep disorders, and there are differences between sexes. Since more than one sleep disorder can be present in the same individual, studies that adjust the analyses for possible confounders are important to avoiding possible overlap between them.

Anterior Ethmoidal Nerve Syndrome - An Under-diagnosed Cause of Headache

Introduction The anterior ethmoidal nerve syndrome is a group of symptoms resulting from irritation of the terminal branches of the anterior ethmoidal nerve. Middle turbinate compression against the septum or the lateral nasal wall may cause a neuropathic facial pain syndrome which is often confused with sinogenic headache or other causes of headache. The diagnosis of anterior ethmoidal nerve syndrome is based on clinical and radiologic findings and needs a high index of suspicion. Our objective is to determine the nasal cause of headache and to create awareness among young ENT surgeons about various local causes of craniofacial pain. Materials and Methods A retrospective observational study carried out in a tertiary care hospital of North India. 30 patients who fulfilled the clinical diagnostic criteria were selected for the study. Results All the patients were analysed, managed accordingly by conservative and surgical management and outcome analysed. All patients were managed with medical and surgical management. Out of 30 patients, 28 (93.33%) patients improved in which 2 patients improve by medical management and 26 patients by surgical management. Conclusion The diagnosis requires a strong clinical suspicion and appropriate evaluation including nasal endoscopy, scan and anesthesia of the suspected point of contact.

Occipital Nerve Stimulation for the Treatment of Craniofacial Pain

The occipital nerve stimulation (ONS) is a minimally invasive, adjustable, and reversible alternative therapy for chronic headaches refractory to first line treatments. With its efficacy being variable between studies, we wanted to report on our experience with the neuromodulation technique. The objective of this study is to evaluate the benefits of ONS on various pathologies and discuss different factors that may affect the efficacity of the therapy to treat craniofacial pain.

Prepontine cisternal routine for intrathecal targeted drug delivery in craniofacial cancer pain treatment: technical note

Intrathecal targeted drug delivery provides effective relief for cancer-related pain. However, its validation in management of craniofacial pain remains much less widely practiced, mainly due to the localized diffusion of analgesic agent with current approach. Here, we report our experience of prepontine cisternal routine for placement and implantation of intrathecal targeted drug delivery in two cases of cancer-related craniofacial pain. Lumbar cannulation was applied and the intrathecal catheter tip was positioned at the prepontine cistern under fluoroscopic guidance during the surgical implantation. Postoperative imaging confirmed that the catheter tip was successfully placed in the prepontine cisternal space. Satisfactory control of pain was achieved after intrathecal therapy, with significant reduction of background and breakthrough cancer pain. None obvious complications were observed in this study. Thus, our novel intrathecal routine may provide an alternative option for craniofacial pain caused by tumor, who were insufficiently treated by oral analgesic agents.

Education-Enhanced Conventional Care versus Conventional Care Alone for Temporomandibular Disorders: A Randomized Controlled Trial

The objective of this study was to determine the effect of enhancing conventional care for people with chronic painful temporomandibular disorders (TMD) with an individualised contemporary pain science education (PSE) intervention. In this randomized controlled trial, a consecutive sample of 148 participants (18–55 years of age) was randomized into 2 groups: PSE-enhanced conventional care or Conventional care alone. Conventional care involved a 6-week, 12-session manual therapy and exercise program. The PSE enhancement involved 2 sessions of modern PSE, undertaken in the first 2 treatment sessions. Primary outcomes were pain intensity, assessed with a numeric pain rating scale, and disability, assessed with the craniofacial pain and disability inventory, post-treatment. Linear mixed model analyses were used to investigate between-group differences over time. There was a statistically and clinically meaningful effect of PSE enhancement on disability (Mean Difference = 6.1, 95% CI: 3.3–8.8), but not on pain intensity, post-treatment. Secondary analyses suggested clinically meaningful benefit of PSE enhancement on pain and disability ratings at 10-week and 18-week follow-ups, raising the possibility that preceding conventional care with a PSE intervention may result in long-term benefits. PerspectiveThe addition of modern Pain Science Education (PSE) intervention improved disability for people with chronic TMD receiving manual therapy and exercise, but not pain. A mean difference in pain and disability favoring the PSE group at the 10- and 18-week follow-ups, respectively, suggests that PSE addition resulted in longer-lasting effects. Trial registration: NCT03926767. Registered on April 29, 2019. https://clinicaltrials.gov/ct2/show/NCT03926767

Botulinum Toxin as an Effective Treatment for Trigeminal Neuralgia in Surgical Practices

Background: Trigeminal neuralgia (TN) is a common cause of craniofacial pain with many medical and surgical therapies, all of which are imperfect. We examine the use of botulinum toxin type-A (BTX-A) as an intermediary approach in surgical practices. Methods: We retrospectively identified TN patients seen by both pain neurology and neurosurgery at our center. Demographics were collected. Pain intensity was assessed using the numerical rating scale (NRS) and compared from baseline to after BTX-A treatment via paired t test. Responder status was assessed, and success of BTX-A was determined for each cohort. Doses of common medications were compared between baseline visit and the most recent BTX-A administration visit. Results: Thirty-one patients underwent BTX-A therapy for TN, 24 (77%) female and 7 (23%) male. Mean age was 62.5 ± 3.1 years and 29 (94%) identified as white. When divided into cohorts according to indication, 11 (35%) failed prior TN surgery, 9 (29%) either declined surgery or were poor surgical candidates, 4 (13%) had multiple sclerosis, 4 (13%) had trigeminal neuropathic pain, and 3 (10%) had atypical TN with pain in additional dermatomes outside the trigeminal distribution. Significant reductions in NRS from baseline to following initial BTX-A treatment were seen in the declined/high risk for surgery (p = 0.004) and those who failed prior TN surgery (p = 0.035) groups. No significant variation in demographics was found between any two groups (p > 0.05 for all). Finally, there was no significant reduction in total daily dose of gabapentin, carbamazepine, oxcarbazepine, baclofen, or lamotrigine in BTX-A responders (p > 0.05 for all). Discussion: Indication is an important predictor for BTX-A, with classical TN patients exhibiting the highest response rates. This research highlights the viability of BTX-A as an important tool in the arsenal of providers seeking to treat TN in a minimally invasive manner.

A Standardized Programming Algorithm for Spinal Cord Stimulation and Peripheral Nerve Stimulation for Headache

Over the last three years, a programming pattern has been developed which has shown to improve outcomes for our patient population. A standardized set of algorithms have been developed for programming both spinal cord stimulators and peripheral nerve stimulators for craniofacial pain.

Clinical Features and Headache Diagnoses in Patients With Chief Complaint of Craniofacial Pain.

Investigate the use of nasal endoscopy, sinus imaging, and neurologic evaluation in patients presenting to a rhinologist primarily for craniofacial pain. This was a retrospective analysis of consecutive outpatients presenting to a rhinologist between 2016 and 2019 with chief complaints of craniofacial pain with or without other sinonasal symptoms, who were then referred to and evaluated by headache specialists. Data analyzed included sinusitis symptoms, Sino-Nasal Outcome Test (SNOT-22) scores (and facial pain subscores), pain location, nasal endoscopy, computed tomography (CT) findings, and headache diagnoses made by headache specialists. Of the 134 patients with prominent craniofacial pain, the majority of patients were diagnosed with migraine (50%) or tension-type (22%) headache, followed by multiple other non-sinogenic headache disorders. Approximately 5% of patients had headaches attributed to sinusitis. Amongst all patients, 90% had negative nasal endoscopies. Patients with negative endoscopies were significantly less likely to report smell loss (P = .003) compared to those with positive endoscopies. Poor agreement was demonstrated between self-reported pain locations and sinus findings on CT (kappa values < 0.20). Negative nasal endoscopy showed high concurrence with negative CT findings (80%-97%). Patients presenting with chief complaints of craniofacial pain generally met criteria for various non-sinogenic headache disorders. Nasal endoscopy was negative in 90% of patients, and CT demonstrated poor agreement with pain locations. Nasal endoscopy and CT shared high concurrence rates for negative sinus findings. The value of nasal endoscopy over sinus imaging in craniofacial pain evaluation should be explored in future studies.

Local Anesthetic Therapy in a Patient with Primary Headache and Lipid Keratopathy

A headache is characterized as a craniofacial pain that may derive from any involvement of the structure of the head, neck or cranial cavity. It may be associated with any pathology, negatively affecting the quality of life of the individuals afflicted by it. We present the case of a woman with bilateral lipid keratopathy associated with a headache of a moderate to severe intensity, refractory to treatment with non-steroidal anti-inflammatory drugs, treated with lidocaine 1% injections in supraorbital and infraorbital nerves. A clear improvement was observed in visual symptoms and headache with a decrease in symptom frequency, duration and intensity. The improvement lasted over 6 months, which positively impacted the patient’s quality of life. The treatment was well tolerated and no adverse effects were observed. In this case, local injections of lidocaine showed a favorable outcome. Well-designed studies should be conducted to elucidate the role of LA for this condition.

ID:16594 C1/C2 High Cervical Spinal Cord Stimulation in Refractory Facial Pain: A Retrospective, Single-Center Case Series

The prevalence of craniofacial pain has been estimated to be approximately 25%(1). Within this group, Trigeminal Neuralgia (TN) and Trigeminal Neuropathy (TNP) are challenging entities to treat(2). C1/C2 High Cervical (C1/C2-HC) stimulation has been used in the management of refractory chronic migraine(3). The purpose of this study was to evaluate the efficacy and safety of C1/C2-HC stimulation in the management of TN & TNP.

ID:16068 IPG-Free PNS for the Treatment of CFNS: Interim Results* of a Prospective Randomized Controlled Trial

Numerous studies of peripheral nerve stimulation (PNS) over occipital and trigeminal nerves have shown it to be highly effective for neuropathic pain. However, a variety of difficulties limit widespread use of these techniques, including cosmetic concerns, difficulties tunneling to the IPG, and a high incidence of adverse events such as lead erosion, migration, lead fracture, disconnection and infection. This is a prospective, randomized, clinical study investigating a novel, miniature, wirelessly powered peripheral nerve stimulation treatment for the treatment of chronic craniofacial pain. The nerves targeted include peripheral branches of trigeminal as well as nerves originating from upper cervical dermatomes, including greater and lesser occipital nerves.

CGRP and the Calcitonin Receptor are Co-Expressed in Mouse, Rat and Human Trigeminal Ganglia Neurons.

The neuropeptide calcitonin gene-related peptide (CGRP) is expressed in the trigeminal ganglia, a key site in craniofacial pain and migraine. CGRP potently activates two receptors: the CGRP receptor and the AMY1 receptor. These receptors are heterodimers consisting of receptor activity-modifying protein 1 (RAMP1) with either the calcitonin receptor-like receptor (CLR) to form the CGRP receptor or the calcitonin receptor (CTR) to form the AMY1 receptor. The expression of the CGRP receptor in trigeminal ganglia has been described in several studies; however, there is comparatively limited data available describing AMY1 receptor expression and in which cellular subtypes it is found. This research aimed to determine the relative distributions of the AMY1 receptor subunit, CTR, and CGRP in neurons or glia in rat, mouse and human trigeminal ganglia. Antibodies against CTR, CGRP and neuronal/glial cell markers were applied to trigeminal ganglia sections to investigate their distribution. CTR-like and CGRP-like immunoreactivity were observed in both discrete and overlapping populations of neurons. In rats and mice, 30–40% of trigeminal ganglia neurons displayed CTR-like immunoreactivity in their cell bodies, with approximately 78–80% of these also containing CGRP-like immunoreactivity. Although human cases were more variable, a similar overall pattern of CTR-like immunoreactivity to rodents was observed in the human trigeminal ganglia. CTR and CGRP appeared to be primarily colocalized in small to medium sized neurons, suggesting that colocalization of CTR and CGRP may occur in C-fiber neurons. CGRP-like or CTR-like immunoreactivity were not typically observed in glial cells. Western blotting confirmed that CTR was expressed in the trigeminal ganglia of all three species. These results confirm that CTR is expressed in trigeminal ganglia neurons. The identification of populations of neurons that express both CGRP and CTR suggests that CGRP could act in an autocrine manner through a CTR-based receptor, such as the AMY1 receptor. Overall, this suggests that a trigeminal ganglia CTR-based receptor may be activated during migraine and could therefore represent a potential target to develop treatments for craniofacial pain and migraine.

Dental Hygiene and Noncommunicable Diseases – Current Trends and Future Perspective

Dental hygiene is an integral and also a major part of a person's general health, thereby better prevention of oral disease would save millions of rupees for the health-care systems. Noncommunicable diseases (NCDs) and their rising global burden are the primary reason for disability among people worldwide. Oral health is one of the reflections on the overall health and well-being of a person, and several oral diseases are even associated with chronic diseases like diabetes and periodontal diseases. Oral health is a heterogeneous entity composing the ability to chew, swallow, smile, smell, speak, taste and touch to convey a wide spectrum of emotions via expressions of face with confidence and without craniofacial complex discomfort, pain, and disease. Oral health remains a neglected and an under-recognized global health issue, where oral diseases affect around 3.9 billion people globally. Exacerbation of certain NCDs predisposes to oral dysbiosis and poor dental hygiene that may further lead to increased edentulism and periodontal diseases. The organizations and policymakers must shift the programs, policies, and public perceptions and viewpoints in support of sustaining adequate hygiene for overall health and well-being.