1/11. cluster headache and cocaine use.We present 3 patients who had episodes of orofacial pain compatible with cluster headache, the differential diagnosis being established with pulp pain of dental origin. cocaine inhalation triggered pain in the premolar zone of the upper jaw, followed by spread of pain to the periorbital region on the same side. The pain episodes were very intense and lasted between 30 and 120 minutes. The patients presented conjunctival injection and lacrimation of the affected eye during these episodes. The crises were always unilateral. In one patient, pain shifted sides from one crisis to another within the same symptomatic or cluster period, affecting the side through which the drug was inhaled. Pain usually appeared 1 to 2 hours after cocaine consumption, though it disappeared 5 to 10 minutes after again inhaling the drug. None of our patients acknowledged cocaine consumption at the first visit; drug inhalation was only admitted at subsequent visits, once a degree of confidence had been established with the physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. facial pain as the presenting symptom of lung carcinoma with normal chest radiograph.facial pain is a rare presenting symptom of nonmetastatic lung carcinoma. Referred pain from tumor invasion and compression of the vagus nerve was the presumed cause in the 31 cases published to date. We report 2 additional cases having an unusual clinical feature, namely, both had radiographic evidence of malignancy absent on initial chest films. Severe facial pain in both cases was explained by pulmonary carcinoma detected only through further investigations. From these cases follows the notable conclusion that referred facial pain of malignant origin can occasionally precede the appearance of neoplasm on routine chest films. It is therefore important for physicians to be familiar with the clinical features of this syndrome in order to choose appropriate further diagnostic testing in patients who may be at risk.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/11. Heterogeneity in the clinical presentation of Eagle's syndrome.OBJECTIVE: Eagle's syndrome (ES) or symptomatic elongated styloid process is an uncommon but important cause of chronic head and neck pain. This study reports our experience in the diagnosis and treatment of a series of patients with ES. STUDY DESIGN: Patient histories, radiographic tests, and operative reports of 3 patients over a 3-month period were prospectively collected. SETTING: Tertiary referral otolaryngology service. RESULTS: All patients had resolution of symptoms relating to their elongated styloid processes after surgical resection. CONCLUSION: Although sometimes clouded by coexisting symptoms, ES can be easily diagnosed based on good history taking and physical examination. If diagnosed appropriately, surgical treatment can be administered promptly. SIGNIFICANCE: patients with ES commonly have a long history of chronic pain treated by multiple physicians. Appropriate diagnosis can lead to prompt treatment of this condition. EBM rating: C-4.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/11. hyoid bone syndrome: a degenerative injury of the middle pharyngeal constrictor muscle with photomicroscopic evidence of insertion tendinosis.This article describes the condition known as hyoid bone syndrome, its diagnosis by exclusion, and the histopathologic evidence of focal, degenerative muscle injury. The injury involves the origin fibers of the middle pharyngeal constrictor muscle on the greater cornu of the hyoid bone. The importance of the dentist and physician in recognizing the condition is emphasized, because dental and nondental pain reference sites make up the syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/11. Cavernous angioma presenting as atypical facial and head pain.Recurrent headache is a common pediatric problem. As the differential diagnosis of headache is extensive, physicians rely on the mode of presentation to focus any investigation. A report of an adolescent in whom atypical facial and head pain caused by a preexisting cerebellar cavernous angioma is presented. facial pain and headache resolved following excision of the tumor.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/11. Pain in the neck, face, and head. role of the consultation-liaison psychiatrist.The special nature of pain in the face, head, and neck is not emphasized in the psychiatric literature on chronic pain. Although chronic pain of all types and locations share many features the psychological and symbolic significance of the head in the development of self-esteem, body image, and interpersonal relationships often confers special characteristics of pain on this area. As psychiatric consultation is not likely to be requested for patients with head, face, and neck pain in the absence of blatant "psychiatric" problems, it behooves the psychiatrist to exercise his liaison functions to enhance patient care in the inpatient setting and to help physicians recognize the utility of early psychiatric assessment on an outpatient basis with patients not yet requiring hospitalization. A collegial relationship with internists, dentists, neurologists, and surgeons facilitates the psychiatrist's role as a "team participant," often more effective in providing brief diagnostic, therapeutic, and management recommendations for patients who are usually not psychologically-minded and reluctant to pursue ongoing psychiatric treatment. However, the consultation-liaison psychiatrist can play an important role in expanding his colleagues' awareness of the multiple meanings of pain and the accompanying illness behavior, provide pedagogic help in the interviewing or history-taking process, offer suggestions about psychopharmacologic and other drug treatment, and serve as a resource for appropriate referral to sources of a variety of chronic pain treatments, including biofeedback, acupuncture, and family consultation. To fulfill both his consultative and liaison functions, it is incumbent upon the psychiatrist to be knowledgeable as well about nonpsychiatric aspects of pain of the head, face, and neck. We must acknowledge also how much we yet do not know: for example, why the psyche "chooses" a locus of pain in the body; how an external (or internal) stimulus is converted via cognitive, neuroendocrine, enzymatic, and other pathways to a somatic representation; the biochemistry of pain reduction by naturally occurring and synthetic drugs; and what characteristics distinguish the continuously creative individual who sustains persistent pain with barely an utterance from another who may "cave in" to seemingly trivial distress that results in total invalidism.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/11. Orofacial pain resulting from ill-fitting dentures.The patient who presents to the physician with a history of facial pain can be a diagnostic challenge. The etiology can be elusive, and this problem is compounded by the subjective nature and the often multi-factorial causes of facial pain. The differential diagnoses to be considered include both local and systemic disorders such as neuropathy, myofascial pain, dentoalveolar pathoses, and psychological disturbances, among others. This paper presents the case of a patient with a history of left auricular pain that was managed for over 12 years with drug therapy with only limited success. A thorough head and neck evaluation revealed probable myofascial pain with a poorly occluding set of complete dentures as a potential etiology. Fabrication of a new set of dentures and modification of the patient's denture-wearing habits has produced an almost complete remission of the pain. This case demonstrates the importance of a dental consultation to rule out a possible oral-musculoskeletal and/or dental etiology in the management of the patient with facial pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/11. Comparison of two patients with similar facial pain complaints of dental and non-dental etiologies.The medical and lay communities have become more aware of the role of dentistry in the diagnosis and management of facial pain disorders. In some cases, the patient or physician may presume that a facial pain complaint is of odontogenic origin and seek the opinion of a dental practitioner. While the majority of facial pain complaints may be due to dental pathologies, some may also be due to non-dental causes. The diagnostic acumen of the dentist must include a basic understanding of non-dental causes for facial pain as well as those related to dentistry. The following case reports may serve to underscore this observation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/11. Case report. synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome.A case of the SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome in a 35-year-old woman is presented. Ignorance of this entity on the part of the physicians treating the patient may have contributed to her having repeated diagnostic procedures and treatment, some of which may have been unnecessary. dentists are encouraged to suspect the SAPHO syndrome when they encounter a patient with mandibular osteomyelitis together with symptoms involving other bones and skin lesions such as pustulosis or psoriasis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/11. trigeminal neuralgia: sudden and long-term remission with transcutaneous electrical nerve stimulation.OBJECTIVE: To discuss a case of trigeminal neuralgia that responded to an accidental high-intensity discharge of electrical current delivered by a transcutaneous electrical nerve stimulator (TENS). CLINICAL FEATURES: A 36-yr-old man suffering from a 5-month history of worsening paroxysmal pain of the left facial and temporal regions was referred to a neurologist by his family physician. A clinical diagnosis of trigeminal neuralgia was made; before committing to pharmaceutical treatment, however, the patient sought chiropractic consultation. INTERVENTION AND OUTCOME: A trial of self-applied TENS was recommended for pain control. Initial application to patient tolerance provided transient pain relief until an accidental, intense discharge resulted in immediate remission of symptoms, lasting now for three years. CONCLUSION: As an initial treatment of choice, TENS can be a safe and effective therapy for trigeminal neuralgia. The unique effect of this accidental application leads us to speculate that diffuse noxious inhibitory controls may have been the pain inhibitory pathway responsible for the resolution of symptoms in this case. Although firm conclusions are difficult to draw from one incident, using TENS at an intense, noxious level may improve its therapeutic efficacy by decreasing treatment time and frequency and eliciting long-lasting effects. This case suggests the need for further investigation of TENS in the treatment of trigeminal neuralgia and related pain syndromes.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |