1/5. trigeminal neuralgia. New treatment options for a well-known cause of facial pain.trigeminal neuralgia is an idiopathic disorder of unilateral facial pain that is characterized by lancinating paroxysms of pain in the lips, gums, cheek, or chin. Pain in trigeminal neuralgia is associated with physical triggers. Much of the treatment has been unchanged for more than 10 years, with cabamazepine being the standard first-line treatment. There are several promising new medications available, such as pimozide, tizanidine hydrochloride, and topical capsaicin. Surgical management is also effective.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Oral and maxillofacial surgery in patients with chronic orofacial pain.PURPOSE: In this investigation, we evaluated a population of patients with chronic orofacial pain who sought treatment at a pain center in an academic institution. These patients were evaluated with respect to 1) the frequency and types of previous oral and maxillofacial surgery procedures, 2) the frequency of previous significant misdiagnoses, and 3) the number of patients who subsequently required surgical treatment as recommended by an interdisciplinary orofacial pain team. The major goal of this investigation was to determine the role of oral and maxillofacial surgery in patients with chronic orofacial pain. patients and methods: The study population included patients seen at the Center for Oral, Facial and Head Pain at new york Presbyterian Hospital from January 1999 through April 2001. (120 patients; female-to-male ratio, 3:1; mean age, 49 years; average pain duration, 81 months; average number of previous specialists, 6). The patient population was evaluated by an interdisciplinary orofacial pain team and the following characteristics of this population were profiled: 1) the frequency and types of previous surgical procedures, 2) diagnoses, 3) the frequency of previous misdiagnoses, and 4) treatment recommendations made by the center team. RESULTS: There was a history of previous oral and maxillofacial surgical procedures in 38 of 120 patients (32%). Procedures performed before our evaluation included endodontics (30%), extractions (27%), apicoectomies (12%), temporomandibular joint (TMJ) surgery (6%), neurolysis (5%), orthognathic surgery (3%), and debridement of bone cavities (2%). Surgical intervention clearly exacerbated pain in 21 of 38 patients (55%) who had undergone surgery. Diagnoses included myofascial pain (50%), atypical facial neuralgia (40%), depression (30%), TMJ synovitis (14%), TMJ osteoarthritis (12%), trigeminal neuralgia (10%), and TMJ fibrosis (2%). Treatment recommendations included medications (91%), physical therapy (36%), psychiatric management (30%), trigger injections (15%), oral appliances (13%), biofeedback (13%), acupuncture (8%), surgery (4%), and Botox injections (1%) (Allergan Inc, Irvine, CA). Gross misdiagnosis leading to serious sequelae, with delay of necessary treatment, occurred in 6 of 120 patients (5%). CONCLUSIONS: Misdiagnosis and multiple failed treatments were common in these patients with chronic orofacial pain. These patients often have multiple diagnoses, requiring management by multiple disciplines. Surgery, when indicated, must be based on a specific diagnosis that is amenable to surgical therapy. However, surgical treatment was rarely indicated as a treatment for pain relief in these patients with chronic orofacial pain, and it exacerbated and perpetuated pain symptoms in some of them.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/5. Unilateral black hairy tongue in trigeminal neuralgia.Unilateral hairlike discoloration of the tongue is described in a patient with ipsilateral mandibular division trigeminal neuralgia. This unusual physical sign coincided with the patient's painful trigger zone and was attributed to hypertrophy of keratinized filiform papillae, where guarded avoidance of mechanical stimulation over time prevented normal desquamation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/5. facial pain.facial pain is a common symptom that may be a feature of a primary headache disorder or a secondary feature of organic disease. A thorough clinical history and physical examination may reveal the characteristic clinical features and assist in diagnosis. However, in some cases, the etiology may remain indeterminate.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/5. Chronic neuropathic pain and its control by drugs.The medical treatment and some currently known aspects of the aetiology of five neurogenic pain states are discussed. Neurogenic pain can be described as pain resulting from noninflammatory dysfunction of the peripheral or central nervous system without nociceptor stimulation or trauma. The enormity of the field has limited this review to post-herpetic neuralgia, complex regional pain syndromes, phantom pain, trigeminal neuralgia and diabetic neuralgia. Evidence suggests that many neurogenic pain states are not effectively controlled. This may be due in part to a lack of understanding of the aetiology of these conditions and to the lack of high quality studies evaluating existing treatments. A compact review of the literature is presented with some treatment options and possible future directions. Where appropriate surgical management and physical therapy have been discussed; however, a thorough appraisal of nondrug treatments was not the main priority of this review.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |