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Thimma Ravindranath P, Smith JG, Niloofar RN, Ebelthite C, Renton T. Sleep disturbances are associated with pain intensity and pain-related functional interference in patients experiencing orofacial pain. J Oral Rehabil 2023; 50:980-990. [PMID: 37243957 DOI: 10.1111/joor.13521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/08/2023] [Accepted: 05/23/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Sleep and pain have a reciprocal relationship, interacting with psychosocial aspects including depression, anxiety, somatization and significant stressful events. OBJECTIVE The aim of this study was to assess patients with oro-facial pain (OFP) and related sleep disturbances and determine the strongest psychosocial correlates. METHODS A cross-sectional study of anonymized data of consecutive patients with OFP {January 2019 and February 2020} were analysed. Diagnostic and Axis-II data were integrated to assess the relationship between sleep disturbances, measured using Chronic Pain Sleep Inventory, and demographic factors, clinical comorbidities, recent stressful events, pain severity and pain- and psychological-related function. RESULTS Five out of six patients with OFP were presented with pain-related sleep disturbances. Sleep problems were enhanced in patients with primary oro-facial headache compared with other OFP conditions. However, once the level of pain intensity and interference was accounted for, primary headache, was not a significant correlate of pain-related sleep disturbances. Multivariate analysis revealed (average) pain severity and pain interference were both significantly associated with sleep problems. There were also significant independent associations of sleep problems with somatization levels and reported experience of recent stressful events. CONCLUSION Identifying sleep problems as a part of OFP management may be beneficial and could result in better management outcomes.
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Affiliation(s)
| | - Jared G Smith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Rasooli Nia Niloofar
- Faculty of Dentistry, Oral and Craniofacial Science, King's College London, London, UK
| | - Candice Ebelthite
- IMPARTS, Mind and Body Programme, King's Health Partners, London, UK
| | - Tara Renton
- Faculty of Dentistry, Oral and Craniofacial Science, King's College London, London, UK
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Yanez Regonesi F, Kaspo GA, Boggero IA, Moreno-Hay I. The impact of the COVID-19 pandemic on orofacial pain practice: Perceptions from a convenience sample of orofacial pain practitioners. J Am Dent Assoc 2023; 154:266-271. [PMID: 35715264 PMCID: PMC9035375 DOI: 10.1016/j.adaj.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/21/2021] [Accepted: 03/17/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND COVID-19 has had a substantial impact on people's lives. Increasing evidence indicates that patients with chronic pain particularly are being affected; however, few articles have examined how the pandemic has affected the care or clinical presentation of patients with orofacial pain. The aim of this study was to describe COVID-19-related changes in referral patterns and numbers, in patient demographics, in patients' seeking treatment for problems, and in administrative procedures in 3 orofacial pain clinical settings. METHODS Practitioners participating in the American Academy of Orofacial Pain webinar titled "Practicing Orofacial Pain, Headache, and Sleep Care During the COVID-19 Pandemic" completed a voluntary anonymous online survey. Survey respondents completed general questions related to their orofacial pain practices and about perceptions of their patients' symptoms. For statistical analysis, the authors calculated frequencies and used analysis of variance for continuous variables or Likert scale variables and the χ2 test for dichotomous or categorical variables. Statistical significance was set at P value of .05 or below. RESULTS Practitioners noted an increase in new patients with orofacial pain. Of the participants, 33% indicated the onset of their patients' pain was often or extremely often related to COVID-19. The 5 most common symptoms that providers felt were aggravated in their patients were masticatory muscle myalgia, anxiety, tension-type headache, bruxism, and insomnia or fragmented sleep. CONCLUSION The COVID-19 pandemic has resulted in a marked increase in the number of patients seeking consultation for orofacial pain and associated symptoms. PRACTICAL IMPLICATIONS Because of the COVID-19 pandemic, orofacial pain practitioners have noticed an increase in orofacial pain symptoms across practice settings.
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Affiliation(s)
| | | | | | - Isabel Moreno-Hay
- Address correspondence to Dr. Moreno-Hay, 740 S Limestone, Lexington, KY 40536
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Huang X, Li Z, Ma J, Huang D, Yan X, Zhou H. A novel implantable device for sensory and affective assessment of orofacial pain in rats. Front Vet Sci 2022; 9:1028147. [DOI: 10.3389/fvets.2022.1028147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectiveOrofacial pain, in particular, chronic orofacial pain remains a great challenge in clinical practice. To better understand the underlying mechanism of disease, it is essential to apply a feasible and stable preclinical measurement of facial pain. Here, we introduced a novel electrical noxious stimulator in freely behavioral rodents and examined its validation in both naïve and chronic orofacial pain animals.MethodsOne subcutaneous device of electrical stimulator was implanted in the facial region for delivery of the nociceptive input. The sensory component of orofacial pain was assessed by response scoring tool, and conditioned place aversion (CPA) paradigm for pain affect respectively. To confirm its usage in chronic pain state, the chronic constriction injury of the infraorbital nerve (ION-CCI) model was then applied.ResultsWe found that responsive scores increased with stimulation intensity, and acted in a dosage-dependent manner, which can be attenuated by the administration of morphine intraperitoneally. Naïve rats displayed significant aversive reaction to the noxious electrical stimulation (25V) in the CPA testing. In addition, an obvious sensory hypersensitivity to electrical stimulation was confirmed by the increased response scores in ION-CCI rats. Furthermore, ION-CCI animal showed significant avoidance to electrical stimulation at relatively low intensity (10V), which was innoxious to naïve rats.ConclusionOur findings may provide an alternative pre-clinical measurement of orofacial pain, to quantitively assess both sensory and affective component of orofacial pain.
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Roithmann CC, Silva CAGD, Pattussi MP, Grossi ML. Subjective sleep quality and temporomandibular disorders: Systematic literature review and meta-analysis. J Oral Rehabil 2021; 48:1380-1394. [PMID: 34599524 DOI: 10.1111/joor.13265] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/11/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVES To assess the general subjective sleep quality in individuals with and without TMD, and its distribution among the TMD diagnostic groups. METHODS A systematic review search was performed in Pubmed/MEDLINE, Embase, LILACS, Web of Science, SciELO, CINAHL and Cochrane Central as well as in the grey literature. Observational studies published since 1992 which used either the DC/TMD or RDC/TMD for TMD diagnosis and either the PSQI, SAQ or ESS questionnaires for sleep assessment were included. Articles selected for meta-analysis underwent quality, heterogeneity and publication bias evaluation. RESULTS A total of 1071 articles were found by online search, and 10 articles were added manually. For full-text reading, 138 papers were selected. Thirty-six articles were included in the final review, and 19 in the meta-analysis (PSQI only). Subjective sleep quality was shown to be associated with all RDC/TMD or DC/TMD Axis I diagnostic groups: muscle disorders, arthralgia/osteoarthritis/osteoarthrosis and disk displacements; with the highest association in the first two groups, and the lowest in the last one. A 4.45 times increased odds ratio of TMD prevalence was found for individuals who presented poor subjective sleep quality. CONCLUSION Subjective sleep quality should be considered in the management of TMD.
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Affiliation(s)
- Camila Caspary Roithmann
- Post-Graduate Program in Dentistry (Prosthodontics), School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Carlos Augusto Gomes da Silva
- Post-Graduate Program in Dentistry (Prosthodontics), School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Marcos Pascoal Pattussi
- Post-Graduate Program in Public Health, Vale do Rio dos Sinos University (UNISINOS), São Leopoldo, Brazil
| | - Márcio Lima Grossi
- Post-Graduate Program in Dentistry (Prosthodontics), School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Ettlin DA, Napimoga MH, Meira E Cruz M, Clemente-Napimoga JT. Orofacial musculoskeletal pain: An evidence-based bio-psycho-social matrix model. Neurosci Biobehav Rev 2021; 128:12-20. [PMID: 34118294 DOI: 10.1016/j.neubiorev.2021.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 12/13/2022]
Abstract
Pain is a multidimensional experience comprising sensory-discriminative, affective-motivational, and cognitive-evaluative dimensions. Clinical and research findings have demonstrated a complex interplay between social burdens, individual coping strategies, mood states, psychological disorders, sleep disturbances, masticatory muscle tone, and orofacial musculoskeletal pain. Accordingly, current classification systems for orofacial pain require psychosocial assessments to be an integral part of the multidimensional diagnostic process. Here, we review evidence on how psychosocial and biological factors may generate and perpetuate musculoskeletal orofacial pain. Specifically, we discuss studies investigating a putative causal relationship between stress, bruxism, and pain in the masticatory system. We present findings that attribute brain structures various roles in modulating pain perception and pain-related behavior. We also examine studies investigating how the nervous and immune system on cellular and molecular levels may account for orofacial nociceptive signaling. Furthermore, we review evidence pointing towards associations between orofacial musculoskeletal pain and neuroendocrine imbalances, sleep disturbances, and alterations of the circadian timing system. We conclude with several proposals that may help to alleviate orofacial pain in the future.
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Affiliation(s)
- Dominik A Ettlin
- Clinic of Masticatory Disorders, Orofacial Pain Unit, Center of Dental Medicine, University of Zurich, Zurich, Switzerland; Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Berne, Berne, Switzerland.
| | - Marcelo Henrique Napimoga
- Laboratory of Neuroimmune Interface of Pain Research, Faculdade São Leopoldo Mandic, Instituto e Centro De Pesquisas São Leopoldo Mandic, Campinas, SP, Brazil
| | - Miguel Meira E Cruz
- Laboratory of Neuroimmune Interface of Pain Research, Faculdade São Leopoldo Mandic, Instituto e Centro De Pesquisas São Leopoldo Mandic, Campinas, SP, Brazil; Sleep Unit, Cardiovascular Center of University of Lisbon, Lisbon School of Medicine, Lisbon, Portugal
| | - Juliana Trindade Clemente-Napimoga
- Laboratory of Neuroimmune Interface of Pain Research, Faculdade São Leopoldo Mandic, Instituto e Centro De Pesquisas São Leopoldo Mandic, Campinas, SP, Brazil
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Bhalang K, Steiger B, Lukic N, Zumbrunn Wojczyńska A, Hovijitra RS, Ettlin DA. The Pain-to-Well-Being Relationship in Patients Experiencing Chronic Orofacial Pain. Front Neurol 2020; 11:557415. [PMID: 33343482 PMCID: PMC7744627 DOI: 10.3389/fneur.2020.557415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Orofacial pain features may negatively influence a person's well-being and vice versa. Some aspects of well-being can be measured with axis II instruments that assess patients' psychosocial and behavioral status. The aim of this study was to investigate associations between pain features and psychosocial variables as indicators of well-being. Materials and Methods: Seven hundred ninety-nine anonymized datasets collected using the Web-based Interdisciplinary Symptom Evaluation (WISE) of patients reporting to the Interdisciplinary Orofacial Pain Unit, University of Zurich, between March 19, 2017 and May 19, 2019, were analyzed. Pain features including intensity, number of locations, impact, and duration were evaluated. Psychometric measures assessed pain-related catastrophizing and disability, illness perception, distress, anxiety, depression, injustice experience, dysmorphic concerns, and insomnia. Results: Most patients were between 30 and 59 years old (58.3%), female (69.8%), working (66.0%), and experienced pain for more than 6 months (68.5%). Pain intensities were higher in women than men and higher in disabled than working patients. Scores indicating elevated stress and depression were also observed in disabled patients. The sample prevalence rates of clinically relevant axis II instrument scores were as follows: Graded Chronic Pain Scale for the Head (GCPS-H), 27%; Patient Health Questionnaire 4 (PHQ4), 21%; PHQ9, 21%; Pain Catastrophizing Scale (PCS), 20%; General Anxiety Disorder 7 (GAD7), 15%; Insomnia Severity Index (ISI), 15%; Injustice Experience Questionnaire (IEQ), 14%; GCPS for the Body (GCPS-B), 13%; PHQ for Stress (PHQstr), 6%; and Dysmorphic Concern Questionnaire (DCQ), 2%. Noteworthy results of correlation analysis of the clinically relevant axis II scores and pain measures were as follows: the PHQstr had moderate associations (0.34-0.43) with the sum of pain intensity at rest and during function, number of pain locations, and typical pain intensity. The IEQ scores were moderately associated with typical pain intensity at 0.39. The DCQ scores were moderately associated with pain extension at 0.41. Conclusions: Moderate correlations of certain pain and well-being measures were found in patients reporting clinically relevant stress, injustice experience, and dysmorphic concern, all of which reflect impaired well-being. PHQ4 is suitable for routine distress screening in the clinical setting.
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Affiliation(s)
- Kanokporn Bhalang
- Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Beat Steiger
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Aarau, Switzerland
| | - Nenad Lukic
- Orofacial Pain Unit, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | | | - Ray S Hovijitra
- Dental Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Dominik A Ettlin
- Orofacial Pain Unit, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,São Leopoldo Mandic Institute and Research Center, São Paulo, Brazil.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Berne, Berne, Switzerland
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Quality of life, chronic pain, insomnia, and jaw malfunction in patients after alloplastic temporomandibular joint replacement: a questionnaire-based pilot study. Int J Oral Maxillofac Surg 2020; 50:948-955. [PMID: 33162296 DOI: 10.1016/j.ijom.2020.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/03/2020] [Accepted: 09/25/2020] [Indexed: 11/24/2022]
Abstract
Studies of patients undergoing alloplastic total temporomandibular joint replacement seldom report on quality of life (QoL) and sleep. The aim of this pilot study was to assess these factors in such a patient cohort using validated psychometric questionnaires. Data were collected via online surveys comprising the following six questionnaires: Short Form-12 Health Survey (SF-12), Patient Health Questionnaire-15, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, Insomnia Severity Index, Graded Chronic Pain Scale, and Jaw Disability List. Pain intensity, limitation in nutrition, and treatment satisfaction were assessed using numerical rating scales. Mouth opening was measured at follow-up. The SF-12 Physical Composite Score was markedly lower than that of the age-matched general population, whereas the Mental Composite Score did not differ significantly. Participants indicated a low somatization level and low level of disability due to pain, but reduced QoL. Clinically relevant insomnia was reported by 36% of participants. In conclusion, the results of this pilot study indicate that QoL and sleep in patients with a total temporomandibular joint replacement differ from those in the general population, indicating the need for a comprehensive outcome assessment utilizing validated psychometric tools in accordance with the current biopsychosocial model of chronic disorders.
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