Is myofascial pain of the temporal muscles relieved by oral sumatriptan? A cross-over pilot study
ABSTRACT There is evidence that serotonin may be implicated in the pathophysiology of myofascial pain (MFP). Because of this, we used oral sumatriptan (Imitrex, Glaxo), a peripherally acting agonist of 5-HT1D receptors, in a double-blind, randomized, placebo-controlled double crossover pilot study of 7 patients with episodic MFP of the temporalis muscles. The results showed that there was a significant reduction in pain intensity and increase in pain relief over time with both the active medication and the placebo, but no significant difference between treatments. All but 1 patient reported that they are not interested in retaking the same medication. These data suggest that oral sumatriptan may not be the drug of choice in the control of episodic MFP.
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ABSTRACT: Cervical spinal pain is frequently found in conjunction with idiopathic cervical dystonia (ICD), a focal dystonia characterized by sustained deviation of the head. Since the perception of noxious stimuli has never been studied in ICD, we performed a controlled study to obtain more insight into the psychophysics of dystonia-related muscle pain by evaluating pressure-induced pain levels. In nine ICD patients and five gender- and age-matched asymptomatic control subjects, pain-pressure thresholds (PPTs) were determined in the sternocleidomastoid and upper trapezius muscles, both at resting activity and at maximal voluntary contraction (MVC). The masseter muscles served as non-pathological control regions. To determine the accuracy of PPT values, pain intensity and unpleasantness were rated at threshold on 100-mm visual analogue scales. Four replication measurements were obtained. The data were analyzed by multilevel procedures. For all muscles under investigation, average PPTs of the ICD patients were about two times lower than those of the control subjects (P < 0.001-0.0005) and showed a smaller intra-subject variance. Further, average PPTs at MVC were about two times higher than those at resting activity (P < 0.005). These results provide psychophysical evidence to suggest that, at controlled levels of muscle contraction, the threshold of pain perception is decreased in ICD. In addition, ICD patients seem to be better able to establish their own PPTs than control subjects, which might be due to a different setting of the discriminative aspect of pain in ICD. Surprisingly, lower intensity and unpleasantness scores were found in ICD patients with coinciding painful and deviated sides than in ICD patients for whom the painful side was opposite to the deviated one (P < 0.05). This finding might be of clinical importance for defining functional disability and predicting treatment outcome.Pain 10/1996; 67(2-3):483-91. DOI:10.1016/0304-3959(96)03153-3 · 5.84 Impact Factor
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ABSTRACT: Despite the extensive use of oral splints in the treatment of temporomandibular disorders (TMD) and bruxism, their mechanisms of action remain controversial Various hypotheses have been proposed to explain their apparent efficacy (i.e., true therapeutic value), including the repositioning of condyle and/or the articular disc, reduction in the electromyographic activity of the masticatory muscles, modification of the patient's "harmful" oral behavior, and changes in the patient's occlusion. Following a comprehensive review of the literature, it is concluded that any of these theories is either poor or inconsistent, while the issue of true efficacy for oral splints remains unsettled. However, the results of a controlled clinical trial lend support to the effectiveness (i.e., the patient's appreciation of the positive changes which are perceived to have occurred during the trial) of the stabilizing splint in the control of myofascial pain. In light of the data supporting their effectiveness but not their efficacy, oral splints should be used as an adjunct for pain management rather than a definitive treatment. For sleep bruxism, it is prudent to limit their use as a habit management aid and to prevent/limit dental damage potentially induced by the disorder. Future research should study the natural history and etiologies of TMD and bruxism, so that specific treatments for these disorders can be developed.Critical Reviews in Oral Biology & Medicine 02/1998; 9(3):345-61. DOI:10.1177/10454411980090030701
Article: Outcome measures in pain therapy[Show abstract] [Hide abstract]
ABSTRACT: The context of the current outcome movement is discussed and different outcome measures are presented. One central issue is analysing the advantages and drawbacks of the various methods of assessing pain. However, relying solely on pain as an outcome measure is mostly inadequate in chronic conditions: the report of pain itself is already influenced by psychosocial factors, which, in turn, are themselves substantially related to outcome and are therefore considered to be important outcome variables. The impact of pain on psychological as well as work-related factors is emphasized, and appropriate ways of measuring improvement, and distinguishing statistically from clinically important change, are presented. Basic principles to develop and use good outcome assessment need to be observed.Baillière s Clinical Anaesthesiology 03/1998; DOI:10.1016/S0950-3501(98)80003-2