Orofacial Pain and Headache

Cover
Title Page
Copyright
Chapter 1: The DiagnosticProcess
Epidemiology:The Silent Crisis
Chronic Pain Is a Disease
Approach to Diagnosis and Management
Classification, Disease, and Diagnosis
Diagnosis ofOrofacial Pain
Getting to Know Your Patient and the Patient’s Pain
The Pain History
Location
Temporal behavior
Modes of onset
Pain intensity
Pain quality
Aggravating or alleviating factors
Impact on daily function and qualityof life
Sleep disruption
Associated features
Drug history as it pertains to the paincondition
Listening to the language of pain
Physical Examination
Confirmatory Tests
Choosing wisely
Establishing a Diagnosis
Diagnosis for beginners
The Patient with Pain
Genetics and epigenetics
Sex
Culture and ethnicity
Treatment
Provider Characteristics and Analgesic Prescription
Outcomes
Follow-Up
Prognosis and Long-Term Management
The Pain Clinic
Chapter 2: Anatomy and Neurophysiology of Orofacial Pain
Pain in the Orofacial and Cranial Region
Nociceptive (Normal), Inflammatory, and Neuropathic Pain
Basic types of pain
Tactile allodynia and central sensitization
The paradox of neuropathic pain
Sensory and Motor Innervation of Craniofacial Structures
Sensory neurons
Peculiarities of craniofacial sensory innervation
Fiber types
Teeth
Trigeminal mesencephalic nucleus
Embryonic origin
Innervation of the head
Overview
The trigeminal nerve
Pain and specific craniofacial structures
Skin
Nasal and oral cavities
Cornea and conjunctiva
Muscles
Dentition
Cranial bones
Craniocervical joints and mastication
Intracranial structures (brain, dura, vasculature)
Pain associated with strong stimulation of special sense organs
Autonomic innervation of trigeminalstructures
Sympathetic and parasympatheticefferents
CNS Processing ofTrigeminal Inputs
Orofacial and cranial nociceptive inputs
The brainstem trigeminal complex
Neuronal response to afferent input
Fiber type–specific input
Ascending trigeminal pathways
The trigeminal brainstem
Forebrain processing
Trigeminal pain is subject to descending control
Gate control: Modulation by peripheral input
Descending modulation from the brainstem
The cortex as a widespread source of top-down modulation
Autonomic, visceral, and neuroendocrine control
Sensory Dysfunction in Chronic OrofacialPain States
Overview
Spontaneous (ongoing) pain
Stimulus-evoked pain
Altered sensory quality
Distortions in the perception of body image
Neuropathic pain
CNS processes
Neuropathic pain: Peripheral nervous system processes
Cellular mechanisms
Central sensitization
Pain Mechanisms and Craniofacial Pain Diagnoses
Nociceptive (normal) pain
Inflammatory pain
Neuropathic pain
Acknowledgments
Chapter 3: Measuring and Assessing Pain
Methods for Pain Assessment
Pain scales
Visual analog scale
Numeric and verbal rating scales
Pain questionnaires
The McGill Pain Questionnaire
The Research Diagnostic Criteria for Temporomandibular Disorders
Spontaneous and behavioral responses
Physiologic measurements
Electromyography
Microneurography
Imaging
Quantitative Sensory Testing
QST methods
Levels of sensation
Modalities and nerve fibers
Mechanical stimuli
Thermal stimuli
Chemical stimulation
Electrical stimulation
Dynamic psychophysical testing
Clinical relevance of QST
Chapter 4: Psychologic Aspects of Chronic Orofacial Pain
Comorbidity of Psychiatric and Chronic Orofacial Pain Conditions
Psychologic Factors and Orofacial Pain:An Overview of Explanatory Models
The psychogenic model
Psychosocial stress as the link between orofacial pain and psychologic symptoms
Psychosocial stress and TMDs
Psychosocial stress and other orofacial pain conditions
Psychosocial characteristics as risk factors for pain onset
Psychosocial characteristics as risk factors for course and outcome of orofacial pain
Psychosocial characteristics as risk factors for TMD outcome
Psychosocial characteristics as risk factors for outcome in other orofacial pain disorders
Shared pathogenesis for psychiatric disorders and orofacial pain
Psychologic factors and illness behavior
Psychologic Management of Chronic Orofacial Pain
Cognitive-behavioral theory of illness behavior
Psychologic management of chronic orofacial pain
Evidence-based psychologic treatment
Cognitive therapy
Adjunctive modalities: Biofeedback and relaxation training
Screening patients for psychiatric disorder or psychologic dysfunction
Screening instruments
Referral to a mental health provider
Conclusion
Chapter 5: Orofacial Pain, Headache, and Sleep
Sleep Basics
Sleep Disturbance and Pain
Sleep disturbance and chronic pain
Sleep disturbance and pain perception measured by quantitative sensory testing
Sleep disturbance, proinflammatory substances, and pain perception
Sleep and Temporomandibular Disorders
Comorbidity with sleep disorders
Insomnia disorder and TMDs
Obstructive sleep apnea and TMDs
Sleep bruxism
Sleep and Primary Headache Disorders
Migraine
Cluster headache
Sleep and SecondaryHeadache
Obstructive sleep apnea as a cause of headache
Other Topics
Trigeminal neuralgia
Treatment of sleep disorders in patients with chronic pain
Behavioral sleep modification
Pharmacologic management of insomnia associated with chronic pain
Conclusion
Chapter 6: Acute Orofacial Pain
Caries and Symptom Progression
Epidemiology
Dental Pain
Dentinal pain
Symptoms
Physical and radiographic signs
Cracked tooth syndrome
Treatment of dentinal pain
Pulpal pain
Symptoms
Physical and radiographic signs
Treatment
Mechanisms of dental pain
Dentinal sensitivity
Pulpal pain
Differential diagnosis of odontalgia
Periodontal Pain
Acute periapical periodontitis
Symptoms
Physical and radiographic signs
Pathophysiology
Treatment
Lateral periodontal abscess
Symptoms
Physical and radiographic signs
Pathophysiology
Treatment
Interrelationships between pulpal and periodontal diseases: The “perio-endo” lesion
Treatment
Vertical root fracture
Gingival pain
Food impaction
Pericoronitis
Acute necrotizing ulcerative gingivitis
Mucosal Pain
Localized mucosal pain
Aphthous lesions
Acute herpetic gingivostomatitis
Diffuse mucosal pain
Pain from Salivary Glands
Treatment
Conclusion
Chapter 7: Otolaryngologic Aspects of Orofacial Pain
Ear Pain (Otalgia)
Common diseases causing primary otalgia
Auricular cellulitis
Relapsing polychondritis
Furuncle of the external ear canal
Acute otitis externa
Necrotizing otitis externa
Ramsay Hunt syndrome (herpes zoster oticus)
Acute otitis media
Myringitis bullosa
Eustachian tube dysfunction
Ear barotrauma
Facial Pain
Common diseases causing facial pain
Sinonasal disorders causing pain: The neurobiology of primary sinonasal pain
Rhinosinusitis
Chronic rhinosinusitis
Rhinosinusitis of dental origin: Odontogenic rhinosinusitis
Sinusitis caused by complications of sinus elevation and/or dental implants
Midfacial segment pain
Persistent idiopathic facial pain
Scuba diving and facial pain
Sphenopalatine neuralgia
Migraine and sinus headache
Throat Pain
Acute pharyngitis
Tonsillitis
Peritonsillar cellulitis and abscess
Lingual tonsillitis
Parapharyngeal space infection
Retropharyngeal space infection
Ludwig’s angina
Vestibular Syndromes Related to Orofacial Pain or Structures
Vestibular migraine
Mastication-induced vertigo and nystagmus
Chapter 8: Myalgia, Myofascial Pain, Tension-TypeHeadaches, and Fibromyalgia
Clinical Approach
Temporomandibular Disorders
Study design and reliability
Epidemiology
Signs and symptoms versus treatment need
Age distribution of TMDs
Sex
Personal and societal impact of TMDs
Myofascial Pain
Clinical features
Location and quality
Temporal pattern
Triggers
Associated signs
Physical findings
Differential diagnosis
Additional diagnostic tools
Treatment
Chronicity in myofascial pain
Physical and combined modalities
Occlusal adjustments and the management of TMDs
Occlusal splints
Pharmacologic
Biobehavioral therapy
Trigger point injections and needling
Complementary and alternative therapy
Treatment: Summary and prognosis
Pathophysiology of MFP
Historical perspective on TMD concepts
Nervous system alterations and pain modulation
Autonomic nervous system and MFP
Neuropeptides and MFP
Trauma
Psychosocial factors
Occlusion
Skeletal morphologic features and orthodontics
TMJ disorders
Muscle hyperactivity, bruxism, and MFP
Muscle hyperactivity and the pain adaptation model
Trigger points and the sympathetic nervous system
Lifestyle
Genetics
Sleep disturbance
Comorbidities
Pathophysiology: Summary
Tension-Type Headaches
Epidemiology and genetics of TTH
Episodic tension-type headache
Clinical features
Chronic tension-type headache
Chronic daily headache
Clinical features of chronic TTH
Treatment of TTH
Pharmacologic
Nonpharmacologic interventions
Clinical features
Location
Quality and severity
Temporal features
Headache onset
Accompanying signs/symptoms
Aggravating/relieving factors
Epidemiology
Treatment
Differential diagnosis
Pathophysiology
Headache, Myofascial Pains, and Fibromyalgia
Headache and masticatory myofascial pain
Fibromyalgia
Diagnosis
Clinical features
Epidemiology
Risk factors and pathophysiology
Management
Temporomandibular disorders and fibromyalgia
Headache and fibromyalgia
Future of MFP
Chapter 9: Pain and Dysfunction of the Temporomandibular Joint
Classification
Patient Assessment
Interview and clinical examination
Imaging
Other special tests
Joint sounds
Laboratory findings
Diagnosis of TM J Disorders
Historical perspective
Current thinking
The Temporomandibular Joint
Anatomy and function
Load distribution and lubrication
Innervation
Effects of inflammation
Pathophysiology of TMJ Disorders: General Factors
Intra-articular
Production of free radicals
Neuropeptides
Cytokines
Proinflammatory agents
Enzymes
Bone morphogenetic proteins and growth factors
Interactions and progressive damage
Extra-articular
Nutrition
Genetics
Sex
The Painful TM J
Arthralgia: Capsulitis and synovitis
Capsulitis
Synovitis
Derangements of the TM J
The clicking joint
Persistent click
Disc displacements
Disc displacement with reduction
Diagnostic criteria and symptomatology of intermittent clicking
Clicking joint: Treatment guidelines
Limited mouth opening
Prognosis of disc displacements
Treatment of disc displacement without reduction
Anchored disc phenomenon
Pathogenesis of anchored disc phenomenon
Treatment of anchored disc phenomenon
TMJ disorders characterized by inability to close the mouth
Open lock versus TMJ condylar dislocation
Treatment of open lock/dislocation
Degenerative Joint Disease of the TM J: Osteoarthritis
Epidemiology and clinical features
Specific comments on the pathogenesis of osteoarthritis
Imbalance in bone physiology
Metabolic syndrome and osteoarthritis
Jaw movement
Treatment of osteoarthritis
Secondary osteoarthritis
Idiopathic condylar resorption (condylysis)
Nonsurgical management of ICR
Surgical management of ICR
Pain in the TMJ: Differential Diagnosis
Treatment of TM J Disorders
Nonsurgical treatment options
Joint unloading: Functional behavioral modification
Physical therapy
Intraoral appliances
Medications
TMJ surgery
Indications
TMJ arthrocentesis
TMJ arthroscopy
Modified condylotomy
Open joint surgery (arthrotomy)
Summary
Chapter 10: Migraine and Possible Facial Variants: Neurovascular Orofacial Pain
Migraine
Migraine without aura
Clinical features
Migraine triggers
Migraine with aura
Migraine Epidemiology
Migraines and Disability
Migraine Comorbidity
Genetics
Differential Diagnosis
Tension-type headache
Sinusitis
Secondary migraine
Treatment
Abortive treatment
Nonspecific medication
Triptans
Prophylactic treatment
Principles of preventive therapy
Anticonvulsants
Beta-adrenergic blockers
Antidepressants
Migraine therapy in pregnancy
Migraine in Children and Adolescents
Prognosis
Chronic Migraine
Definition and characteristics
Epidemiology and predictors for chronicity
Disability and comorbidity
Treatment
Botulinum toxin
Clinical example
Neurovascular Orofacial Pain or Facial Migraine
Clinical features
Location
Quality and temporal pattern
Accompanying phenomena
Clinical examples
Epidemiology
Treatment
Differential diagnosis
Nosologic issues
Pathophysiology of Migraine
The trigeminovascular system
Neurogenic inflammation
The trigeminocervical complex
Central pain activation and modulation
Pathophysiology of Neurovascular Orofacial Pain
Neurogenic inflammation in oral tissues and dental pulp
The trigeminal-parasympathetic reflex in the orofacial region
Conclusion
Choosing wisely
Chapter 11: The Trigeminal Autonomic Cephalalgias
Cluster Headache
Clinical features
Clinical example
Location
Quality
Temporal pattern of individual attacks
Nocturnal attacks
Interictal pain
Cluster periods
Triggers
Nitroglycerin provocative test
Autonomic signs
Migrainous features
Laterality of features
Systemic features
Prodromata and premonitory symptoms
Patient behavior
Prognosis
Symptomatic cluster headache
Epidemiology
Genetics
Treatment
Abortive
Transitional
Prophylactic
Cluster headache refractory to pharmacotherapy
Paroxysmal Hemicrania
Clinical features
Clinical example
Location
Quality
Temporal pattern
Autonomic phenomena
Cluster headache–like features
Migrainous features
Epidemiology
Symptomatic paroxysmal hemicrania
Treatment
The indomethacin effect
Short-Lasting Unilateral Neuralgiform Headache Attacks
Clinical presentation
Clinical example
Location
Quality
Temporal pattern
Triggering
Autonomic signs
Migrainous symptoms
Patient behavior
Associated phenomena
Epidemiology
Symptomatic SUNHA
Treatment
Pharmacotherapy
Surgery
Hemicrania Continua
Clinical features
Clinical example
Location
Quality
Temporal pattern
Precipitating or aggravating factors
Physical and laboratory findings
Accompanying phenomena
Epidemiology
Symptomatic hemicrania continua
Treatment
Differential Diagnosis of TACs
Within the TACs
Migraine
Dental pain
Ocular pain
Temporomandibular disorders
Sinus headache
Trigeminal neuralgia
Combination syndromes
Cervicogenic headache
Pathophysiology of TACs
Pain
Pain and the hypothalamus
Rhythmicity and the hypothalamus
Autonomic signs and the trigeminoparasympathetic reflex
Neuropathic mechanisms
Chapter 12: Neuropathic Orofacial Pain
Clinical Approach to Neuropathic Pain
Epidemiology
Trigeminal Neuralgia
Clinical features of CTN
Classical trigeminal neuralgia, purely paroxysmal
Triggering
Features of CTN with concomitant persistent facial pain
Pretrigeminal neuralgia
CTN comorbidity
Combination syndromes
Hypertension
Other neuralgias
Differential diagnosis
Dental
SUNCT and cluster-tic syndrome
Epidemiology
Treatment
Pharmacologic
Surgical
Summary
Pathophysiology of CTN
Painful trigeminal neuropathy
Painful trigeminal neuropathy attributed to acute herpes zoster
Postherpetic neuropathy
Painful traumatic trigeminal neuropathy
Complex regional pain syndrome
Treatment of painful traumatic trigeminal neuropathies
Pathophysiology of painful traumatic neuropathies
Painful trigeminal neuropathy attributed to multiple sclerosis plaque
Painful trigeminal neuropathy attributed to space-occupying lesion
Glossopharyngeal Neuralgia
Clinical features
Location
Temporal pattern
Associated signs
Investigations
Differential diagnosis
Symptomatic glossopharyngeal neuralgia
Epidemiology
Treatment
Pharmacologic
Surgical
Pathophysiology
Nervus Intermedius (Facial Nerve) Neuralgia
Treatment
Occipital Neuralgia
Clinical features
Location
Associated features
Investigations
Differential diagnosis
Treatment
Burning Mouth Syndrome
Epidemiology
Clinical features
Location
Temporal pattern
Associated signs
Secondary BMS
Treatment
Pathophysiology
Burning mouth syndrome and taste
Burning mouth syndrome as a painful neuropathy
Persistent Idiopathic Facial Pain
Clinical features
Atypical Odontalgia
Central Causes of Facial Pain
Central post-stroke pain
Clinical features
Pathophysiology
Epidemiology
Chapter 13: Neurosurgical Aspects of Orofacial Pain
Intracranial Sources
Vascular
Neoplastic
Incidence
Tumor types
Other
Neurosurgical Interventions for Orofacial Pain
Trigeminal neuralgia
Peripheral neurectomy
Percutaneous trigeminal rhizotomy
Microvascular decompression
Stereotactic radiosurgery
Timing and choice of neurosurgical procedure in trigeminal neuralgia
Trigeminal neuralgia secondary to multiple sclerosis
Glossopharyngeal neuralgia
Geniculate neuralgia
Trigeminal autonomic cephalalgias
Atypical facial pain
Conclusion
Chapter 14: Secondary Orofacial Pain and Headache: Systemic Diseases, Tumors, and Trauma
Orofacial Pain in Metabolic and Endocrine Disorders
Diabetic neuropathy
Alcohol and nutritional neuropathy
Hypothyroidism
Orofacial Pain in Joint Disorders
Rheumatoid arthritis
Psoriatic arthritis
Ankylosing spondylitis
Infectious arthritis
Hyperuricemia
Reiter syndrome
Neck-tongue syndrome
Orofacial Pain in Bone Disorders
Osteoporosis
Paget’s disease
Orofacial Pain in Immunologically Mediated Diseases
Systemic lupus erythematosus
Sjögren’s syndrome
Systemic sclerosis (scleroderma)
Mixed connective tissue disorder
Antiphospholipid syndrome
Allergy
Wegener’s granulomatosis
Neurosarcoidosis
Melkersson-Rosenthal syndrome
Giant cell arteritis
Behçet’s disease
Orofacial Pain in Neurologic Disorders
Cerebrovascular accident
Intracranial pressure
Orofacial Pain in Cardiovascular Diseases
Orofacial pain in hypertension
Orofacial pain of cardiac origin
Cervical artery dissection
Orofacial Pain in Blood Disorders
Orofacial Pain in Dialysis and Renal Disorders
Orofacial Pain in Pulmonary Diseases
Orofacial Pain in Patients with Cancer
Orofacial pain due to cancer
Pain in regional malignancy
Pain secondary to malignancy at a distant site
Orofacial pain due to cancer therapy
Pain due to conventional chemotherapy and radiotherapy
Pain due to surgical procedures
Orofacial pain of noncancerous etiology in patients with cancer
Treatment of orofacial pain in patients with cancer
Prevention of mucosal damage
Basic oral care
Systemic medications
Complementary pain management strategies
Orofacial Pain in Patients with HIV
HIV-related headache
HIV-related oral painful mucosal lesions
HIV-related neuropathy
Aggregation Disease
Fabry disease
Amyloidosis
Craniofacial Pain Related to Miscellaneous Medical Conditions
Medication-overuse headache
Tolosa-Hunt syndrome
Cervicogenic headache
Craniofacial pain attributed to trauma or injury to the head and/or neck
CFPATI epidemiology and risk factors
CFPATI clinical features and comorbidity
CFPATI pathophysiology
CFPATI treatment
Other types of craniofacial pain attributed to trauma
Paratrigeminal oculosympathetic syndrome
Conclusion
Chapter 15: Pharmacotherapy for Acute Orofacial Pain
Pharmacotherapy Strategy for Acute Orofacial Pain
Commonly Used Analgesics for Acute Orofacial Pain
Efficacy of analgesics
Acetaminophen (paracetamol)
Mode of action
Efficacy
Clinical considerations
Conventional NSAIDs
Ibuprofen
Ibuprofen and acetaminophen combined
Naproxen
Etodolac
Diclofenac
Indomethacin
Selective COX-2 inhibitors (coxibs)
Rofecoxib
Celecoxib
Etoricoxib
Valdecoxib
Lumiracoxib
Dual-acting NSAIDs
NSAIDs: Conclusion
Dipyrone
Clinical considerations
Opioids
Multiple opioid receptors
Mechanisms and sites of opioid-induced analgesia
Efficacy for acute pain
Adverse effects
Administration for chronic pain
Analgesic Drug Combinations
Acetaminophen in combination with opioids
Codeine and acetaminophen
Oxycodone and acetaminophen
Tramadol and acetaminophen
NSAID drug combinations
NSAIDs and opioids
NSAIDs and acetaminophen
Mechanisms of Analgesia
The inflammatory soup
Prostaglandins
Modes of action of NSAIDs
COX isoforms
Adverse Effects ofAnalgesics
Gastrointestinal
Pathophysiology
Epidemiology
Risk factors
Clinical spectrum of injury
Prevention and management
Cardiovascular
Risk for myocardial infarction and ischemic stroke
Hypertension
Platelet effects and concomitant aspirin use
American Heart Association statement
Renal
Hypersensitivity reaction
Considerations for Analgesic Use
Pregnancy and breastfeeding
Pharmacogenomics
Chapter 16: Pharmacotherapy for Chronic Orofacial Pain
Treatment Approach
Drug Prescription and Treatment Plan
Assessing Drug Effects
Randomized controlled trials
Expressing drug efficacy
Systemic Drugs Used in the Management of Chronic Pain
Antidepressants
Tricyclic antidepressants
Venlafaxine/desvenlafaxine
Duloxetine
Antiepileptic drugs
Modes of action
Antiepileptic drug hypersensitivity syndrome
Carbamazepine
Oxcarbazepine
Valproate
Gabapentin
Pregabalin
Clonazepam
Topiramate
Lamotrigine
Antihypertensives
Beta-adrenergic receptor blockers: Propranolol
Mode of action
Efficacy
Adverse effects
Calcium antagonists: Verapamil and flunarizine
Mode of action
Efficacy
Adverse effects
Muscle Relaxants
Cyclobenzaprine
Mode of action
Efficacy
Adverse effects
Baclofen
Mode of action
Efficacy
Adverse effects
Triptans
Mode of action
Cannabinoids
Mode of action
Efficacy
Adverse effects
NMDA Receptor Antagonists
Onabotulinumtoxin A
BoNT and migraine
BoNT in trigeminal neuralgia and other neuropathic pain
BoNT and muscle pain
Topical Therapy for the Management of Pain
Topical anesthetics
Topical NSAIDs
Capsaicin
Low-concentration capsaicin
Capsaicin 8%
Mode of action
Antidepressants
Opioids
Corticosteroids (steroids)
Chapter 17: Complementary and Alternative Medicine
What Is CAM?
The Placebo Effect and CAM
Conclusions
CAM and Chronic Facial Pain
Facial pain and acupuncture
Facial pain, relaxation, and hypnosis
Conclusions
CAM and Headaches
Headaches and acupuncture
Headaches and behavioral management
Conclusions
Mechanisms of Acupuncture
Omega-3 Fatty Acids
Conclusions
Index