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Biomedical subjects

J P Okeson

Publications and source records attributed to J P Okeson.

At least 19 recordsLinked to original sources
PubMed2004

Psychological and sleep quality differences between chronic daily headache and temporomandibular disorders patients.

The aim of this study was to investigate whether chronic daily headache (CDH) and temporomandibular disorders (TMD) patients present with different psychological and sleep quality characteristics. Sixty-seven patients diagnosed with CDH, according to classification criteria from Silberstein et al., were matched by age and sex with 67 patients who had a primary diagnosis of myofascial pain (MP) and 67 patients with a primary diagnosis of TMJ intracapsular pain (IC) according to the Research Diagnostic Criteria for TMD. The CDH group was comprised of three mutually exclusive diagnostic groups: chronic migraine (n = 35); chronic tension-type headache (n = 26); 'other CDH' (n = 6). All patients completed a battery of psychological and sleep quality questionnaires. All CDH subgroups showed similar psychological and sleep quality profiles. Pain intensity and duration were controlled in the multivariate analyses (Mancova) by treating them as covariates. The CDH and MP groups revealed higher levels of psychological distress than the IC group on most psychological domains. The MP group also revealed numerically higher levels of psychological distress in most psychological domains than the CDH group, although these differences were generally not significant. We did not find significant differences between the three groups on post traumatic stress symptoms either. Sleep quality was significantly worse in the MP group than in the CDH and IC groups. These results are discussed in the context of multimodal patient evaluation and treatments that are often necessary for successful clinical management.

Adolescent↗
PubMed2001

Orofacial pain emerging as a dental specialty.

The emerging field of orofacial pain was considered by the American Dental Association for full status as a new dental specialty. While the recognition of orofacial pain as a specialty was denied, the American Academy of Orofacial Pain plans to continue its efforts. Many recent advances in the neuroscience of orofacial pain have led to treatments that provide significant relief for patients with chronic orofacial pain disorders. However, access to this care has been limited, leaving many patients to suffer. Dentists are generally supportive of the efforts to develop oral pain treatment into a specialty because the field will provide benefits for both dentists and their patients. A recent survey of 805 individuals who reported having a persistent pain disorder revealed that more than four out of 10 people have yet to find adequate relief, saying their pain is out of control--despite having the pain for more than five years and switching doctors at least once. "This survey suggests that there are millions of people living with severe uncontrolled pain," says Russell Portenoy, MD, president of the American Pain Society. "This is a great tragedy. Although not everyone can be helped, it is likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed." Development of the field of orofacial pain into a dental specialty has been moved primarily by the fact that historically, patients with complex chronic orofacial pain disorders have not been treated well by any discipline of healthcare. Recent studies of chronic orofacial pain patients have found that these patients have a higher number of previous clinicians and have endured many years with pain prior to seeing an orofacial pain dentist (see Figure 1). Complex pain patients and the clinicians who see them are often confused about who they should consult for relief of the pain. Treatment for those patients within the existing structure of dental or medical specialties has been inadequate, with millions of patients left suffering. Insurers are also confused with regard to reimbursement and may make decisions to exclude treatment for orofacial pain disorders under both dental and medical policies. However, dentistry has taken a leading role in healthcare to address the national problem of developing the field of orofacial pain into a dental specialty. A study of dentists and dental specialists has shown that there is a recognized need and broad support for developing this field into a specialty.

Adult↗
PubMed2001

Orofacial pain as the sole manifestation of syringobulbia-syringomyelia associated with Arnold-Chiari malformation.

This is a case report of a male patient who presented with orofacial pain for a year as the only manifestation of syringobulbia-syringomyelia associated with Arnold-Chiari malformation. This article places emphasis on the clinical presentation and possible differential diagnoses. The pain was continuous and affected the left side of the face. It was exacerbated by coughing and physical effort, possibly as a consequence of an increase in intracranial pressure. Paroxysmal pain crises developed over this background of continuous pain, compatible with neurogenic trigeminal pain of the left second branch, together with pain episodes similar to cluster headache on the same side. The symptoms were resolved following neurosurgical management with amplification of the foramen magnum.

Arnold-Chiari Malformation↗
PubMed2000

Broad support sought for emerging specialty of orofacial pain.

The American Dental Association is considering giving the emerging field of orofacial pain full status as a new dental specialty. Many recent advances in the neuroscience of orofacial pain have lead to treatments by orofacial pain dentists that provide significant relief for patients with chronic disorders. However, access to this care has been limited, leaving many patients to continue to suffer. Recent efforts to improve this situation by developing the field into a specialty have received broad support among dentists and have increased awareness of the benefits this field can provide for dentists and their patients.

American Dental Association↗
PubMed2000

Influence of biased clinician statements on patient report of referred pain.

AIMS: The purpose of this study was to examine the influence of clinician bias on patients' reports of referred pain. Diagnosis of temporomandibular disorders is dependent on subjective reports of pain and referred pain upon manual muscle palpation. The influence of biased clinician statements in such subjective reports has not been previously investigated. METHODS: Forty subjects with pain and who met specific inclusion criteria were randomly assigned to 1 of 2 experimental groups. One group was subjected to a standardized biasing statement, while the other group was not. Tender points in the masseter muscle were then stimulated with a pressure algometer to the pressure-pain threshold. Subjects then recorded the presence or absence, location, intensity, and unpleasantness of any referred pain. State-trait anxiety and social desirability were also assessed to explore the possibility that anxiety levels or subjects' desires to please the experimenter influenced results. RESULTS: The biased group reported increased presence (P < 0.01), intensity (P < 0.001), and unpleasantness (P < 0.003) of referred pain as compared to the non-biased group. There were no differences between groups on state-trait anxiety or social desirability (P > 0.05). CONCLUSION: These data suggest that patient reports of pain referral may be subject to clinician bias, and recommendations to control this bias are offered.

Adolescent↗
PubMed2000

Broad support evident for the emerging specialty of orofacial pain.

The emerging field of Orofacial Pain is being considered by the American Dental Association for full status as a new dental specialty. Many recent advances in the neuroscience of orofacial pain have lead to treatments by orofacial pain dentists that provide significant relief for patients with chronic orofacial pain disorders. However, access to this care has been limited leaving many patients to continue to suffer. Subsequently, recent efforts to improve this by developing the field into a specialty have shown broad support among dentists and increased awareness of the benefits this field can provide for dentists and their patients. A recent survey of 805 individuals in the general population who reported having a persistent pain disorder revealed that more than four out of 10 people have yet to find adequate relief, saying their pain is out of control-despite having the pain for more than 5 years and switching doctors at least once. "This survey suggests that there are millions of people living with severe uncontrolled pain," says Russell Portenoy, MD, President of the American Pain Society. "This is a great tragedy. Although not everyone can be helped, it is very likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed." (1). Development of the field of Orofacial Pain into a dental specialty has been motivated primarily by this issue; patients with complex chronic orofacial pain disorders have not been historically treated well by any discipline of health care. Recent studies of chronic orofacial pain patients have found that these patients have a high number of previous clinicians and have endured many years with pain prior to seeing an orofacial pain dentist (2) (Fig. 1). Complex pain patients and the clinicians who see them are often confused about whom they should consult for relief of the painful disorder. Treatment for these patients within the existing structure of dental or medical specialties has been inadequate and millions of patients are left suffering. Insurers are also confused with regard to reimbursement and make decisions to exclude treatment for orofacial pain disorders under both dental and medical policies. However, Dentistry has taken a leading role in health care to address this national problem by developing the field of Orofacial Pain into a dental specialty. A study of dentists and dental specialists have shown that there is a recognized need and broad support for further development of this field into a new dental specialty(3).

Adult↗
PubMed2000

Broad support evident for the emerging specialty of orofacial pain.

The emerging field of orofacial pain is being considered by the American Dental Association for full status as a new dental specialty to improve the care for these patients. The broad support among dentists for this initiative stems from an awareness of the benefits the field can provide for dentists and their patients.

Adult↗
PubMed2000

Nonodontogenic toothache.

Toothache is a common complaint in the dental office. Most toothaches have their origin in the pulpal tissues or periodontal structures. These odontogenic pains are managed well and predictably by dental therapies. Nonodontogenic toothaches are often difficult to identify and can challenge the diagnostic ability of the clinician. The most important step towards proper management of toothache is to be suspicious that the pain may not be of dental origin. The cardinal warning symptoms of nonodontogenic toothache are as follows (28): a. spontaneous multiple toothaches; b. inadequate local dental cause for the pain; c. stimulating, burning, nonpulsatile toothaches; d. constant, unremitting, nonvariable toothaches; e. persistent, recurrent toothaches; f. local anesthetic blocking of the offending tooth does not eliminate the pain; and g. failure of the toothache to respond to reasonable dental therapy.

Facial Pain↗
PubMed1999

Toothache of cardiac origin.

Pain referred to the orofacial structures can sometimes be a diagnostic challenge for the clinician. In some instances, a patient may complain of tooth pain that is completely unrelated to any dental source. This poses a diagnostic and therapeutic problem for the dentist. Cardiac pain most commonly radiates to the left arm, shoulder, neck, and face. In rare instances, angina pectoris may present as dental pain. When this occurs, an improper diagnosis frequently leads to unnecessary dental treatment or, more significantly, a delay of proper treatment. This delay may result in the patient experiencing an acute myocardial infarction. It is the dentist's responsibility to establish a proper diagnosis so that the treatment will be directed toward the source of pain and not to the site of pain. This article reviews the literature concerning referred pain of cardiac origin and presents a case report of toothache of cardiac origin.

Angina Pectoris↗
PubMed1997

Current terminology and diagnostic classification schemes.

This article reviews the current terminology and classification schemes available for temporomandibular disorders. The origin of each term is presented, and the classification schemes that have been offered for temporomandibular disorders are briefly reviewed. Several important classifications are presented in more detail, with mention of advantages and disadvantages. Final recommendations are provided for future direction in the area of classification schemes.

Humans↗
PubMed1997

Nonodontogenic toothache.

Toothache is a common complaint in the dental office. Most toothaches have their origin in the pulpal tissues or periodontal structures. These odontogenic pains are managed well and predictably by dental therapies. Nonodontogenic toothaches are often difficult to identify and can challenge the diagnostic ability of the clinician. The most important step toward proper management of toothache is to consider that the pain may not be of dental origin. Signs and symptoms suggestive of nonodontogenic toothache are as follows: 1. Inadequate local dental cause for the pain. 2. Stimulating, burning, nonpulsatile toothaches. 3. Constant, unremitting, nonvariable toothaches. 4. Persistent, recurrent toothaches over months or years. 5. Spontaneous multiple toothaches. 6. Local anesthetic blocking of the suspected tooth does not eliminate the pain. 7. Failure to respond to reasonable dental therapy of the tooth.

Anesthetics, Local↗
PubMed1996

Ambulatory electromyogram activity in the upper trapezius region: patients with muscle pain vs. pain-free control subjects.

STUDY DESIGN: This study compared the ambulatory electromyogram activity of persons reporting pain in the shoulder and cervical regions with an equal group of persons not reporting such pain. Ambulatory electromyogram data were obtained over 3-day periods. In addition, all participants completed several standard psychological questionnaires. OBJECTIVES: The results were analyzed with inferential statistics to determine whether subjects reporting significant pain in the shoulder and cervical regions had greater ambulatory electromyogram activity than an equal number of subjects not reporting pain. SUMMARY OF BACKGROUND DATA: Considerable controversy exists regarding the role of muscle activity in the etiology and maintenance of muscle pain disorders. Given the availability of ambulatory recording devices that can provide a detailed record of muscle activity over an extended period of time, the present research was conducted to determine whether persons reporting shoulder and cervical pain could be differentiated from a group of normal subjects. METHODS: All subjects (N = 20) completed a battery of tests with standardized psychometric instruments and then were fitted with ambulatory electromyogram monitors to record electromyographic activity of the upper trapezius region of the dominant side; the time, duration, and amplitude of electromyogram activity greater than 2 microV was recorded. The monitors were worn during normal working hours (mean, 6.2 hours per day) over 3 consecutive days. In addition to wearing the monitors, all subjects completed hourly self-ratings of perceived muscle tension during the recording periods. RESULTS: As expected, subjects with muscle pain reported significantly more pain (mean, 4.9) than did the normal control subjects (mean, 0.9), t(15) = 3.29, P < 0.01. However, patients with muscle pain did not have greater average electromyogram activity (mean, 6.4 microV) over the 3-day period as compared to the normal controls (mean, 7.1 microV), t(18) = -0.25, P < 0.80. Self-monitoring of perceived muscle tension also did not reveal differences between pain subjects and the normal control subjects (P < 0.75). CONCLUSIONS: Ambulatory measurements of electromyogram activity did not differentiate persons reporting upper trapezius or cervical pain from those that did not report such pain. Persons reporting pain are also not distinguishable from normal control subjects on a variety of self-report measures. These results raise questions regarding the role of ambulatory electromyogram recordings in the evaluation and treatment of muscle pain disorders.

Adult↗
PubMed1996

Temporomandibular disorders in the medical practice.

Patients suffering with various orofacial pain conditions are likely to seek advice and treatment from a family physician. Temporomandibular disorders (TMD) are common in the general population, and the clinician should be aware of the common associated signs and symptoms so that proper therapy can be provided. The family physician can often provide initial therapies that are effective in reducing TMD symptoms. In some instances, it is appropriate for the family physician to refer the patient to a dentist for a more comprehensive evaluation of the masticatory system. This article describes the common patient complaints associated with TM disorders. A few simple therapies are discussed along with suggestions regarding the appropriate time for referral to a dentist for a thorough dental evaluation.

Family Practice↗
PubMed1996

Emotional and physiologic responses to laboratory challenges: patients with temporomandibular disorders versus matched control subjects.

This study explored psychologic and physiologic factors differentiating patients with temporomandibular disorders (n = 23) from sex-, age-, and weight-matched asymptomatic control subjects. Each subject completed several standard psychologic questionnaires and then underwent two laboratory stressors (mental arithmetic and pressure-pain stimulation). Results indicated that patients with temporomandibular disorders had greater resting respiration rates and reported greater anxiety, sadness, and guilt relative to control subjects. In response to the math stressor, patients with temporomandibular disorders reacted with greater anger than did control subjects. There were no differences between patients with temporomandibular disorders and control subjects on pain measures or any other measured variable for the pressure-pain stimulation trial. In addition, there were no differences in electromyography levels between patients with temporomandibular disorders and control subjects. The results are discussed in terms of their implications for the etiology and treatment of this common and debilitating set of disorders.

Adult↗
PubMed1995

The relationship between forward head posture and temporomandibular disorders.

This study investigated the relationship between forward head posture and temporomandibular disorder symptoms. Thirty-three temporomandibular disorder patients with predominant complaints of masticatory muscle pain were compared with an age- and gender-matched control group. Head position was measured from photographs taken with a plumb line drawn from the ceiling to the lateral malleolus of the ankle and with a horizontal plane that was perpendicular to the plumb line and that passed through the spinous process of the seventh cervical vertebra. The distances from the plumb line to the ear, to the seventh vertebra, and to the shoulder were measured. Two angles were also measured: (1) ear-seventh cervical vertebra-horizontal plane and (2) eye-ear-seventh cervical vertebra. The only measurement that revealed a statistically significant difference was angle ear-seventh cervical vertebra-horizontal plane. This angle was smaller in the patients with temporomandibular disorders than in the control subjects. In other words, when evaluating the ear position with respect to the seventh cervical vertebra, the head was positioned more forward in the group with temporomandibular disorders than in the control group (P < .05).

Adolescent↗
PubMed1995

Occlusion, Orthodontic treatment, and temporomandibular disorders: a review.

A review of the current literature regarding the interaction of morphologic and functional occlusal factors relative to TMD indicates that there is a relatively low association of occlusal factors in characterizing TMD. Skeletal anterior open bite, overjets greater than 6 to 7 mm, retruded cuspal position/intercuspal position slides greater than 4 mm, unilateral lingual crossbite, and five or more missing posterior teeth are the five occlusal features that have been associated with specific diagnostic groups of TMD conditions. The first three factors often are associated with TMJ arthropathies and may be the result of osseous or ligamentous changes within the temporomandibular articulation. With regard to the relationship of orthodontic treatment to TMD, the current literature indicates that orthodontic treatment performed during adolescence generally does not increase or decrease the odds of developing TMD later in life. There is no elevated risk of TMD associated with any particular type of orthodontic mechanics or with extraction protocols. Although a stable occlusion is a reasonable orthodontic treatment goal, not achieving a specific gnathologically ideal occlusion does not result in TMD signs and symptoms. Thus, according to the existing literature, the relationship of TMD to occlusion and orthodontic treatment is minor. Signs and symptoms of TMD occur in healthy individuals and increase with age, particularly during adolescence; thus, TM disorders that originate during various types of dental treatment may not be related to the treatment but may be a naturally occurring phenomenon.

Adolescent↗
PubMed1995

Occlusion and functional disorders of the masticatory system.

Understanding the relationship between occlusion and functional disorders of the masticatory system is no easy task. This article explores the static, functional, and dynamic relationships of the occlusal condition to the signs and symptoms of masticatory dysfunction. Some possible relationships are discussed.

Bruxism↗