Cortical power spectrum (CPS) is a quantitative estimate of EEG spectral power density. The CPS provides suitably precise data for quantification and statistical inference compared to the qualitative evaluation of EGG when interpreted by clinicians or researchers. In the past decade, the CPS has been applied to the studies of cognitive functions, memory, psi phenomena, speech laterality, and states of consciousness including coma, sleep, anesthesia, pathophysiology and pain state. However, few systematic evaluations of CPS methodology have been reported, rendering cross-laboratory comparisons difficult and external validity of experimental results uncertain. This report first describes a calibration procedure employing a microcomputer system for measuring the functional relationship between input signals and output cortical powers. Second, we examine controlled behavioral artifact effects on the CPS. The behavioral artifacts observed in the CPS can provide a measurement anchor for less ambiguous interpretation of CPS experiments conducted in clinical or laboratory settings.

Cerebral Cortex↗

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Chronic pain and use of ambulatory health care.

Chronic pain status and health care utilization were assessed in a probability sample of 1016 adult HMO enrollees, and among 242 HMO enrollees seeking treatment for Temporomandibular Disorder (TMD) pain. Likelihood of health care contact for a painful symptom: Among persons reporting back pain, headache, chest pain, abdominal pain or temporomandibular pain in the prior six months, we evaluated whether (1) pain characteristics (severity, persistence, recency of onset), and (2) psychological distress were associated with the likelihood of recent use of health care for each pain symptom. Severity, persistence, and recency of onset of pain were generally associated with recent health care contact for a pain symptom. Females with a pain symptom were no more likely than males to report recent health care contact for the symptom after controlling for pain characteristics. The presence of psychological distress did not increase the likelihood of health care contact for individual pain symptoms. However, psychologically distressed persons were more likely to report pain at multiple anatomical sites and to report recent health care contact for one or more of the five pain symptoms (as a group). Chronic pain status and total use of ambulatory health care: Total number of health care visits (irrespective of reason for visit) was measured by automated data. Chronic pain status (summarized across all five anatomical sites) showed a modest correlation with the volume of health care use. Persons with recurrent pain and severe-persistent pain with no pain-related disability days used ambulatory care at rates close to population means. Persons with severe-persistent pain and seven or more pain related disability days used health care at rates substantially above population means. There was a statistically significant association between the volume of health care use and chronic pain after controlling for age, sex, self-rated health status, and psychological distress.

Adult↗

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Dental and associated attitudinal aspects of heroin addiction: a pilot study.

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Adolescent↗

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Behavioral dentistry: a renewed paradigm for the future.

The clinical field of behavioral medicine has become firmly entrenched as an indispensable part of modern health care. From a biopsychosocial perspective, susceptibility to disease invokes a powerful mix of complex factors beyond biology. Behavioral pathogens can be identified which cause us to get sick, stay sick, and resist sound treatment. Biopsychosocially based scientific inquiry can contribute to a more enriched understanding of fear of dental procedures, management of pain, prevention of oral malignancy, and changing patterns in availability of dental care. Dentistry will need to take new directions in research to understand behavioral and psychosocial factors as well as biologic factors that promote and contribute to health and disease.

Behavior↗

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Diagnostic studies of temporomandibular disorders: challenges from an epidemiologic perspective.

UNLABELLED: Adequate data on the incidence, prevalence, natural history, and clinical course of temperomandibular disorders (TMD) and other chronic pain conditions are largely lacking, though the need to derive such basic data is recognized by clinicians, researchers, and public health agencies. This paper discusses challenges to the epidemiologic study of TMD diagnosis. These challenges include:• CASE DEFINITION: There is currently poor agreement regarding which combinations of clinical and psychosocial findings differentially define cases of TMD• Differentiation of normal variation v pathophysiologic signs: To what extent do commonly gathered clinical measurements constitute pathophysiologic signs of TMD v reflect normal biologic variation• Reliability of clinical measurement: Factors influencing reliability of clinical signs and reliability of examiners have not been adequately assessed• Progressive v self-limiting disease activity: Do TMD subtypes represent a continuum of pathologic disease activity, or nonmutually exclusive categories describing largely symptomatic pain conditions that are selflimiting or stable.It is recommended that epidemiologic studies not be constrained by a priori definitions of TMD subtypes, but continue to gather data on clinical signs and symptoms that have theoretical and clinical relevance to mandibular dysfunction and psychosocial status. An approach is proposed for development of reliable and valid criteria of TMD subtypes suitable for epidemiologic research.

Chronic Disease↗

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Integrating behavioral and pharmacological therapeutic modalities.

Fear of dental procedures and associated anxiety are widely accepted as important deterents to optimal oral health. Such health care-related fears and anxieties are also common in many areas of medicine. For both medical and dental care a large body of psychologically derived therapeutic modalities have evolved. These methods have been shown to interact positively with pharmacological therapies also designed to help patients better tolerate medical and dental treatment. Despite these findings, behavioral interventions have not found widespread acceptance in medical and dental practice. A multidimensional model which emphasizes the simultaneous consideration of pharmacologic, psychologic, and clinical dental factors is suggested in order to arrive at therapeutic decisions. Further research could address more powerful behavioral modalities, safer pharmacologic methods, and behavioral and pharmacologic combinations which interact optimally for particular clinical conditions.

Adult↗

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Analgesic action of intravenous diazepam.

Intravenous diazepam is commonly used in clinical dentistry to produce sedation for dental procedures. Its chief benefit seems to derive from its sedative and amnesic properties. The literature contains conflicting reports about the direct analgesic effects of the drug. In the present study, we observed significant increases for conventional pain threshold measures in response to electric tooth pulp stimulation and decreased sensitivity to a fixed painful stimulus when diazepam was administered intravenously using clinical criteria for conscious sedative dosages. The data support the possibility that intravenously administered diazepam in conscious sedative doses may have some analgesic action in addition to its better documented sedative and amnesic properties.

Adult↗