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Biomedical subjects

Steven B Graff-Radford

Publications and source records attributed to Steven B Graff-Radford.

13 recordsLinked to original sources
PubMed2007

Temporomandibular disorders and headache.

Headache is a common symptom, but when severe, it may be extremely disabling. It is assumed that patients who present to dentists with headache often are diagnosed with a temporomandibular disorder (TMD), although many may have migraine. TMD as a collective term may include several clinical entities, including myogenous and arthrogenous components. Because headache and TMD are so common they may be integrated or separate entities. Nevertheless, the temporomandibular joint (TMJ) and associated orofacial structures should be considered as triggering or perpetuating factors for migraine. This article discusses the relationship between the TMJ, muscles, or other orofacial structures and headache.

Facial Pain↗
PubMed2006

Chronic headache.

Explore the source record for details and available documents.

Antidepressive Agents↗
PubMed2004

Myofascial pain: diagnosis and management.

Clinical understanding and management of myofascial pain is overlooked frequently when dealing with pain. Myofascial pain is defined as pain or autonomic phenomena referred from active trigger points, with associated dysfunction. The trigger point is a focus of hyperirritability in the muscle that, when compressed, is locally tender and, if sensitized, gives rise to referred pain and tenderness. The pain quality is dull or achy and associated with autonomic changes. Myofascial pain is poorly understood, which results too often in underdiagnosis and poor management. The pathogenesis likely has a central mechanism with peripheral clinical manifestations. The therapy for myofascial pain requires enhancing central inhibition through pharmacology or behavioral techniques and simultaneously reducing peripheral inputs through physical therapies including exercises and trigger point-specific therapy.

Analgesics↗
PubMed2004

Obstructive sleep apnea and cluster headache.

UNLABELLED: A patient with cluster headache often wakes from sleep. The relationship to sleep apnea has been described. This study sought to confirm the relationship cluster may have with sleep apnea. METHODS: Thirty-nine consecutive patients diagnosed with episodic cluster headache according to the International Headache Society (IHS) criteria were sent for polysomnographic studies. All patients were in an active phase when they were in the study. Patients were told of the proposed relationship and were allowed to choose a sleep laboratory close to their home. RESULTS: Thirty-one patients with episodic cluster headache completed an overnight polysomnographic study. Twenty-three were male and eight female. The average age was 51 years (range 33 to 78 years). The average weight was 173 pounds (range 117 to 260 pounds). A total of 80.64% had sleep apnea (25/31). Average respiratory depression index (RDI) was 19.0 (SD 14.6) with 6 patients having no apnea, 10 having mild, 11 having moderate, and 4 having severe apnea (RDI < 5 = none; RDI 5 to 20 mild; RDI 20 to 40 moderate; RDI > 40 severe). Oxygen saturation decreased on average to 88.4% SD 4.5. Sleep efficiency was 76.2% (SD 13.4). CONCLUSIONS: The data closely approximate those of Chervin et al, where 80% had RDI > 5. The relationship sleep apnea has in the perpetuation or precipitation of cluster headache is still to be determined. There are some reports that treatment stops the cluster but there is no prospective study. The high incidence (80.64%) seen in this population suggests the cluster patient should receive a sleep evaluation and perhaps intervention with continuous positive airway pressure (CPAP) or an appropriate dental device.

Adult↗
PubMed2004

The effects of transcutaneous electrical nerve stimulation on experimental pain and sympathetic nervous system response.

OBJECTIVE: Transcutaneous electrical nerve stimulation (TENS) is a technique widely used in clinical practice to control pain, although its clinical efficacy remains controversial. Though many mechanisms have been proposed for its analgesic effects, there is a conspicuous lack of experimentally controlled research investigating whether TENS analgesia is related to its effects on the sympathetic nervous system (SNS). METHODS: Using an established psychophysiological paradigm, the present study investigated the effects of high-frequency/low-intensity TENS, low-frequency/high-intensity TENS, and sham TENS on the perception of experimental pain and SNS function in healthy volunteers. Measures of heart rate, digital pulse volume, and skin conductance were recorded during a 20-minute TENS stimulation period and in anticipation of a series of painful electric shocks prior to and following TENS stimulation. Healthy volunteers rated the intensity of the shocks using a 0-10-point verbal pain rating scale. RESULTS: The three TENS conditions failed to differentially effect SNS responses during either the 20-minute TENS treatment period or the shock anticipation periods, and TENS did not affect ratings of pain intensity to the shock stimuli. CONCLUSIONS: While these results may not generalize to acute or chronic pain patients, within the limitations of the present experimental paradigm, no support was found for TENS affecting either SNS function or acute experimental pain perception.

Adult↗
PubMed2003

Lingual nerve injury.

Lingual nerve injury is a common complication following dental and medical procedures. The clinical presentation of lingual nerve injury, its epidemiology, predisposing factors, and anatomy are explored in an attempt to identify those patients at risk for developing neuropathic pain. Nonsurgical and surgical therapies also are discussed.

Adult↗
PubMed2003

Multidimensional subgroups in migraine: differential treatment outcome to a pain medicine program.

OBJECTIVE: The present study compared two different approaches for deriving patient profiles on their ability to predict treatment outcome to a pain medicine program for migraine headache. DESIGN/METHODS: Using visual analog scale measures of pain intensity and functional limitations and the Beck Depression Inventory (BDI), as a measure of depression, 235 migraine patients were classified into statistical clusters. The same patients were also classified using the Multidimensional Pain Inventory (MPI) algorithm into three subgroups: Adaptive copers (AC), characterized by lower reported levels of pain intensity, life interference, and distress, as well as higher levels of perceived life control; interpersonally distressed (ID), characterized by more intermediate levels of pain, distress, and interference, with a predominant perception of inadequate support and punishing responses from significant others; and dysfunctional (Dys), characterized by high levels of pain severity, life interference, and distress and low levels of perceived life control and activity. RESULTS: The results of the K-cluster analysis yielded a three-cluster solution: The low impact cluster, was characterized by low pain, low functional limitations and low depression and showed significant reductions in pre-to-posttreatment pain; the moderate impact cluster displayed higher levels of pain and functional limitations and low depression and showed only slight pre-to-posttreatment pain reduction; and the high impact cluster displayed the highest levels of pain, functional limitations, and depression and showed significant increases in pre-to-posttreatment pain. Unlike the K-clustered groups, MPI subgroups failed to differentially predict treatment outcome. When the K-clustered groups were crosstabulated with the MPI subgroups, the predictive validity of the MPI subgroups was enhanced. CONCLUSION: This study questions the validity of the MPI subgroup classification algorithm. The results indicate that the K-clustering approach is more useful than the MPI in deriving meaningful patient clusters that differentially predict treatment outcome in a migraine population.

Adolescent↗
PubMed2003

Current concepts in chronic pain management.

The majority of people afflicted with orofacial pain have acute pain that resolves quickly, but some are left with chronic and disabling pain. Therapy must be provided to deal with the nociception, behavior, and suffering. Appropriate behavioral evaluation may be required prior to developing a treatment plan. The treatment should then be carefully outlined and presented in a treatment-planning visit and may include physical, pharmacologic, and behavioral aspects.

Analgesics↗
PubMed2002

The role of temporomandibular disorders and cervical dysfunction in tension-type headache.

It has been estimated that 30% to 80% of the population has at least one tension-type headache each year. Tension-type headaches can be located in any region of the head, which can confuse a differential diagnosis with temporomandibular joint disorders and cervical dysfunction. The roles of temporomandibular joint disorders and cervical dysfunction in tension-type headache are evaluated. Definitions, pathophysiology, and treatment considerations for each are discussed.

Cervical Plexus↗
PubMed1989

Effects of transcutaneous electrical nerve stimulation on myofascial pain and trigger point sensitivity.

The effects of transcutaneous electrical nerve stimulation (TENS) on myofascial pain and trigger point sensitivity were assessed. Four modes of TENS and a no-stimulation control were compared in a double-blind design. Stimulation, carried out for 10 min on 60 subjects (12/group), showed significant pain reductions with 100 Hz, 250 msec stimulation followed by 100 Hz, 50 msec and then pain suppressor TENS. No pain reductions were found in the 2 Hz, 250 msec TENS or the control. No significant alteration in myofascial trigger point sensitivity, assessed with the pressure algometer, was found between the groups. The results suggest that high frequency, high intensity TENS is effective in reducing myofascial pain, and that these pain reductions do not reflect changes in local trigger point sensitivity.

Adult↗
PubMed1986

Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity.

Three studies are presented demonstrating the reliability of the pressure algometer as an index of myofascial trigger point sensitivity. The first study showed high reliability between and within experimenters when measuring marked trigger point locations. In study 2, significant between experimenter reliability in locating and measuring the same unmarked trigger point locations was shown, while study 3 supported the idea that trigger points are discrete points of focal tenderness within the muscle. The ability to quantify and reliably measure trigger point sensitivity opens the door to a range of clinical and research possibilities for myofascial and related musculoskeletal pain problems.

Adult↗
PubMed1985

Memory for pain: relation between past and present pain intensity.

Memory for the intensity of past physical pain depends critically on the intensity of present pain. When their present pain intensity was high, patients with chronic headaches of myofascial origin rated their maximum, usual, and minimum levels of prior pain as being more severe than their hourly pain diaries indicated. When their present pain intensity was low, the same patients remembered all 3 levels of prior pain as being less severe than they actually had been. The results show that pain produces systematic distortions of memory similar to those associated with alterations of affect or mood, and suggest a resolution to a conspicuous conflict in the current pain literature.

Adult↗