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Biomedical subjects

C Feinmann

Publications and source records attributed to C Feinmann.

At least 19 recordsLinked to original sources
PubMed2000

Factors associated with anxiety and depression in facial arthromyalgia.

Facial arthromyalgia (temporomandibular joint pain dysfunction syndrome, TMD) is a chronic pain condition of unknown origin. This paper examines the extent to which the condition is associated with symptoms of anxiety and depression. It also identifies factors which may be predictive of raised levels of these two moods and of the presence of clinical anxiety and clinical depression. Self-report measures of pain beliefs, coping strategies, pain intensity, disability and mood were administered to a sample of 80 facial arthromyalgia patients of differing chronicity. The results showed anxious mood to be associated with several factors including beliefs that pain is itself worsened by negative mood, passive coping in terms of catastrophising about pain, and speech problems. Depressed mood was associated with catastrophising and disability in the form of disturbance in taste and digestion. These factors may be considered as potential targets for therapy, rather than the orthodox objective of pain relief.

Adaptation, Psychological↗
PubMed2000

GPs' attitudes towards the treatment of drug misusers.

General practitioners (GPs) are encouraged to play a major part in the care and treatment of drug users; however, many regularly encounter physical or verbal abuse and feel frustration, disappointment, and disillusionment when treating such patients. Furthermore, communication difficulties between doctor and patient and the advent of HIV serve to intensify these problems. In order to address these issues, a questionnaire survey was carried out to assess what proportion of GPs are commonly employed in the management of drug misusers, and to examine the attitudes towards, and knowledge of, the management of these patients. The results show that this group of GPs are concerned about drug misuse in their immediate geographic area and believe it should be detected in general practice. Despite this, fewer than half of the GPs felt they had adequate knowledge of the issues surrounding opiate misuse. This finding certainly raises the question of the availability of training and education in the area of drug misuse.

Attitude of Health Personnel↗
PubMed1999

Cerebral responses to pain in patients suffering acute post-dental extraction pain measured by positron emission tomography (PET).

Previous studies with normal volunteers have demonstrated distributed cortical responses to experimental heat pain within a network of structures. The network includes the insula, anterior cingulate, prefrontal, inferior parietal and somatosensory cortices. Patients suffering from chronic nociceptive pain following rheumatoid arthritis (RA) have shown damped central responses to experimental heat pain applied to the back of the right hand. In this study of patients with acute, left-sided, post-molar-extraction (surgical) pain, we assessed the cortical responses to experimental heat pain, applied to the back of the right hand, using positron emission tomography (PET), and compared the responses with a previously reported control group and the RA group. In response to the experimental heat pain, the surgical group indicated significantly increased regional cerebral blood flow in the prefrontal cortex [Brodman's area (BA) 44] ipsilateral to the heat stimulus. Contralateral increases were detected in the putamen and transverse temporal gyrus (BA 40/41/42) with bilateral increases in the insular cortex. Compared to the control and RA group, there were significantly reduced responses in the anterior cingulate (BA 24), pre-frontal medial, and orbito-frontal (BA 9/10/32/47) cortices. These results suggest that relatively discrete regions of the cerebral cortex are responsible for acute nociceptive processing during an acute inflammatory episode. The reduced frontal and anterior cingulate responses to the experimental heat pain (applied to the right hand) during acute inflammatory pain (left jaw) illustrates cortical modulation of nociceptive processing that may be related to non-somatotopic, bilateral, nociceptive inputs to these areas. Copyright 1999 European Federation of Chapters of the International Association for the Study of Pain.

Journal Article↗
PubMed1998

Ocular psychiatric disorders in maxillofacial injuries. Two case reports and a review of psychogenic ocular symptoms.

Ocular signs and symptoms associated with facial trauma can be a manifestation of an underlying psychiatric disorder which may exist prior to the traumatic incident, or even develop as a result of the stressful traumatic experience in a psychologically vulnerable individual. Two such cases are presented. A brief review of psychogenic ocular symptoms as well as suggestions for evaluation and treatment are discussed.

Adult↗
PubMed1998

Psychological assessment of patients requesting orthognathic surgery and the relevance of body dysmorphic disorder.

The psychological assessment of patients requesting orthognathic treatment is a vital and integral part of the overall assessment procedure. It allows identification of potential problems at an early stage before irreversible decisions have been made. This paper aims to highlight some of the aspects of psychological assessment which are particularly important. It also discusses current concepts in the diagnosis and treatment of those patients suffering from body dysmorphic disorder (BDD). This is the term applied to those individuals with a normal appearance who present requesting treatment because they believe that they have a 'defect'.

Humans↗
PubMed1997

Liaison psychiatry and psychology in dentistry.

Dentists are trained to provide treatment for patients with straightforward problems that respond to routine therapy and do not recur. However, patients may present to dentists and complain solely of physical symptoms such as toothache, headache, and facial pain: only after much inappropriate treatment these symptoms are revealed to be due to emotional disturbance. The dentist may spend hours investigating such patients, in some of whom dental pathology may be present, but the symptoms and ensuing disability cannot be satisfactorily explained as a result. There are other patients who are preoccupied by physical symptoms or by their appearance. In others, anxiety may manifest itself as a phobia, or a dysmorphic concern about certain aspects of their appearance. This article reviews the role of liaison psychiatry and psychology in dentistry.

Dental Anxiety↗
PubMed1997

Does short-term group therapy affect unexplained medical symptoms?

This paper describes an intensive time-limited group-therapy program conducted in a busy surgical clinic by two nursing staff with the support of a consultant psychiatrist. Nineteen patients with chronic idiopathic facial pain were recruited to the study and underwent weekly group therapy over 8 weeks. At the end of the study period, results showed decreases in pain, anxiety and depression scores, along with an improvement in the patients coping skills. The findings support the use of group psychological interventions undertaken by appropriately trained nursing staff in reducing symptoms associated with chronic idiopathic facial pain.

Adult↗
PubMed1997

Atypical facial pain: a double-blind placebo-controlled crossover pilot study of subcutaneous sumatriptan.

A double-blind placebo-controlled crossover pilot study involving 19 patients was undertaken to evaluate the efficacy of subcutaneous sumatriptan, a selective 5-hydroxytryptamine (5-HT)-like receptor agonist, in the treatment of atypical facial pain (AFP). A reduction in total pain was found 120 min post injection in the sumatriptan group. Most patients, however, described the medication as ineffective overall, despite significant pain score reduction. The temporary improvement of pain scores with the active drug was thought to be too small to be of any clinical benefit, but suggests that vascular or neurogenic mechanisms may be involved in the aetiology of AFP. Sumatriptan is not an appropriate therapeutic option for patients with AFP, but could prove a valuable drug in experimental clinical pharmacology.

Adolescent↗
PubMed1996

Dysmorphophobia: recent developments of interest to the maxillofacial surgeon.

Recent changes in the classification of psychiatric illnesses have resulted in the term dysmorphophobia being replaced by that of body dysmorphic disorder (BDD). This paper attempts to alert the clinician to the presenting features of the condition and discusses its management, with particular emphasis on the role of surgery and current concepts of pharmacological treatment. A number of case reports are included to illustrate the diversity of this interesting disorder and the difficulties involved in treatment.

Adolescent↗
PubMed1996

Perceptions of outcome following orthognathic surgery.

The definition, evaluation and assurance of quality of health care are becoming increasingly important with health care moving into purchaser/provider mode. This questionnaire based study investigated patient satisfaction and changes in their quality of life following joint orthodontic/surgical treatment for the correction of facial deformity. Questionnaires were distributed to 83 pre-operative and a separate group of 100 postoperative patients with data analysis involving comparison of pre- and postoperative mood states and opinions about various aspects of appearance and personality. The results indicated that the majority of respondents were happy with the outcome of treatment. There was significant improvement in appearance, as well as in self-confidence, overall mood states and the ability to mix socially. The majority of respondents felt that the technical aspects of the operation had been well explained but almost a quarter felt that the effects following surgery were badly explained. Pre-operative counselling, therefore, needs to be improved.

Affect↗
PubMed1996

A double-blind, placebo-controlled, crossover, study to evaluate the efficacy of subcutaneous sumatriptan in the treatment of atypical facial pain.

A double-blind, placebo-controlled crossover study was undertaken to assess the efficacy and tolerability of sumatriptan in patients with atypical facial pain. Patients were aged 18-65 years and had at least a 6 months history of atypical facial pain. A total of 19 patients were recruited and assessed for pain scores (total, sensory and affective) by using a short form McGill pain questionnaire preinjection and and at 60 and 120 minutes after subcutaneous injection of sumatriptan (6 mg) or placebo. Safety and tolerability was assessed by recording adverse events during and after the injection. One patient received only one treatment since her pain symptoms resolved after the first treatment. Rest of the patients returned to the clinic 3-6 weeks later and received alternate treatment for atypical facial pain in the same fashion as on the first occasion. Treatment of patients with sumatriptan produced significant relief in sensory, affective and total pain at 120 minutes postinjection (P < .05). Sumatriptan failed to produce a significant reduction in sensory and total pain scores at 60 minutes following treatment, however the result was statistically significant for the affective pain score (P < .05). No death or other serious adverse events were reported. No patient was withdrawn from the study due to an adverse event. However, all the patients treated with sumatriptan experienced one or more adverse events. The most common reported adverse symptoms during the sumatriptan treatment period were injection site reactions, headache, feeling of heaviness, warm or hot sensation and disorders of mouth or tongue. However, most of these side effects were mild and transient. In conclusion, this study points towards some beneficial effect of a single subcutaneous injection of sumatriptan in the treatment of atypical facial pain. However, this data is not sufficient to suggest the clinical utility of subcutaneous sumatriptan (6 mg) for the management of atypical facial pain. Further studies are necessary to test the effects of prolonged subcutaneous and oral multiple dose administration of sumatriptan for the treatment of atypical facial pain.

Adolescent↗
PubMed1995

Third molar surgery: an audit of the indications for surgery, post-operative complaints and patient satisfaction.

A prospective investigation was undertaken of 522 patients undergoing third molar surgery. Data relating to indications for surgery and quality of care were collected on both pre- and post-operative proformas. This investigation showed that over half of the patients did not have clinically sound indications for surgery. The incidence of post-operative complications was approximately the same as other studies on third molar surgery. Patient satisfaction was at a high level, although this study revealed that a percentage of symptom-free patients undergoing third molar surgery sustained nerve damage some of which remains unreported. Clear and well defined indications for third molar surgery do exist and should be adhered to. Operating on patients without good reason involves unnecessary expenditure to purchasing authorities, cost to the patient in both time off work and post-operative complications and further, may result in potentially avoidable legal problems for practitioners. A reappraisal of the impacted third molar is indicated prior to committing the patient to surgery, such that the indications for surgery are compatible with current views on quality assurance, health service economics and medico-legal common sense.

Cost of Illness↗
PubMed1995

Psychological aspects of orthognathic surgery: a review of the literature.

A review of the literature clearly shows that dental and facial disfigurements have significant effects and can be an important social disadvantage. The motivational patterns of patients requesting orthognathic surgery are many and varied, but a desire for improvement in esthetics and alleviation of functional problems are the two most commonly cited reasons. The careful assessment of patients requesting orthognathic surgery is imperative, because the success of surgery may well depend on careful patient selection. Care must be taken with those patients suspected of exhibiting dysmorphophobic tendencies and, if there is any doubt, psychiatric referral should be undertaken. Patient satisfaction following orthognathic surgery has been reported as high overall, as has been the number of patients who have said they would re-elect to have surgery. Many of the studies found that patients had improved self-confidence and social skills after treatment.

Esthetics↗
PubMed1994

Cerebral responses to pain in patients with atypical facial pain measured by positron emission tomography.

The localised PET cerebral correlates of the painful experience in the normal human brain have previously been demonstrated. This study examined whether these responses are different in patients with chronic atypical facial pain. The regional cerebral responses to non-painful and painful thermal stimuli in six female patients with atypical facial pain and six matched female controls were studied by taking serial measurements of regional blood flow by PET. Both groups displayed highly significant differences in responses to painful heat compared with non-painful heat in the thalamus, anterior cingulate cortex (area 24), lentiform nucleus, insula, and prefrontal cortex. These structures are closely related to the "medial pain system". The atypical facial pain group had increased blood flow in the anterior cingulate cortex and decreased blood flow in the prefrontal cortex. These findings show the importance of the anterior cingulate cortex and the reciprocal (possibly inhibitory) connections with the prefrontal cortex in the processing of pain in patients with this disorder. A hypothesis is proposed to explain the mechanisms of cognitive and pharmacological manipulation of these pain processes.

Adult↗
PubMed1993

Temporomandibular joint and orofacial pain: clinical and medicolegal management problems.

Idiopathic pain in the face, temporomandibular joint (TMJ), and teeth is common but varied in its duration and severity. Many cases respond to informed reassurance or simple physical therapy using an occlusal splint. Those that do not should be referred for specialist management by medication, and where necessary, arthroscopy or occasionally arthrotomy. Awareness of the underlying psychogenic factors is important at all levels of management, particularly as some patients will benefit from the support of a liaison psychiatrist. The failure to recognise these factors, together with prolonged unsuccessful physical or surgical therapy can render the pain intractable or incite certain patients to seek relief through litigation.

Antidepressive Agents, Tricyclic↗