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Biomedical subjects

C Feinmann

Publications and source records attributed to C Feinmann.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1993

The long-term outcome of facial pain treatment.

The long-term outcome of facial pain treatment is largely unknown. This study reports the results of a 4-yr review which indicated that conservative treatments including drug therapy and counselling are effective for 70% of patients. Refractory pain was associated with a long complex history of pain, a preoccupation with physical symptoms and poor psychosocial adjustment.

Adaptation, Psychological↗
PubMed1993

Orofacial neuralgia. Diagnosis and treatment guidelines.

Patients with facial pain, without overt dental disease, are often seen in both medical and dental practice. The differential diagnosis includes (a) cluster headache, in which patients have severe unilateral pains lasting 30 to 120 minutes that respond to verapamil, corticosteroids or lithium; (b) migraine, in which attacks are longer and are often accompanied by nausea and visual disturbance, and can be managed using anti-inflammatory analgesics, with or without metoclopramide, or sumatriptan, although frequent attacks are best suppressed by continuous propranolol or pizotifen; (c) trigeminal neuralgia, knifelike unilateral pains usually responsive to carbamazepine; and (d) temporal arteritis, a steadier pain very responsive to corticosteroids. There is no evidence that continuous 'idiopathic facial pain' is a result of malocclusion (i.e. the way in which the teeth fit together), and its aetiology remains obscure, although there is some biochemical evidence linking it to depression. Many patients respond to simple analgesia and firm reassurance from the physician, although antidepressant therapy (e.g. nortriptyline or dothiepin) is often of great value.

Anti-Inflammatory Agents↗
PubMed1992

Prevalence of post-traumatic stress disorder in patients with chronic idiopathic facial pain.

34 patients with chronic idiopathic orofacial pain were assessed by a structured clinical interview for diagnosis of mental disorders according to the Diagnostic and Statistical Manual for Mental Disorders (DSM-III-R). Five (15%) had a history of post traumatic stress disorder (PTSD) which coincided with the pain onset. The majority of these PTSD sufferers also had a personality disorder. The implications of these findings in the diagnosis and management of post-traumatic chronic TMJ pain syndromes is discussed.

Adult↗
PubMed1992

Managing service change in post HIV drugs services--a case study from Inner London.

The advent of HIV/AIDS has presented a major ideological challenge to established drug treatment agencies, where the incorporation of HIV-prevention strategies has proved problematic. This case study analyses the response to the HIV/AIDS epidemic by the drug misuse services of one Inner London district health authority (Bloomsbury) during the period 1985-89. While innovation and enthusiasm were much in evidence, a number of special problems prevented an effective and coherent strategic response. Key factors in the management of change in drugs/HIV services are identified which may be of special importance to clinicians, managers and funders and a number of key organizational and managerial competencies are suggested.

HIV Infections↗
PubMed1990

A standard way to measure pain and psychological morbidity in dental practice.

Dental surgeons are continually faced with patients in pain. In complicated cases, a measure of pain and its psychological consequences are essential. The McGill Pain Questionnaire measures pain using 78 descriptors and is useful not only in diagnosis but in monitoring treatment outcome. The Hospital Anxiety and Depression Scale is a simple way of assessing anxiety and depression in non psychiatric out-patient clinics. These two scales are compared with other measures that can be used.

Anxiety↗
PubMed1990

The practical business of treatment--13. Providing health care for drug users?

The majority of drug users neglect their health and have limited access to primary and preventative health care services. A health care team was developed in an attempt to provide health care for drug users, to prevent the spread of HIV and provide health education to the drug users. The health problems were related to injecting drugs, comprising abscesses, peripheral neuropathy and poor peripheral circulation. A high level of past infection with hepatitis B virus was noted, indicating the need for hepatitis B vaccination for drug users.

England↗
PubMed1990

Psychogenic regional pain.

Psychogenic regional pain develops in association with emotional stress. This article suggests that the role of the liaison psychiatrist is to encourage other clinicians to evaluate emotional factors, restrict excessive investigation and provide appropriate reassurance and treatment for such problems.

Diagnosis, Differential↗
PubMed1989

Risk behaviours for HIV infection among injecting drug users attending a drug dependency clinic.

To study a range of possible risk factors for HIV among injecting drug user patients attending a clinic in London were interviewed from November 1986 to November 1987. Serum samples were tested for viral markers. Of 116 patients, 101 had shared injecting equipment, 75 on the first occasion of injecting and 76 during the past year. Seventy said that sharing was because equipment was not available. In the past year 102 had been sexually active, a third having two to 20 partners; a quarter of the women had exchanged sexual intercourse for money. The four patients who were positive for antibody to HIV antigen had shared equipment or had intercourse with drug users from areas with a high prevalence of HIV. Eleven patients had injected drugs while in prison. Despite a low prevalence of HIV infection this infection remains a threat to drug users in London; strenuous efforts are still needed to prevent its further transmission.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Psychological factors influencing post-operative pain and analgesic consumption.

The personality factors, post-operative pain experience and analgesic requirements after minor oral surgery under general anaesthesia of 103 patients are presented. Psychiatric morbidity, neuroticism and anxiety were related to increased pain which tended to persist longer than normal. Trait anxiety also correlated with simple analgesic consumption, and neuroticism was weakly associated with Omnopon requirements. Thus, regular analgesics prescribed for at least 3 days will anticipate the needs of such patients. Despite higher levels of anxiety and neuroticism, women did not complain of more pain or require more analgesia than men in this study. There was also no overall correlation between post-operative pain experience and analgesic requirements. Therefore analgesic tablet consumption cannot be used as a measure of pain control.

Adolescent↗
PubMed1986

The medical management of facial pain.

The management of patients with facial pain tends to be dictated by the specialist to whom the patient present. This paper reviews the various factors associated with pain development, examines the available treatments and concludes that conservative management including medication and counselling are the most appropriate treatment for patients with chronic facial pain.

Antidepressive Agents, Tricyclic↗