Biomedical subjects

Charles R Carlson

Publications and source records attributed to Charles R Carlson.

18 recordsLinked to original sources

PubMed2007

Psychological factors associated with orofacial pains.

This article develops the case for why trigeminal pain is a unique and challenging problem for clinicians and patients alike, and provides the reader with insights for effective trigeminal pain management based on an understanding of the interplay between psychologic and physiologic systems. There is no greater sensory experience for the brain to manage than unremitting pain in trigeminally mediated areas. Such pain overwhelms conscious experience and focuses the suffering individual like few other sensory events. Trigeminal pain often motivates a search for relief that can drain financial and emotional resources. In some instances, the search is rewarded by a treatment that immediately addresses an identifiable source of pain; in other cases, it can stimulate never-ending pilgrimages from one health provider to another.

Cognitive Behavioral Therapy↗

PubMed2006

Brain activity during stimulation of the trigeminal nerve with noxious heat.

OBJECTIVE: The aim of this study was to observe areas of brain activation with painful hot stimulation to the trigeminal nerve. STUDY DESIGN: Nine healthy pain-free women (mean age 26.2 +/- 6.9 yrs) with a natural, regular menstrual cycle participated in the study. Whole-brain functional magnetic resonance imaging (fMRI) data were acquired for each participant on day 2 or 3 after the onset of menses using echo-planar imaging at 1.5T with near-isotropic spatial resolution and a temporal resolution of 4 s. RESULTS: Whole-brain fMRI with a Peltier thermode inside the head coil yielded a feasible imaging protocol with little disturbance from the thermode. Painful thermal stimulation of the left trigeminal system activated discrete brain regions within the insula, cingulate gyrus, thalamus, inferior parietal lobe/postcentral gyrus, right middle and inferior frontal gyri, cuneus, precuneus, and precentral gyrus. CONCLUSION: Painful stimulation of the trigeminal nerve resulted in activation of similar brain areas generally known for pain processing of painful peripheral stimulation.

Adult↗

PubMed2006

Cerebral activation during thermal stimulation of patients who have burning mouth disorder: an fMRI study.

The pathophysiology of burning mouth disorder (BMD) is not clearly understood, but central neuropathic mechanisms are thought to be involved. The aim of this study was to gain insight into the pathophysiology associated with BMD by using functional magnetic resonance imaging (fMRI). Areas of brain activation following thermal stimulation of the trigeminal nerve of eight female patients with BMD (mean age 49.1+/-10.1) were mapped using fMRI and compared with those of eight matched pain-free volunteers (mean age 50.3+/-12.3). Qualitative and quantitative differences in brain activation patterns between the two study groups were demonstrated. BMD patients displayed greater fractional signal changes in the right anterior cingulate cortex (BA 32/24) and bilateral precuneus than did controls (p<0.005). The control group showed larger fractional signal changes in the bilateral thalamus, right middle frontal gyrus, right pre-central gyrus, left lingual gyrus, and cerebellum than did the BMD patients (p<0.005). In addition, BMD patients had less volumetric activation throughout the entire brain compared to the control group. Overall, BMD patients displayed brain activation patterns similar to those of patients with other neuropathic pain conditions and appear to process thermal painful stimulation to the trigeminal nerve qualitatively and quantitatively different than pain-free individuals. These findings suggest that brain hypoactivity may be an important feature in the pathophysiology of BMD.

Adult↗

PubMed2006

Influence of estrogen on brain activation during stimulation with painful heat.

PURPOSE: Several studies have shown that women express higher pain sensitivity during periods of low estrogen than during periods of high estrogen. The aim of this study was to show whether the difference in pain sensitivity could be visualized as a function of brain activity by means of functional magnetic resonance imaging (fMRI). METHODS: Nine healthy, pain-free women (mean age, 26.2 +/- 6.9 years) with a natural, regular menstrual cycle participated in the study. Whole-brain fMRI data were acquired during a period of high and during a period of low estrogen at 1.5 T using echo-planar imaging with near-isotropic spatial resolution and a temporal resolution of 4 seconds. Heat pain thresholds were obtained before the scans, and pain ratings were obtained before and after each scan. Blood samples were taken after each scan to verify the appropriate level of estrogen. RESULTS: The heat pain thresholds during the low (46.4 degrees +/- 3.5 degrees C) and high (46.4 degrees +/- 3.8 degrees C) estrogen conditions were not significantly different. The pain ratings before (4.6 +/- 2.2 low versus 3.6 +/- 2.1 high) and during the scans (4.4 +/- 2.4 low versus 4.7 +/- 2.3 high) also did not differ between the 2 conditions. Generally, similar patterns of activation were observed for both estrogen conditions. However, significant differences were found in the magnitude of activation of the anterior part of the anterior cingulate (BA 24/32), the cerebellum, and the precuneus. Furthermore, activations in the anterior part of the anterior cingulate, left cerebellum, and precuneus were unique to the low-estrogen phase. These regions have been linked with attention to or anticipation of pain. CONCLUSIONS: The results of this study suggest that the affective component of pain may be enhanced during the low-estrogen phase of the menstrual cycle in healthy women.

Adult↗

PubMed2005

Prevalence of traumatic stressors in patients with temporomandibular disorders.

PURPOSE: The aim of the present study was to identify the prevalence of significant traumatic stressor(s) reported by chronic temporomandibular disorder patients, and to describe the nature of these stressors. A second aim of this study was to evaluate and compare the behavioral and psychological domains of patients who reported 1 or more significant traumatic stressors to those who did not. PATIENTS AND METHODS: Twelve hundred twenty-one patients with chronic temporomandibular disorder pain completed a battery of psychometric measures including the Symptom Check List-90-Revised, Multidimensional Pain Inventory, Pittsburgh Sleep Quality Index, and a check list of major traumatic stressors. RESULTS: The prevalence of major traumatic stressors among our chronic pain patients was high (49.8%). Traumatic stressors were related to increased pain severity, affective distress, and disability among patients with chronic pain. Patients admitting to major traumatic stressors also scored higher on most psychometric measures and more often had pain from myogenous origin. It is argued that possible significant contributors to chronic orofacial pain may be anxiety, depression, and dysregulation of the hypothalamic-pituitary-adrenal axis. CONCLUSION: Prevalence of major traumatic stressors in chronic temporomandibular disorder patients is high. The greater distress on all psychological domains in patients endorsing major traumatic events may be a reflection of inadequate coping skills in these individuals. Therapy should be oriented toward the resolution of accompanying stressors such as depression, anxiety, and dysregulation of the hypothalamic-pituitary-adrenal axis.

Adaptation, Psychological↗

PubMed2005

Fatigue and fatigue-related symptoms in an orofacial pain population.

OBJECTIVES: The aims of this study were to investigate the presence and magnitude of self-reported fatigue and fatigue-related symptoms and to determine whether fatigue can be distinguished as a unique clinical symptom in a sample of patients diagnosed with chronic temporomandibular joint or masticatory muscle pain. STUDY DESIGN: Fifty-five chronic TMD patients and 55 age-, sex-, and education-matched healthy volunteers completed a battery of 4 different fatigue measures as well as the SCL90-R, MPI, and PSQI. RESULTS: Fatigue and fatigue-related symptoms were reported significantly more often by chronic TMD patients than by healthy volunteers. MANCOVAs with somatization, depression, anxiety, general activity level, and sleep disturbances as covariates eliminated the differences between patients and controls. Stepwise regression showed that fatigue and fatigue-related symptoms did not appear to be a unique clinical symptom of TMD patients, but merely emerged as somatic symptoms accounted for by somatization and depression. CONCLUSION: Fatigue and fatigue related symptoms may be symptoms of somatization and depression in this sample of chronic TMD patients.

Activities of Daily Living↗

PubMed2005

Prevalence of post-traumatic stress disorder symptoms in orofacial pain patients.

OBJECTIVE: There is a high comorbidity between symptoms of post-traumatic stress disorder (PTSD) and chronic pain incidence. The objective of this investigation was to determine the prevalence of PTSD symptoms in chronic orofacial pain patients. STUDY DESIGN: The study included 1478 adult patients (mean age 36.4 +/- 12.7 years) with primary diagnoses of masticatory/cervical muscle pain or temporomandibular joint pain. Patients completed a battery of psychometric questionnaires including a screening for PTSD symptoms. The sample was divided into a PTSD-positive group (n=218, 15%) a PTSD-negative group (n=551, 37%), and a no-stressor group (n=709, 48%) according to stressor incidence and symptom severity. RESULTS: The current prevalence of PTSD symptomatology was considerably higher than that reported in surveys from the general population. Patients in the PTSD-positive symptom group reported significantly higher psychological distress, sleep dysfunction, and pain severity compared to patients in the other groups. Psychological distress as measured by the SCL-90-R reached clinically significant levels only in those patients with PTSD symptomatology. CONCLUSIONS: The results of this study performed at a tertiary care center suggest that TMD patients without PTSD symptomatology show low levels of psychological distress, if any. Clinically significant levels of psychological distress are likely indicators for PTSD. PTSD screening should be included as part of a routine psychometric test battery in TMD patients.

Adult↗

PubMed2005

The link between religion and spirituality and psychological adjustment: the mediating role of optimism and social support.

Although optimism, social support, religiousness, and spirituality are important predictors of adjustment, rarely have studies examined these variables simultaneously. This study investigated whether optimism and social support mediated the relationship between religiousness and adjustment (distress and life satisfaction) and between spirituality and adjustment. Findings indicate that the relationship between intrinsic religiousness and life satisfaction and between prayer fulfillment and life satisfaction was mediated by optimism and social support. Furthermore, the relationship between religiousness and adjustment varied depending on how religiousness was operationalized and whether positive versus negative adjustment indicators were used. That is, intrinsic religiousness and prayer fulfillment were associated with greater life satisfaction, but extrinsic religiousness was not associated with life satisfaction. These findings were significant even after accounting for covariates (age, gender, ethnicity, social desirability). Results suggest religiousness and spirituality are related but distinct constructs and are associated with adjustment through factors such as social support and optimism.

Adaptation, Psychological↗

PubMed2005

Post-traumatic stress disorder among patients with orofacial pain.

AIMS: To examine the presence and impact of post-traumatic stress disorder (PTSD) in a sample of patients seeking treatment for orofacial pain. METHODS: One hundred forty-one consecutive patients with an array of orofacial pain conditions were screened using a structured clinical interview for PTSD and the PTSD Symptom Checklist--Civilian Version (PCL), a brief PTSD self-report inventory. Additionally, participants received a clinical examination and self-report questionnaires to assess pain, coping styles, and presence of post-traumatic symptoms. RESULTS: Thirty-three (23%) patients received a full lifetime or current PTSD diagnosis, with an additional 11 patients receiving a partial PTSD diagnosis. Only 5 of these 44 patients had ever been previously diagnosed with PTSD. PTSD symptoms were associated with higher pain scores (P < .05) and affective distress (P < .01). Furthermore, discriminant function analyses suggested that the PCL accurately classified 89% of these cases (sensitivity = .85, specificity = .90, positive predictive power = 74%, negative predictive power = 95%). CONCLUSION: These results suggest that PTSD is prevalent in the orofacial pain setting and that PTSD symptomatology is associated with increased pain and affective distress that may complicate clinical presentation. Furthermore, PTSD can be accurately and efficiently assessed using a brief, self-report inventory.

Adaptation, Psychological↗

PubMed2003

Burning mouth (syndrome) disorder.

Burning mouth disorder (BMD) is a chronic, oral pain condition associated with burning sensations of the tongue, lips, and mucosal regions of the mouth. Diagnosis of the condition is complicated by the fact that a variety of systemic and local factors can be contributory. Treatment goals are to reduce symptoms by eliminating identifiable abnormalities. Secondary lines of therapy include pharmacotherapeutic approaches that target neuropathologic mechanisms that appear to be active.

Burning Mouth Syndrome↗

PubMed2002

Routine dental care in patients with temporomandibular disorders.

AIMS: While a significant number of therapeutic models have been suggested for management of orofacial pain and limited opening in patients experiencing temporomandibular disorders (TMD), little attention has been given to the issue of routine daily care activities, such as toothbrushing and flossing. The purpose of this study was to develop an understanding of the extent to which TMD patients experience difficulty in performing routine daily mouth care. METHODS: Forty patients seeking care for TMD in the Orofacial Pain Center at the University of Kentucky College of Dentistry were age- and gender-matched to a group of general dentistry patients not experiencing TMD. Participants completed a survey of oral health habits, and a clinical exam. RESULTS: Results indicated that TMD patients felt their discomfort had created more difficulty with daily mouth care as compared with the general dentistry patients (P < .000). Most TMD patients, however, continued with routine daily mouth care, except for 15% who reported an inability to floss on a regular basis. Also, a majority of TMD patients (63%) reported a change in seeking routine professional care because of their disorder (P < .000). CONCLUSION: The present data indicate the need for TMD patients to receive information concerning routine daily mouth care and visits for professional dental care. The results are discussed in terms of the strategies that dental care providers need to develop in order to address the significant consequences of orofacial pain on regular dental care.

Adult↗

PubMed2002

Comparison of sleep quality and clinical and psychologic characteristics in patients with temporomandibular disorders.

AIMS: To explore the relationships between sleep quality, perceived pain, and psychologic distress among patients with temporomandibular disorders (TMD). METHODS: A total of 137 consecutive patients who sought care at the University of Kentucky Orofacial Pain Center for the management of TMD participated in this study and completed a battery of standardized, self-report questionnaires at their first clinic visit. The Pittsburgh Sleep Quality Index (PSQI) and the Multidimensional Pain Inventory (MPI) were used to measure patients' sleep quality and multiple dimensions of pain and suffering, respectively. The Revised Symptom Checklist-90 (SCL-90R) was used to evaluate psychologic symptoms. A median cutoff (PSQI total score: 10) divided the patients into 2 groups, i.e., 67 poor sleepers and 70 good sleepers. RESULTS: There were no statistically significant differences in gender and age distributions between the 2 groups. Poor sleepers reported significantly higher scores than good sleepers on each of the 14 scales of the SCL-90R (P < .003) and on 7 of the 13 scales of the MPI (P < .05). Stepwise multiple regression analyses demonstrated that poorer sleep quality was predicted by higher pain severity (P < .001), greater psychologic distress (P < .05), and less perceived life control (P < .05). CONCLUSION: This study supports the frequent comorbidity of reported sleep disturbance, perceived pain severity, and psychologic distress in patients with TMD.

Adolescent↗

PubMed2002

A comparison between masticatory muscle pain patients and intracapsular pain patients on behavioral and psychosocial domains.

AIMS: To identify differences between 2 groups of patients with temporomandibular disorders (TMD), those with masticatory muscle pain (MMP) versus intracapsular pain (ICP), and to compare these differences on behavioral and psychosocial domains. METHODS: There were 435 patients in the MMP group and 139 patients in the ICP group. The overall sample was 88.2% female and had an average age of 36.1 years (SD = 11.7). Patients completed measures of psychological symptoms (SCL-90), pain severity (MPI), sleep (PSQI), activity (MBI), and life stressors (PCL). Heart rate and blood pressure were also measured, and a complete medical/dental history was taken for each patients. RESULTS: Results indicated no significant difference in pain severity or duration between the 2 groups (P > 05). The ICP group, however, reported fewer affective symptoms of pain than the MMP group (t = 6.8, P = .01). The ICP group had twice as many adaptive copers as dysfunctional patients (chi 2 = 7.84, P < .01), while there was no significant difference between these 2 categories for the MMP group (P > .05). Finally, the ICP group reported fewer psychological symptoms (P < .05), better sleep quality (F = 7.54, P = .01), and fewer life stressors (F = 7.00, P = .01) than the MMP group. CONCLUSION: In contrast to many previous studies, the data set in this study showed no differences in pain severity and duration between the MMP and the ICP groups. Even though pain severity levels were equivalent, the MMP diagnostic group of chronic TMD patients demonstrated more dysfunctional behavioral profiles and significantly higher psychological distress than the ICP subgroup.

Adaptation, Psychological↗

PubMed2002

Impact of criteria-based diagnosis of burning mouth syndrome on treatment outcome.

AIMS: Burning mouth syndrome (BMS) primarily affects postmenopausal women and is often difficult to treat successfully. Treatment outcomes have been problematic because of failure to distinguish between patients with BMS and patients presenting with oral burning (OB) resulting from other clinical abnormalities. The purpose of this study was to determine characteristics that might uniquely identify BMS patients from patients with OB and to determine whether proper classification influences treatment outcome. METHODS: The clinical sample consisted of 69 patients (83% female) with an average age of 62 years, pain duration of 2.45 years, and visual analog scale pain rating of 49 mm (rated from 0 to 100 mm). All patients underwent a clinical exam and completed the Multidimensional Pain Inventory and Symptom Checklist 90-Revised. RESULTS: There were no differences between the BMS and OB groups with respect to age, pain duration, pain intensity, life interference, and levels of psychologic distress. Patients with OB demonstrated more clinical abnormalities than BMS patients. Hyposalivation and greater use of prescription medications, most notably hormone replacement therapy, were more common in the OB group compared with the BMS group. When treatment was provided that corrected an identifiable abnormality, significantly more OB than BMS patients reported greater than 50% relief from baseline pain rating. CONCLUSION: These data indicate that while BMS and OB groups may initially present with similar clinical and psychosocial features, they are distinguishable with careful diagnosis that often enables successful management of symptoms for each group.

Adult↗

PubMed1998

Psychological and physiological parameters of masticatory muscle pain.

The objective of this research was to identify the psychological and physiological variables that differentiate persons reporting masticatory muscle pain (MMP) from normal controls (NC). This study examined the characteristics of 35 MMP patients in comparison to 35 age-, sex-, and weight-matched NCs. All subjects completed a series of standardized questionnaires prior to undergoing a laboratory evaluation consisting of a psychosocial stressor and pressure pain stimulation at multiple body sites. During the evaluation, subjects' emotional and physiological responses (heart rate, blood pressure, respiration, skin temperature, and muscle activity) were monitored. Results indicated that persons with MMP reported greater fatigue, disturbed sleep, depression, anxiety, menstrual symptoms, and less self-deception (P's < 0.05) than matched controls. At rest, MMPs had lower end tidal carbon dioxide levels (P < 0.04) and lower diastolic blood pressures than the NCs (P < 0.02). During laboratory challenge, both groups responded to the standard stressor with significant physiological activity and emotional responding consistent with an acute stress response (P < 0.01), but there were no differences between the MMPs and NCs. Muscle pain patients reported lower pressure pain thresholds than did NCs at the right/left masseter and right temporalis sites (P's < 0.05); there were no differences in pressure pain thresholds between MMPs and NCs for the left temporalis (P < 0.07) and right/left middle finger sites (P's > 0.93). These results are discussed in terms of the psychological and physiological processes that may account for the development of muscle pain in the masticatory system.

Adult↗

PubMed1993

Two brief interventions for acute pain.

This study evaluated two brief (3-5 min) interventions for controlling responses to acute pain. Eighty male subjects were randomly assigned to 1 of 2 intervention groups (Positive Emotion Induction (PEI) or Brief Relaxation (BR)) or to 1 of 2 control groups (No-instruction or Social Demand). The PEI focused on re-creating a pleasant memory, while the BR procedure involved decreasing respiration rate and positioning the body in a relaxed posture. All subjects underwent a 60-sec finger pressure pain trial. Analyses indicated that the PEI subjects reported lower ratings of pain, fear, and anxiety, and experienced greater finger temperature recovery than controls. The BR procedure resulted in greater blood pressure recovery, but did not alter ratings of pain or emotion relative to controls. Further research is needed to explore the clinical use of the PEI for acute pain management.

Acute Disease↗

PubMed1992

The relationship between pain sensitivity and blood pressure in normotensives.

Hypertension has been found to be related to decreased sensitivity to painful stimuli. The current study explored whether this relationship extends into the normotensive range of blood pressures. Resting blood pressures were assessed in 60 male normotensives. Subjects then underwent a 1 min finger pressure pain stimulation trial. Pain ratings were inversely related to resting systolic blood pressure. This relationship was unrelated to emotional state or coping styles. Multiple regression analyses indicated that over one-third of the variance in pain ratings can be accounted for by resting blood pressure, coping style, and emotional state.

Adaptation, Psychological↗

PubMedDate not supplied

Traumatic stressors and post-traumatic stress disorder symptoms in headache patients.

OBJECTIVE: The aim of this study was to assess the prevalence of significant traumatic stressors and post-traumatic stress disorder (PTSD) symptoms in a headache population. BACKGROUND: Several recent publications have emphasized the relationship between life stressors and/or daily hassles and recurrent headaches. However, little is known about the prevalence and impact of major traumatic stressors in patients with recurrent headaches. METHODS: Eighty patients with either migraine or tension-type headache completed a PTSD checklist. Data were compared with those from patients with chronic masticatory muscle pain of similar intensity and duration. RESULTS: Almost 64% of the headache patients reported one or more major traumatic stressors. This percentage was not significantly different from that of the comparison group, and fell within the broad range reported for exposure to traumatic stressors in epidemiologic studies with nonpatient populations. One out of 6 patients in the total headache sample, and 1 out of 4 of those reporting a traumatic stressor, reported symptoms suggestive of current PTSD. The prevalence of current PTSD-like symptomatology reported by the headache patients was comparable to that of the comparison group of the present study, but higher than that reported for the general population in the available literature printed in English. Traumatic stressors most often reported were not related to direct physical trauma, but rather associated with loss or serious illness of a loved one. CONCLUSION: Exposure to traumatic events in patients with a primary diagnosis of recurrent headaches is similar to that reported for chronic masticatory muscle pain patients or nonpatient populations. However, symptoms consistent with a diagnosis of current PTSD appear to be more frequent in patients with recurrent headaches than reported in the scientific literature printed in English for nonpatient populations. Screening for PTSD symptomatology is recommended as part of the routine clinical evaluation of headache.

Adult↗