Clinical criteria for trigeminal neuralgia.
Explore the source record for details and available documents.
Analgesics, Non-Narcotic↗
Biomedical subjects
Noshir Mehta
Publications and source records attributed to Noshir Mehta.
A survey of medico-legal practice patterns among pain specialists.
OBJECTIVE: Pain clinicians are increasingly asked to provide expert commentary in a variety of medico-legal or forensic contexts. The purpose of this study was to discover the frequency and type of medico-legal activity undertaken by pain specialists, their familiarity with current guidelines, and their opinions with respect to a need for formal ethical or practice guidelines. DESIGN: Members of the New England Pain Association were surveyed with a 20-item questionnaire addressing specific areas of practice including the completion of disability forms, letters/attorney reports, depositions, testimony in court, record reviews, and return-to-work forms. Respondents also were asked to distinguish medico-legal activities for their patients from those that occurred for third parties. SETTING/PARTICIPANTS: Participants included pain specialists from a range of disciplines represented by the membership of a regional pain society. The response rate was 67%, with a total of 144 returned surveys. RESULTS: Survey data revealed that 72% of pain specialists had engaged in some form of medico-legal work within the past year. Of those who engaged in this work, 96% completed this work as a treating clinician for their patients. While the majority of respondents engaged in activities such as the completion of disability forms, other high frequency activities included depositions and testimony. Differences between physicians and nonphysicians also were noted. Results revealed that the majority of pain specialists supported the development of guidelines for medico-legal practice. It was suggested that pain societies move to develop ethical and/or clinical practice guidelines to address this issue.
Data Collection↗
Efficacy of pulsed radio frequency energy therapy in temporomandibular joint pain and dysfunction.
This randomized double-blind study evaluated the effectiveness of pulsed radio frequency energy therapy (PRFE) in patients with temporomandibular joint arthralgia. Forty subjects (age range 22 to 55 yrs.) were assigned randomly into two equal groups: (1) Experimental group received PRFE using the Energex unit (Energex, Inc. Emerson, New Jersey) and (2) Control group received PRFE placebo treatment using a sham device. Both groups received six applications to the TMJ area over two weeks. Data were analyzed for the following times: baseline, first and second follow-up visits. Numerical Rating Scale scores for TMJ pain showed a significant reduction over time for the experimental group (mean = 6.13 to 3.05, p < 0.001). There was also a significant effect for the controls (mean = 5.35 to 4.20, p = 0.01). The effect for experimental subjects was a mean reduction of 3.07 versus 1.15 for controls. The significant reduction in controls was attributed to the placebo effect. The experimental group showed a significant increase in mouth opening (mean = 34.95 to 41.70 mm, p = 0.002), right lateral movement (mean = 7.85 to 10.80 mm, p = 0.001) and left lateral movement (mean = 7.65 to 10.85 mm, p < 0.0001). No significant (p > 0.1) change in the control group occurred for mouth opening (mean = 38.50 to 39.65 mm), right lateral movement (mean = 8.60 to 8.75 mm) and left lateral movement (mean = 8.50 to 8.80 mm). No side effects were reported during the treatment and the two week follow-up. These results suggest strongly that PRFE is a safe and effective treatment for TMJ arthralgia as well as for increasing mandibular range of motion.
Adult↗
Use of Theraflex-TMJ topical cream for the treatment of temporomandibular joint and muscle pain.
This randomized, double-blind study was designed to evaluate the effectiveness of the topical cream Theraflex-TMJ (NaBob/Rx, San Mateo, CA) in patients with masseter muscle pain and temporomandibular joint (TMJ) pain. Fifty-two subjects (5 males and 47 females) were instructed to apply a cream over the afflicted masseter muscle(s) or over the jaw joint(s) twice daily for two weeks. Theraflex-TMJ cream was used by the experimental group, while a placebo cream was used by the control group. The means of pain ratings were calculated prior to the application of the cream (baseline), after ten days of tx (period 1), and 15 days of tx (period 2) days of treatment and five days after stopping the treatment (follow-up). There was a significant decrease in reported pain levels from baseline in the experimental group for period 1 (p < 0.01), period 2 (p < 0.001), and follow-up (p < 0.01). For the control group, no significant differences were found between the different time periods (p > 0.05). There was evidence of minor side effects such as skin irritation and/or burning on the site of the application in two subjects in the experimental as well as two subjects in the control groups. The data strongly suggest that Theraflex-TMJ topical cream is safe and effective for reducing pain in the masseter muscle and the temporomandibular joint.
Adult↗
Effect of a passive jaw motion device on pain and range of motion in TMD patients not responding to flat plane intraoral appliances.
This study was designed to compare the effectiveness of a passive jaw motion device, the Therabite, and wooden tongue depressors (WTD), in patients with temporomandibular joint and muscle disorders, who did not improve after manual manipulation of the mandible and flat bite plane therapy. Forty-three patients were enrolled in the study and were classified as joint or muscle groups according to the Research Diagnostic Criteria for TMD. Twenty-four were assigned to the joint group, and 19 patients were assigned to the muscle group. The patients were assigned at random to three treatment subgroups: 1. passive jaw motion device therapy (Therabite); 2. wooden tongue depressors therapy (WTD); and 3. control group. All subjects received flat bite plane appliance therapy throughout the treatment period. Mandibular range of motion was measured for maximum opening (MO), right and left lateral (Rt. Lateral, Lt. Lateral) and protrusive (Pr) movements. Pain level was also assessed at the beginning and at the end of the treatment. The results suggested that a passive jaw motion device is effective in increasing range of motion in both groups of temporomandibular disorder patients, joint (intracapsular) and muscle (extracapsular). It also appears to decrease pain in patients with temporomandibular disorders. Pain was relieved to a greater degree in the muscle group than the joint group.
Analysis of Variance↗
Complex regional pain syndrome in the head and neck: a review of the literature.
This article reviews the features of complex regional pain syndrome (CRPS), including its pathophysiology, diagnosis, and treatment. CRPS is a pathology that has been described as occurring almost always in a limb, but this review provides a focus on the literature reporting cases in which the face, head, and neck were affected. Very few cases were found that seemed to meet the International Association for the Study of Pain criteria for the disease. The clinical characteristics were similar to those of CRPS elsewhere in the body, with the main features being burning pain, hyperalgesia, and hyperesthesia starting after a trauma to the craniofacial region. Physical signs were reported less frequently. The treatment of choice was seen to be a series of stellate ganglion anesthetic blocks, which resulted in a good outcome in all the cases reviewed.
Autonomic Nerve Block↗
Atypical odontalgia: a review of the literature.
OBJECTIVE: To review previous reports of cases of atypical odontalgia to examine its epidemiological and clinical characteristics and to explore the etiology and pathophysiology of the disease. BACKGROUND: Atypical odontalgia is one of many painful conditions that affect the oral cavity and is often overlooked in the differential diagnosis. METHODS: A search of the literature was performed for all cases of atypical odontalgia reported from 1966 to the present. RESULTS: The typical clinical presentation of atypical odontalgia that has been reported involves pain in a tooth in the absence of any sign of pathology; the pain may spread to areas of the face, neck, and shoulder. The existing literature suggests that this condition occurs in 3% to 6% of the patients who undergo endodontic treatment, with high female preponderance and a concentration of cases in the fourth decade of life. Deafferentation seems to be the most likely mechanism to initiate the pain, but psychological factors, alteration of neural mechanisms, and even an idiopathic mechanism have been implicated. Not all reported cases were preceded by trauma to the teeth or gums. The treatment of choice is a tricyclic antidepressant, alone or in combination with a phenothiazine. The outcome is usually fair, with many patients obtaining complete relief from pain. Especially in the absence of overt pathology, particular attention should be paid to avoiding any unnecessary and potentially dangerous dental intervention on the teeth. CONCLUSION: Atypical odontalgia is surprisingly common, of uncertain origin, and potentially treatable.
Antidepressive Agents, Tricyclic↗