Biomedical subjects
Publications and source records attributed to R Kroening.
Reflex sympathetic dystrophy of the face is an infrequently reported cause of chronic facial pain. We report the cases of two patients who were diagnosed and treated by sympathetic blockade of the stellate ganglion. Pathophysiologic mechanisms and rationale for treatment are discussed.
Myofascial pain syndrome (MPS) is a common but misunderstood muscular pain disorder involving pain referred from small, tender trigger points within myofascial structures in or distant from the area of pain. Misdiagnosis or inadequate management of this disorder after onset may lead to development of a complex chronic pain syndrome. A review of the clinical characteristics of 164 patients whose chief complaints led to the diagnosis of MPS revealed that these patients had (1) tenderness at points in firm bands of skeletal muscle that were consistent with past reports, (2) specific patterns of pain referral associated with each trigger point, (3) frequent emotional, postural, and behavioral contributing factors, and (4) frequent associated symptoms and concomitant diagnoses.
Forty-eight patients underwent electrical stimulation of the brain for treatment of chronic pain between 1978 and 1983. Average pain duration prior to treatment was 4.5 years. Before selection for this procedure patients underwent pain treatment in a multidisciplinary pain center, intensive psychological and psychiatric evaluation, and assessment of pain responsiveness to intravenous administration of placebo, morphine, and naloxone. A total of 71 electrodes were placed in the 48 patients at a variety of stimulating targets, including the periaqueductal gray matter, periventricular gray matter, thalamus, and internal capsule. Seventy-two percent of patients experienced complete or partial pain relief. In addition, 59% of patients were able to discontinue narcotic usage. Twenty-five percent of patients returned to normal physical activities and another 33% showed marked improvement in functional capacity. Follow-up periods ranged from 2 to 60 months; with a mean follow-up period of 20 months. A variety of relatively minor complications occurred, but no mortality or permanent sequelae were experienced. No patient's pain was made worse as a result of electrical stimulation. Electrical stimulation of the brain offers a safe and relatively effective method for the treatment of chronic pain in appropriately selected patients, who are unresponsive to other forms of therapy.
Chronic craniofacial pain afflicts more than one in every ten persons in the United States and Europe. Successful management of chronic craniofacial pain closely follows the thorough evaluation and understanding of the patient and the problem and, subsequently, a correct diagnosis or diagnoses. Evaluation of the patient includes a complete medical, dental, and personal history, physical examination, and appropriate diagnostic studies and consultations. Special consideration should be given the possibility of multiple diagnoses as well as complicating emotional, behavioral, or perceptual factors common in persons with chronic pain. Differential diagnosis is simplified by the use of a practical classification of chronic craniofacial pain.
Patients with chronic orofacial pain must be treated with methods different from those used with patients with acute pain. If different methods are not used, the characteristics of chronic pain may become firmly entrenched. Dentists should be aware of the various methods of treatment for this separate pain entity.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.