Biomedical subjects
R L Merrill
Publications and source records attributed to R L Merrill.
Topical medications for orofacial neuropathic pain: a review.
BACKGROUND: The authors discuss the local pharmacotherapy for chronic orofacial neuropathic pain disorders such as neuropathies, neuromas and neuralgias. METHODS: The authors conducted a systematic literature review on this topic. The focus of the review involved the two most commonly applied medications for neuropathic disorders--local anesthetics and capsaicin. Other compounds such as nonsteroidal anti-inflammatory drugs, sympathomimetic agents, anticonvulsants and N-methyl-D-aspartate receptor antagonists also were reviewed. The medication delivery and retention methods appropriate for oral and perioral disease and pain control are described in this article. RESULTS: There are an ever-increasing number of agents that can be used to help patients with neuropathic-based oral and perioral pain problems. Moreover, a clear advancement in the delivery of these medications is the development of a vehicle-carrier agent (pluronic lecithin organogel) that can penetrate the mucosa and cutaneous tissues and carry the active medication with it to the treatment site. The major caveat underlying these treatment strategies is that except for patient testimony and a few studies, there are limited empirical data on the efficacy of most of these new formulations, and additional research is clearly needed. CONCLUSIONS: Because of their rapid onset and low side-effect profile, topical medications offer a distinct advantage over systemic administration for those orofacial disorders that are regional, near the surface and chronic and that demonstrate some response such as pain relief to topical or subcutaneous anesthetics. CLINICAL IMPLICATIONS: Practicing dentists now have some new tools they can use to help manage patients who have a chronic nerve pain disorder in and around the mouth.
Trigeminal neuralgia due to an acoustic neuroma in the cerebellopontine angle.
This case report first reviews the intracranial tumors associated with symptoms of trigeminal neuralgia (TN). Among patients with TN-like symptoms, 6 to 16% are variously reported to have intracranial tumors. The most common cerebellopontine angle (CPA) tumor to cause TN-like symptoms is a benign tumor called an acoustic neuroma. The reported clinical symptoms of the acoustic neuroma are hearing deficits (60 to 97%), tinnitus (50 to 66%), vestibular disturbances (46 to 59%), numbness or tingling in the face (33%), headache (19 to 29%), dizziness (23%), facial paresis (17%), and trigeminal nerve disturbances (hypesthesia, paresthesia, and neuralgia) (12 to 45%). Magnetic resonance imaging with gadolinium enhancement or computed tomography with contrast media are each reported to have excellent abilities to detect intracranial tumors (92 to 93%). This article then reports a rare case of a young female patient who was mistakenly diagnosed and treated for a temporomandibular disorder but was subsequently found to have an acoustic neuroma located in the CPA.
Orofacial pain mechanism.
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Orofacial pain mechanisms and their clinical application.
This article has discussed the peripheral and central mechanisms of the various orofacial pain conditions, including musculoskeletal disorders, neurogenic inflammation, and neuropathic pain. To make an accurate diagnosis of orofacial pain and render treatment, all organ systems need to be considered and evaluated. Central sensitization was discussed as it relates to musculoskeletal disorders and neuropathic pain. It has been suggested that treatment of these disorders be problem oriented, addressing both peripheral and central mechanisms if present. Musculoskeletal disorders are characterized by pain that is provokable with function and manipulation. Neurovascular pain is episodic with pain-free periods between attacks. The pain is not related to or provoked by jaw function. Neuropathic pain is more continuous and may be aggravated by light touch. Neuropathy with peripheral involvement responds variably to local anesthetics but may need to be treated with topical or local agents as well as centrally acting agents. Neuropathic pain that does not respond to topical or local agents is more profoundly centralized. These conditions need to be treated with centrally acting agents. In addition, if there is no response to medications, sympathetic involvement needs to be ruled out with sympathetic ganglion blockade.
Trigeminal neuralgia: how to rule out the wrong treatment.
Toothache is difficult to diagnose and treat appropriately when traditional dental diagnostic test results are negative. This study looked at 61 patients who were treated for pretrigeminal or trigeminal neuralgia. Of these, 61 percent were incorrectly diagnosed and treated.
A consideration of amalgam--data and conclusions. 4.
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