[Diagnosis problems in oro-facial pain. (II). Pain referred from the ear].
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The role of routine medical examination in dental diagnosis is described in a report of case involving a young, seemingly healthy patient whose only symptom, pain in the mandibular left molars, proved a manifestation of a malignant mediastinal lymphoma.
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PURPOSE: Existing animal models of visceral pain in the mouse are of limited practical usefulness since they are labor intensive or not visceral specific. Recently a rat model of cyclophosphamide (CP) cystitis was developed that requires only intraperitoneal injection and features inflammation confined to the bladder. We adapted this model for use in multiple mouse strains to investigate the genetic basis of variability in visceral nociception. MATERIALS AND METHODS: Outbred CD-1 mice and 12 inbred mouse strains were tested for behavioral changes induced by CP (0 to 300 mg/kg intraperitoneally). RESULTS: We noted that despite the absence of postural changes or abdominal crises in CD-1 mice, CP produced dose dependent decreases in voluntary locomotor activity unaccompanied by ataxia measured on the rotarod test; referred hyperalgesia of the tail base region but not of the hind paw, which was inhibited in dose dependent fashion by morphine (0 to 20 mg/kg); and bladder inflammation corresponding to these behavioral indices. Furthermore, the extent of hypolocomotion was genotype dependent across 12 inbred strains. CONCLUSIONS: The simple and automatable nature of CP cystitis using hypolocomotion as a dependent measure renders it an attractive model in which to investigate the genetic and physiological bases of visceral pain. Comparison of strain sensitivity to CP induced hypolocomotion with other nociceptive assays suggests that genes specific to visceral nociception may exist.
PURPOSE: The purpose of this study was to determine the prevalence and the nature of the relationships between 3 temporomandibular joint disease (TMD) symptoms and symptoms of associated structures. MATERIALS AND METHODS: This study was designed to rule out the effect from the uneven composition of the samples on TMD symptoms. The samples were collected from subjects who were of the same age, gender, district, and race. Nineteen-year old men (n = 27,978) were selected and investigated by means of questionnaires and clinical examinations. The prevalence of each symptom was studied and tried to determine the effects of the TMD-associated signs on the TMD signs. The indices allocated to reflect the TMD signs and symptoms and the others were dichotomized for bivariate analysis. The predictor variables were headache, neck pain, referred pain, stress, past trauma history in the TMJ, past TMJ dislocation, bruxism, and clenching. The outcome variables were mouth opening limitation, TMJ pain on rest, and TMJ pain during function. RESULTS: The incidence of masticatory muscle stiffness was 17.8%; TMJ sounds, 14.3%; headache, 7.2%; neck pain, 13.5%; bruxism, 8.4%; and clenching, 9.9%. Stress occurred in 12.8%, past trauma history in 11%, and previous joint dislocation in 2.5%. The experience of dislocation in the TMJ was found to be the most important risk factor in terms of mouth opening limitation (odds ratio, 4.08, P <.0001), joint pain during function (odds ratio, 5.50, P <.0001), and joint pain in the rest state (odds ratio, 4.63, P <.0001). Referred pain and the experience of trauma in TMJ were the secondary risk factors in terms of joint pain and referred pain and the stress in terms of mouth opening limitation. Considering referred pain can be induced by TMD, stress may be more related to mouth opening limitation (odds ratio, 2.18, P <.0001), and the experience of trauma in TMJ may be more related to pain in the rest state (odds ratio, 2.56, P <.0001) and during function (odds ratio, 2.47, P <.0001). CONCLUSIONS: The prevalence of TMD signs and symptoms as determined by this examination was in accord with the findings in women or mixed samples of other workers. Prior experience of a dislocated disc was found to be the most risky factor in TMD. Stress was related to limitations of mouth opening, and the experience of trauma in the TMJ was found to be related to pain in the joint region. Bruxism may not be a direct risk factor in TMD, and the clenching habit found to be more harmful than bruxism.
Administration of 10 micrograms of capsaicin into the anterior portion of a lumbar intervertebral disc of rats pretreated with Evans blue (i.v.) caused dye extravasation in the groin skin. This phenomenon occurred even when the spinal nerve of the same segment, bilateral sympathetic trunks, and/or the anterior L2 spinal root had been cut; it did not occur in rats with a cut genitofemoral nerve. Infiltration of capsaicin solution directly into the genitofemoral nerve did not cause dye extravasation. These results suggested the presence of dichotomizing sensory C-fibers which innervate both the intervertebral discs and the groin skin in the L2 spinal nerve. If such dichotomizing fibers exist in man, they may contribute to the groin pain sometimes associated with intervertebral disc lesions.
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