191 results on '"Richard Ohrbach"'
Search Results
2. Perspective: Advancing the science regarding temporomandibular disorders
- Author
-
Richard Ohrbach, Alexandre F. DaSilva, Mildred C. Embree, and John W. Kusiak
- Subjects
temporomandibular disorders ,precision medicine ,temporomandibular joint ,research methods ,science transfer ,Dentistry ,RK1-715 - Abstract
This Special Issue was initiated in response to the call for improved research by the National Academies of Sciences, Engineering, and Medicine (NASEM) (United States) Consensus Study Report on Temporomandibular Disorders (TMDs), a set of putatively localized musculoskeletal conditions. In this Special Issue, the importance of systems biology for TMDs emerges from each of three separate publications. The importance of systems biology to patients is anchored in two domains—laboratory research and clinical observation. The three publications fully speak to the underlying goals in the NASEM recommendations for initiatives: that research on TMDs needs to broaden, that integration between basic and clinical science needs to improve, and that while better evidence is needed, clinicians need to utilize the evidence that already exists. All three of these initiatives, taken together, would lead to better understanding of these complex diseases and to better care of patients with these diseases.
- Published
- 2024
- Full Text
- View/download PDF
3. Creating patients: how technology and measurement approaches are misused in diagnosis and convert healthy individuals into TMD patients
- Author
-
Charles Greene, Daniele Manfredini, and Richard Ohrbach
- Subjects
temporomandibular disorders ,diagnosis ,technology ,device ,instrument ,validity ,Dentistry ,RK1-715 - Abstract
The advances made in recent years regarding technological approaches to medical and dental diagnosis are impressive. However, while those tools, procedures, and instruments may produce an improved clinical diagnosis or discover a new disorder, they also can be misused and misinterpreted in various ways. In the field of temporomandibular disorders (TMDs), the very nature of those conditions is similar to common orthopedic problems elsewhere in the body. Yet, beyond imaging of the affected areas, there have been few important new technological approaches to augment the traditional history and examination for a sufficient diagnosis of such problems. The traditional approach is exemplified by the Diagnostic Criteria for Temporomandibular Disorders, which has high inter-examiner reliability and diagnostic validity; translations into over 20 languages allow for widespread use. In contrast and unfortunately, the TMD field is replete with a variety of so-called diagnostic instruments and procedures, which have not been tested for diagnostic validity; these instruments and procedures, through misuse, are capable of complicating a true diagnosis of patients who present with symptoms, while also creating new patients by finding so-called abnormalities in healthy subjects. This paper discusses those technological approaches and their misuse with respect to TMD diagnosis from a critical viewpoint, and the authors argue that there are significant risks for patients if their uncritical implementation becomes accepted and widespread. Therefore, dentists are encouraged to reject the proposed application of such technological approaches to diagnosis of the stomatognathic system.
- Published
- 2023
- Full Text
- View/download PDF
4. Remarks on 'Temporomandibular Disorders: Priorities for Research and Care': how will Chile advance?
- Author
-
Juan Fernando Oyarzo, Manolis Jusakos, Charles Greene, and Richard Ohrbach
- Subjects
temporomandibular disorders ,diagnosis ,pain management ,chronic pain ,health care ,Medicine ,Medicine (General) ,R5-920 - Abstract
Temporomandibular disorders (TMDs) are complex multi-system disorders for which common traditional dental-centric approaches to research and care unfortunately continue to prevail. A committee appointed by the National Academies of Sciences, Engineering and Medicine (NAM) of the United States of America summarized important recommendations regarding the urgent need to transform, from the predominantly biomedical model, the research, professional education/training, and patient care for TMDs into the biopsychosocial model that is standard in the rest of pain medicine. The release of the Consensus Study Report identifies eleven short-term and long-term recommendations regarding gaps and opportunities oriented towards the situation in the US, which are equally applicable to the situation in Chile. The first four recommendations focus on basic and translational research, public health research and strengthening clinical research. The next three recommendations concern risk assessment, diagnostics, and dissemination of clinical practice guidelines and care metrics to improve patient care and expand its access. Recommendations eight to ten propose Centers of Excellence for Temporomandibular Disorders and Orofacial Pain Treatment, improving professional school education, and expanding specialized continuing education for healthcare providers. The eleventh recommendation focuses on patient education and stigma reduction. This article highlights the published recommendations and addresses what should be considered by Chilean professionals, as a first step of a major effort to shift TMD research, treatment, and education paradigms for the years to come.
- Published
- 2023
- Full Text
- View/download PDF
5. Clinical, psychological, and sensory characteristics associated with headache attributed to temporomandibular disorder in people with chronic myogenous temporomandibular disorder and primary headaches
- Author
-
Inna E. Tchivileva, Richard Ohrbach, Roger B. Fillingim, Feng-Chang Lin, Pei Feng Lim, Samuel J. Arbes, and Gary D. Slade
- Subjects
Orofacial pain ,Headache ,Migraine ,Tension-type headache ,Medicine - Abstract
Abstract Background Headache attributed to Temporomandibular Disorder (HATMD) is a secondary headache that may have features resulting in diagnostic overlap with primary headaches, namely, tension-type (TTH) or migraine. This cross-sectional study of people with both chronic myogenous TMD and primary headaches evaluated characteristics associated with HATMD. Methods From a clinical trial of adults, baseline data were used from a subset with diagnoses of both TMD myalgia according to the Diagnostic Criteria for TMD (DC/TMD) and TTH or migraine according to the International Classification of Headache Disorders, 3rd edition. HATMD was classified based on the DC/TMD. Questionnaires and examinations evaluated 42 characteristics of facial pain, headache, general health, psychological distress, and experimental pain sensitivity. Univariate regression models quantified the associations of each characteristic with HATMD (present versus absent), headache type (TTH versus migraine), and their interaction in a factorial design. Multivariable lasso regression identified the most important predictors of HATMD. Results Of 185 participants, 114 (61.6%) had HATMD, while the numbers with TTH (n = 98, 53.0%) and migraine (n = 87, 47.0%) were similar. HATMD was more likely among migraineurs (61/87 = 70.1%) than participants with TTH (53/98 = 54.1%; odds ratio = 2.0; 95%CL = 1.1, 3.7). In univariate analyses, characteristics associated with HATMD included pain-free jaw opening and examination-evoked pain in masticatory muscles and temporomandibular joints (TMJ) as well as frequency and impact of headache, but not frequency or impact of facial pain. Lowered blood pressure but not psychological or sensory characteristics was associated with HATMD. Multiple characteristics of facial pain, headache, general health, and psychological distress differed between TTH or migraine groups. Few interactions were observed, demonstrating that most characteristics’ associations with HATMD were consistent in TTH and migraine groups. The lasso model identified headache frequency and examination-evoked muscle pain as the most important predictors of HATMD. Conclusions HATMD is highly prevalent among patients with chronic myogenous TMD and headaches and often presents as migraine. In contrast to primary headaches, HATMD is associated with higher headache frequency and examination-evoked masticatory muscle pain, but with surprisingly few measures of facial pain, general health, and psychological distress. A better understanding of HATMD is necessary for developing targeted strategies for its management. Trial identification and registration SOPPRANO; NCT02437383 . Registered May 7, 2015.
- Published
- 2021
- Full Text
- View/download PDF
6. Effect of Human Genetic Variability on Gene Expression in Dorsal Root Ganglia and Association with Pain Phenotypes
- Author
-
Marc Parisien, Samar Khoury, Anne-Julie Chabot-Doré, Susana G. Sotocinal, Gary D. Slade, Shad B. Smith, Roger B. Fillingim, Richard Ohrbach, Joel D. Greenspan, William Maixner, Jeffrey S. Mogil, Inna Belfer, and Luda Diatchenko
- Subjects
dorsal root ganglion ,DRG ,single nucleotide polymorphism ,SNPs ,expression quantitative trait loci ,eQTLs ,genome-wide association study ,GWAS ,quantitative sensory testing ,QST ,pain ,Biology (General) ,QH301-705.5 - Abstract
Dorsal root ganglia (DRG) relay sensory information to the brain, giving rise to the perception of pain, disorders of which are prevalent and burdensome. Here, we mapped expression quantitative trait loci (eQTLs) in a collection of human DRGs. DRG eQTLs were enriched within untranslated regions of coding genes of low abundance, with some overlapping with other brain regions and blood cell cis-eQTLs. We confirm functionality of identified eQTLs through their significant enrichment within open chromatin and highly deleterious SNPs, particularly at the exon level, suggesting substantial contribution of eQTLs to alternative splicing regulation. We illustrate pain-related genetic association results explained by DRG eQTLs, with the strongest evidence for contribution of the human leukocyte antigen (HLA) locus, confirmed using a mouse inflammatory pain model. Finally, we show that DRG eQTLs are found among hits in numerous genome-wide association studies, suggesting that this dataset will help address pain components of non-pain disorders.
- Published
- 2017
- Full Text
- View/download PDF
7. Anatomical selectivity in overlap of chronic facial and bodily pain
- Author
-
Gary D. Slade, Jonathan D. Rosen, Richard Ohrbach, Joel D. Greenspan, Roger B. Fillingim, Marc Parisien, Samar Khoury, Luda Diatchenko, William Maixner, and Eric Bair
- Subjects
Anesthesiology ,RD78.3-87.3 - Abstract
Abstract. Background:. Chronic facial pain often overlaps with pain experienced elsewhere in the body, although previous studies have focused on a few, selected pain conditions when assessing the degree of overlap. Aim:. To quantify the degree of overlap between facial pain and pain reported at multiple locations throughout the body. Methods:. Data were from a case–control study of US adults participating in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) project. They were interviewed to determine the presence of chronic facial pain (n = 424 cases) or its absence (n = 912 controls). A mailed questionnaire with a body drawing asked about pain at other locations. Odds ratios (ORs) and 95% confidence limits (95% CLs) quantified the degree of overlap between facial pain and pain at other locations. For replication, cross-sectional data were analyzed from the UK Biobank study (n = 459,604 participants) and the US National Health Interview Survey (n = 27,731 participants). Results:. In univariate analysis, facial pain had greatest overlap with headache (OR = 14.2, 95% CL = 9.7–20.8) followed by neck pain (OR = 8.5, 95% CL = 6.5–11.0), whereas overlap decreased substantially (ORs of 4.4 or less) for pain at successively remote locations below the neck. The same anatomically based ranking of ORs persisted in multivariable analysis that adjusted for demographics and risk factors for facial pain. Findings were replicated in the UK Biobank study and the US National Health Interview Survey. The observed anatomical selectivity in the degree of overlap could be a consequence of neurosensory and/or affective processes that differentially amplify pain according to its location.
- Published
- 2019
- Full Text
- View/download PDF
8. Racial/ethnic differences in experimental pain sensitivity and associated factors - Cardiovascular responsiveness and psychological status.
- Author
-
Hee Jun Kim, Joel D Greenspan, Richard Ohrbach, Roger B Fillingim, William Maixner, Cynthia L Renn, Meg Johantgen, Shijun Zhu, and Susan G Dorsey
- Subjects
Medicine ,Science - Abstract
This study evaluated the contributions of psychological status and cardiovascular responsiveness to racial/ethnic differences in experimental pain sensitivity. The baseline measures of 3,159 healthy individuals-non-Hispanic white (NHW): 1,637, African-American (AA): 1,012, Asian: 299, and Hispanic: 211-from the OPPERA prospective cohort study were used. Cardiovascular responsiveness measures and psychological status were included in structural equation modeling based mediation analyses. Pain catastrophizing was a significant mediator for the associations between race/ethnicity and heat pain tolerance, heat pain ratings, heat pain aftersensations, mechanical cutaneous pain ratings and aftersensations, and mechanical cutaneous pain temporal summation for both Asians and AAs compared to NHWs. HR/MAP index showed a significant inconsistent (mitigating) mediating effect on the association between race/ethnicity (AAs vs. NHWs) and heat pain tolerance. Similarly, coping inconsistently mediated the association between race/ethnicity and mechanical cutaneous pain temporal summation in both AAs and Asians, compared to NHWs. The factor encompassing depression, anxiety, and stress was a significant mediator for the associations between race/ethnicity (Asians vs. NHWs) and heat pain aftersensations. Thus, while pain catastrophizing mediated racial/ethnic differences in many of the QST measures, the psychological and cardiovascular mediators were distinctly restrictive, signifying multiple independent mechanisms in racial/ethnic differences in pain.
- Published
- 2019
- Full Text
- View/download PDF
9. DC/TMD Examination Protocol
- Author
-
Yoly Gonzalez, Jason Chwirut, Thomas List, and Richard Ohrbach
- Subjects
Diagnosis ,Examination ,DC/TMD ,Medicine (General) ,R5-920 ,Education - Abstract
Abstract Introduction This 19½-minute video is an illustration of the standardized clinical examination based on the diagnostic criteria for temporomandibular disorders (DC/TMD). The video was created because of the considerable challenges associated with developing competency in the clinical examination protocol. Typically, multiple learning/training exercises are required in order to achieve mastery. Specifically, this video was conceptualized to address the difficulty that examiners have in integrating their verbal commands, clinical procedures, and responses given by patients. Methods The intended audience includes potential clinical examiners for TMD and dental or medical educators who are teaching the standardized clinical examination for TMD. If implemented in a formal training setting, the video should be used to illustrate how to perform the clinical examination; the instructor/trainer can display the procedures one video segment at a time and follow that with group discussion in order to further explain and to respond to questions. After watching the video, examiner trainees should be paired with a supervisor and practice hands-on implementation of the protocol. If the video is implemented as a self-learning tool, the examiner trainee will benefit from having a training partner. After fully reviewing the video, the two trainees can practice examination procedures on each other, while stepping through the video. Supervision from a trainer is still recommended for final calibration, if possible. Results We have used this video during the last two years as part of both field-testing the examination protocol and field-testing the video as one component of training. The video has been field-tested in both the US and Europe. Feedback from examiner trainees has been incorporated, making the final product the outcome of multiple revisions. Examiner trainees have tended to report a higher level of difficulty, and these issues have been addressed as well. Discussion A major limitation of this work is that it is only presented in English, whereas examiner trainees speak many languages. We are coordinating with several colleagues to translate the clinical protocol into at least 25 languages. It is our goal to eventually incorporate accepted translations into the video in either text or voice formats.
- Published
- 2014
- Full Text
- View/download PDF
10. Temporomandibular joint loads in subjects with and without disc displacement
- Author
-
Laura Rei Iwasaki, Michael Crosby, Yoly Gonzalez, Willard D. McCall, David B. Marx, Richard Ohrbach, and Jeffrey Charles Nickel
- Subjects
modeling, computer, force, TMJ, biting ,Orthopedic surgery ,RD701-811 - Abstract
The likelihood of development of degenerative joint disease (DJD) of the temporomandibular joint (TMJ) is related to the integrity of the TMJ disc. Predilection for mechanical failure of the TMJ disc may reflect inter-individual differences in TMJ loads. Nine females and eight males in each of normal TMJ disc position and bilateral disc displacement diagnostic groups consented to participate in our study. Disc position was determined by bilateral magnetic resonance images of the joints. Three-dimensional (3D) anatomical geometry of each subject was used in a validated computer-assisted numerical model to calculate ipsilateral and contralateral TMJ loads for a range of biting positions (incisor, canine, molar) and angles (1-13). Each TMJ load was a resultant vector at the anterosuperior-most mediolateral midpoint on the condyle and characterized in terms of magnitude and 3D orientation. Analysis of variance (ANOVA) was used to test for effects of biting position and angle on TMJ loads. Mean TMJ loads in subjects with disc displacement were 9.5-69% higher than in subjects with normal disc position. During canine biting, TMJ loads in subjects with disc displacement were 43% (ipsilateral condyle, p=0.029) and 49% (contralateral condyle, p=0.015) higher on average than in subjects with normal disc position. Biting angle effects showed that laterally directed forces on the dentition produced ipsilateral joint loads, which on average were 69% higher (p=0.002) compared to individuals with normal TMJ disc position. The data reported here describe large differences in TMJ loads between individuals with disc displacement and normal disc position. The results support future investigations of inter-individual differences in joint mechanics as a variable in the development of DJD of the TMJ.
- Published
- 2009
- Full Text
- View/download PDF
11. Commentary on 'Temporomandibular Disorders: Priorities for Research and Care': Implications for the readership of the Journal of Prosthetic Dentistry
- Author
-
Richard Ohrbach and Charles Greene
- Subjects
Oral Surgery - Published
- 2023
12. Ratio of Omega-6/Omega-3 Polyunsaturated Fatty Acids Associated With Somatic and Depressive Symptoms in People With Painful Temporomandibular Disorder and Irritable Bowel Syndrome
- Author
-
Anne E. Sanders, E. Diane Weatherspoon, Brandie M. Ehrmann, Paul S. Soma, Saame R. Shaikh, John S. Preisser, Richard Ohrbach, Roger B. Fillingim, and Gary D. Slade
- Subjects
Adult ,Irritable Bowel Syndrome ,Cross-Sectional Studies ,Medically Unexplained Symptoms ,Anesthesiology and Pain Medicine ,Neurology ,Depression ,Fatty Acids, Omega-3 ,Humans ,Pain ,Neurology (clinical) ,Temporomandibular Joint Disorders - Abstract
Somatic symptom disturbance is among the strongest predictors of painful temporomandibular disorder (TMD). Related psychological constructs, such as anxiety and depression, respond therapeutically to omega-3 polyunsaturated fatty acids (PUFAs) in clinical trials. This cross-sectional study investigated associations between the omega-6/omega-3 PUFA ratio and somatic symptom disturbance and depressive symptoms in a community-based sample of 501 adults and determined whether these associations differed between adults with and without TMD or irritable bowel syndrome (IBS). Liquid chromatography tandem mass spectrometry quantified PUFAs in circulating erythrocytes. Somatic symptoms and depression were quantified using Symptom Checklist-90-Revised subscales. Presence or absence of TMD and IBS, respectively, were determined by clinical examination and Rome III screening questions. The standardized beta coefficient for the omega-6/omega-3 long-chain PUFA ratio was 0.26 (95% confidence limits (CL): 0.08, 0.43) in a multivariable linear regression model in which somatic symptom disturbance was the dependent variable. When modelling depressive symptoms as the dependent variable, the standardized beta coefficient was 0.17 (95% CL:0.01, 0.34). Both associations were stronger among TMD cases and IBS cases than among non-cases. Future randomized control trials that lower the omega-6/omega-3 PUFA ratio could consider somatic or depressive symptoms as a therapeutic target for TMD or IBS pain. PERSPECTIVE: In people with TMD or IBS, a high n-6/n-3 PUFA ratio was positively associated with somatic symptom disturbance and depressive symptoms. Both measures of psychological distress were elevated in people with painful TMD and IBS. Future randomized clinical trials will determine whether lowering the n-6/n-3 ratio is therapeutic for pain.
- Published
- 2022
13. New curriculum standards for teaching temporomandibular disorders in dental schools
- Author
-
James Fricton, Hong Chen, Jeffrey R. Shaefer, Jay Mackman, Jeffrey P. Okeson, Richard Ohrbach, Gary D. Klasser, James Hawkins, Robert Hasel, and Gary Heir
- Subjects
General Dentistry - Published
- 2022
14. Diagnostic criteria for temporomandibular disorders in children and adolescents
- Author
-
Roberto Rongo, EwaCarin Ekberg, Ing‐Marie Nilsson, Amal Al‐Khotani, Per Alstergren, Paulo Cesar Rodrigues Conti, Justin Durham, Jean‐Paul Goulet, Christian Hirsch, Stanimira I. Kalaykova, Flavia P. Kapos, Christopher D. King, Osamu Komiyama, Michail Koutris, Thomas List, Frank Lobbezoo, Richard Ohrbach, Tonya M. Palermo, Christopher C. Peck, Chris Penlington, Claudia Restrepo, Maria Joao Rodrigues, Sonia Sharma, Peter Svensson, Corine M. Visscher, Kerstin Wahlund, Ambrosina Michelotti, and Oral Kinesiology
- Subjects
Adult ,Sleep Wake Disorders ,SYMPTOMS ,Adolescent ,Delphi Technique ,Temporomandibular Joint Disorders/diagnosis ,Pain ,Anxiety/diagnosis ,Anxiety ,Young Adult ,ANXIETY ,Humans ,DOR ,Child ,VERSION ,General Dentistry ,SCALE ,TMD ,Temporomandibular Joint Disorders ,DEPRESSION ,SLEEP ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,stomatognathic diseases ,RELIABILITY ,MUSCULOSKELETAL ,CHRONIC PAIN - Abstract
Item does not contain fulltext BACKGROUND: Unlike the psychosocial assessment established for adults in the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), a standardised psychosocial assessment for children and adolescents with TMD complaints has not yet been established. OBJECTIVES: To develop a new standardised instrument set to assess the psychosocial functioning in children and adolescents by adapting the psychosocial status and pain-related disability (Axis II) of the adult DC/TMD and by including new instruments. METHODS: A modified Delphi method was used to survey 23 international TMD experts and four international experts in pain-related psychological factors for consensus regarding assessment tools for psychosocial functioning and pain-related disability in children and adolescents. The TMD experts reviewed 29 Axis II statements at round 1, 13 at round 2 and 2 at round 3. Agreement was set at 80% for first-round consensus level and 70% for each of the second and third rounds. The psychological experts completed a complementary Delphi survey to reach a consensus on tools to use to assess more complex psychological domains in children and adolescents. For the psychological experts, the first round included 10 open-ended questions on preferred screening tools for depression, anxiety, catastrophising, sleep problems and stress in children (ages 6-9 years old) and adolescents (ages 10-19 years old) as well as on other domains suggested for investigation. In the second round, the psychological experts received a 9-item questionnaire to prioritise the suggested instruments from most to least recommended. RESULTS: The TMD experts, after three Delphi rounds, reached consensus on the changes of DC/TMD to create a form to evaluate Axis II in children and adolescents with TMD complaints. The psychological experts added tools to assess depression and anxiety, sleep disorders, catastrophising, stress and resilience. CONCLUSION: Through international expert consensus, this study adapted Axis II of the adult DC/TMD to assess psychosocial functioning and pain-related disability in children and adolescents. The adapted Axis II protocols will be validated in the target populations.
- Published
- 2022
15. Management of painful temporomandibular disorders
- Author
-
Ana Miriam Velly, Gary C. Anderson, John O. Look, Joseph L. Riley, D. Bradley Rindal, Kimberly Johnson, Qi Wang, James Fricton, Kevin Huff, Richard Ohrbach, Gregg H. Gilbert, and Eric Schiffman
- Subjects
General Dentistry - Published
- 2022
16. Impact of Stress and Trait Anxiety on the Sensory and Jaw Motor Responses to a Tonic Orofacial Nociceptive Stimulus
- Author
-
Jeffrey Chow, Paolo Chiodini, Ambra Michelotti, Richard Ohrbach, Iacopo Cioffi, Chow, J. C. F., Chiodini, P., Michelotti, A., Ohrbach, R., and Cioffi, I.
- Subjects
Adult ,Nociception ,Occlusion ,Pain ,Masticatory muscle ,Anxiety ,Anesthesiology and Pain Medicine ,Humans ,Bruxism ,Dentistry (miscellaneous) ,Neurology (clinical) ,Sensory hreshold ,Stress, Psychological ,Human ,Pain Measurement - Abstract
Aims: To investigate how trait anxiety and stress jointly affect the sensory and jaw motor responses to a tonic orofacial nociceptive stimulus. Methods: Orthodontic separators were placed between the first molars in 45 adults with low (n = 14), intermediate (n = 17), and high (n = 14) trait anxiety. Tooth pain, occlusal discomfort, tooth clenching (as a jaw motor behavior), and situational stress were measured three times a day for 5 days using visual analog scales. Mixed-effects regression models were used to evaluate the sensory and motor outcome measures. Results: Pain, discomfort, and frequency of tooth-clenching trajectories were affected by trait anxiety (P =.007, P
- Published
- 2022
17. Temporomandibular Disorders Core Curriculum for Predoctoral Dental Education: Recommendations from the American Academy of Orofacial Pain
- Author
-
AAOP Committee on TMD Predoctoral Education, Hong, Chen, James, Fricton, Joseph, Cohen, Terrie, Cowley, Shuchi, Dhadwal, Roger B, Fillingim, Sandra, Guzman-Armstrong, Robert, Hasel, James, Hawkins, Gary, Heir, David, Holmes, Deepika, Jaiswal, Thomas B, Jordan, Gary, Klasser, Seema, Kurup, Steven M, Levy, J, Mackman, George, Maloney, Shawn, McMahon, Richard, Ohrbach, Jeffrey P, Okeson, Janey, Prodoehl, Sonia, Sharma, Yi, Yuan, and Jeffrey R, Shaefer
- Subjects
Anesthesiology and Pain Medicine ,Facial Pain ,Humans ,Dentistry (miscellaneous) ,Curriculum ,Neurology (clinical) ,Temporomandibular Joint Disorders ,Education, Dental ,United States - Published
- 2021
18. Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for children
- Author
-
Ing-Marie, Nilsson, EwaCarin, Ekberg, Ambrosina, Michelotti, Amal, Al-Khotani, Per, Alstergren, Paulo Cesar Rodrigues, Conti, Justin, Durham, Jean-Paul, Goulet, Christian, Hirsch, Stanimira, Kalaykova, Flavia P, Kapos, Christopher D, King, Osamu, Komiyama, Michail, Koutris, Thomas, List, Frank, Lobbezoo, Richard, Ohrbach, Tonya M, Palermo, Christopher C, Peck, Chris, Penlington, Claudia, Restrepo, Maria Joao, Rodrigues, Sonia, Sharma, Peter, Svensson, Corine, Visscher, Kerstin, Wahlund, Roberto, Rongo, and Oral Kinesiology
- Subjects
Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,All institutes and research themes of the Radboud University Medical Center ,dysfunction ,children ,diagnostic criteria ,temporomandibular disorders ,pain ,General Dentistry - Abstract
Item does not contain fulltext BACKGROUND: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed. OBJECTIVE: The aim of this study was to present comprehensive and short-form adaptations of Axis I and Axis II of the DC/TMD for adults that are appropriate for use with children in clinical and research settings. METHODS: Global Delphi studies with experts in TMDs and in pain psychology identified ways of adapting the DC/TMD for children. RESULTS: The proposed adaptation is suitable for children aged 6-9 years. Proposed changes in Axis I include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for children, (ii) adding a general health questionnaire for children and one for their parents, (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire and (iv) modifying the clinical examination protocol. Proposed changes in Axis II include (i) for the Graded Chronic Pain Scale, to be developmentally appropriate for children, (ii) adding anxiety and depression assessments that have been validated in children and (iii) adding three constructs (stress, catastrophising and sleep disorders) to assess psychosocial functioning in children. CONCLUSION: The recommended DC/TMD, including Axis I and Axis II, for children aged 6-9 years, is appropriate for use in clinical and research settings. This adapted the first version for children includes changes in Axis I and Axis II changes requiring reliability and validity testing in international settings. Official translations to different languages according to INfORM requirements will enable a worldwide dissemination and implementation. 01 februari 2023
- Published
- 2022
19. Temporomandibular Disorders
- Author
-
Richard Ohrbach, Thomas Sollecito, Temitope Omolehinwa, and Martin S. Greenberg
- Published
- 2021
20. Association of Hormonal Contraceptive Use with Headache and Temporomandibular Pain: The OPPERA Study
- Author
-
Richard Ohrbach, William Maixner, Gary D. Slade, Roger B. Fillingim, Sheila M. Gaynor, Joel D. Greenspan, Eric Bair, and Denniz Zolnoun
- Subjects
Orofacial pain ,medicine.medical_specialty ,medicine.medical_treatment ,Risk Assessment ,Contraceptive Agents ,Facial Pain ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Dentistry (miscellaneous) ,Prospective Studies ,Prospective cohort study ,Hysterectomy ,business.industry ,Proportional hazards model ,Headache ,Odds ratio ,medicine.disease ,Menopause ,Anesthesiology and Pain Medicine ,Female ,Body region ,International Classification of Headache Disorders ,Neurology (clinical) ,medicine.symptom ,business - Abstract
Aims To determine the relationship between hormonal contraceptive (HC) use and painful symptoms, particularly those associated with headache and painful temporomandibular disorders (TMD). Methods Data from the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) prospective cohort study were used. During the 2.5-year median follow-up period, quarterly health update (QHU) questionnaires were completed by 1,475 women aged 18 to 44 years who did not have TMD, menopause, hysterectomy, or hormone replacement therapy use at baseline. QHU questionnaires evaluated HC use, symptoms of headache and TMD, and pain of ≥ 1 day duration in 12 body regions. Participants who developed TMD symptoms were examined to classify clinical TMD. Headache symptoms were classified based on the International Classification of Headache Disorders 3 (ICHD-3). Associations between HC use and pain symptoms were analyzed using generalized estimating equations and Cox models. Results HC use, endorsed in 33.7% of QHU questionnaires, was significantly associated with concurrent symptoms of TMD (odds ratio [OR]: 1.20, 95% CI: 1.06 to 1.35) and headache (OR: 1.26, 95% CI: 1.11 to 1.43). HC use was also significantly associated with concurrent pain of ≥ 1 day duration in the head (OR: 1.38, 95% CI: 1.16 to 1.63), face (OR: 1.44, 95% CI: 1.13 to 1.83), and legs (OR: 1.22, 95% CI: 1.01 to 1.47), but not elsewhere. Initiation of HC use was associated with increased odds of subsequent TMD symptoms (OR: 1.37, 95% CI: 1.13 to 1.66) and pain of ≥ 1 day in the head (OR: 1.37, 95% CI: 1.01 to 1.85). Discontinuing HC use was associated with lower odds of subsequent headache (OR: 0.82, 95% CI: 0.67 to 0.99). HC use was not significantly associated with subsequent onset of examiner-classified TMD. Conclusion These findings imply that HC influences craniofacial pain, and that this pain diminishes after cessation of HC use.
- Published
- 2021
21. Circulating Polyunsaturated Fatty Acids and Pain Intensity in Five Chronic Pain Conditions
- Author
-
Anne E. Sanders, E. Diane Weatherspoon, Brandie M. Ehrmann, Paul S. Soma, Saame R. Shaikh, John S. Preisser, Richard Ohrbach, Roger B. Fillingim, and Gary D. Slade
- Subjects
Anesthesiology and Pain Medicine ,Neurology ,Neurology (clinical) - Abstract
Pain intensity is well-known to be influenced by a wide range of biobehavioral variables. Nutritional factors, however, have not been generally considered for their potential importance. This cross-sectional study examined associations between erythrocyte omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acids (PUFAs) and pain intensity in 605 adults. Pain intensity was computed on a 0 to 100 numeric rating scale from questions about 5 chronic pain conditions: orofacial pain, headache, low back pain, irritable bowel syndrome, and bodily pain. For each pain condition, multiple linear regression tested the hypothesis that a higher ratio of n-6 arachidonic acid to the sum of n-3 eicosapentaenoic acid and docosahexaenoic acid (AA/(EPA+DHA) was associated with greater pain intensity. In covariate-adjusted analysis, orofacial pain intensity increased 5.7 points (95% CI: 1.4, 9.9) per unit increase in n-6/n-3 PUFA ratio. Likewise, a 1 unit increase in n-6/n-3 PUFA ratio was associated with significant increases in pain intensity (range 5-8 points) of headache pain, low back pain, and bodily pain, but not abdominal pain. Separate multiple linear regression models investigated the independent strength of association of individual PUFAs to the intensity of each pain condition. Overall, n-3 docosahexaenoic acid was most strongly, and inversely, associated with pain intensity. PERSPECTIVE: A higher ratio of n-6/n-3 long-chain polyunsaturated fatty acids was associated greater pain intensity for orofacial pain, headache, low back pain, and bodily pain, but not abdominal pain. The n-6/n-3 PUFA ratio was more consistently associated with pain intensity than any individual constituent of the long-chain PUFA ratio.
- Published
- 2022
22. Circulating polyunsaturated fatty acids, pressure pain thresholds, and nociplastic pain conditions
- Author
-
Anne E. Sanders, E. Diane Weatherspoon, Brandie M. Ehrmann, Paul S. Soma, Saame R. Shaikh, John S. Preisser, Richard Ohrbach, Roger B. Fillingim, and Gary D. Slade
- Subjects
Adult ,Pain Threshold ,Cross-Sectional Studies ,Fatty Acids, Omega-6 ,Clinical Biochemistry ,Fatty Acids, Omega-3 ,Fatty Acids, Unsaturated ,Humans ,Cell Biology - Abstract
Polyunsaturated fatty acids (PUFAs) play a role in pain regulation. This study sought to determine whether free PUFAs found in red blood cells also play a role in nociceptive processing. We examined associations between circulating PUFAs and nociceptive thresholds to noxious mechanical stimuli. We also determined whether nociceptive thresholds were associated with nociplastic pain conditions.This cross-sectional study used stored red bloods cells and data from 605 adult participants in the OPPERA-2 study of chronic overlapping pain conditions. In OPPERA-2 adults completed quantitative sensory testing in which pressure algometry measured deep muscular tissue sensitivity at six anatomical sites. Standardized protocols classified adults for presence or absence of five nociplastic pain conditions: temporomandibular disorder, headache, low back pain, irritable bowel syndrome and fibromyalgia. Liquid chromatography tandem mass spectroscopy quantified erythrocyte PUFAs. We conducted three sets of analyses. First, a multivariable linear regression model assessed the association between n-6/n-3 PUFA ratio and the number of overlapping nociplastic pain conditions. Second, a series of 36 multivariable linear regression models assessed covariate-adjusted associations between PUFAs and nociceptive thresholds at each of six anatomical sites. Third, a series of 30 multivariable linear regression models assessed covariate-adjusted associations between nociceptive thresholds at six anatomical sites and each of five pain conditions.In multiple linear regression, each unit increase in n-6/n-3 PUFA ratio was associated with more pain conditions (β = 0.30, 95% confidence limits: 0.07, 0.53, p = 0.012). Omega-6 linoleic acid and arachidonic acid were negatively associated with lower nociceptive thresholds at three and at five, respectively, anatomical sites. In contrast, omega-3 alpha-linolenic acid, eicosapentaenoic acid, docosahexaenoic acid and the n-6/n-3 PUFA ratio were not associated with nociceptive thresholds at any site. Pain cases had significantly lower nociceptive thresholds than non-case controls at all anatomical sites.A higher n-6/n-3 PUFA ratio was associated with more pain conditions. Omega-6 PUFAs may promote a generalized upregulation of nociceptive processing.
- Published
- 2022
23. A rose by another name? Characteristics that distinguish headache secondary to temporomandibular disorder from headache that is comorbid with temporomandibular disorder
- Author
-
Sonia Sharma, Gary D. Slade, Roger B. Fillingim, and Richard Ohrbach
- Subjects
Anesthesiology and Pain Medicine ,Neurology ,Neurology (clinical) - Abstract
Co-occurring pain conditions that affect overlapping body regions are complicated by the distinction between primary vs secondary pain conditions. We investigate the occurrence of headache and painful temporomandibular disorder (TMD) in a community-based, cross-sectional study of US adults in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA-II) study. A specific goal was to determine whether headache attributed to TMD is separable from primary headache. Using DC/TMD and International Classification of Headache Disorders-third edition criteria, 3 groups of individuals were created: (a) headache without TMD; (b) headache comorbid with TMD; and (c) headache attributed to TMD. Regression models compared study groups according to demographic and comorbid characteristics, and post hoc contrasts tested for differences. Descriptive statistics and Cohen d effect size were computed, by group, for each predictor variable. Differences in continuous predictors were analyzed using one-way analysis of variance. Nearly all demographic and comorbid variables distinguished the combined headache and TMD groups from the group with headache alone. Relative to the reference group with primary headache alone, markers related to headache, TMD, somatic pain processing, psychosocial, and health conditions were substantially greater in both headache comorbid with TMD and headache attributed to TMD, attesting to their qualitative similarities. However, effect sizes relative to the reference group were large for headache comorbid with TMD and larger again for headache attributed to TMD, attesting to their separability in quantitative terms. In summary, the presence of overlapping painful TMD and headache adds substantially to the biopsychosocial burden of headache and points to the importance of comprehensive assessment and differential management.
- Published
- 2022
24. Phenotypic profile clustering pragmatically identifies diagnostically and mechanistically informative subgroups of chronic pain patients
- Author
-
Shad B. Smith, Andrey V. Bortsov, Andrea G. Nackley, William Maixner, Roger B. Fillingim, Aurelio A. Alonso, Thomas Buchheit, Luda Diatchenko, William E. Whitehead, Joel D. Greenspan, Richard Ohrbach, Inna E. Tchivileva, Sheila M. Gaynor, Richard L. Boortz-Marx, Wolfgang Liedtke, Jongbae Park, and Eric Bair
- Subjects
Biopsychosocial model ,medicine.medical_specialty ,Orofacial pain ,Pain medicine ,Population ,Article ,03 medical and health sciences ,0302 clinical medicine ,Facial Pain ,030202 anesthesiology ,Internal medicine ,medicine ,Cluster Analysis ,Humans ,Prospective Studies ,education ,education.field_of_study ,business.industry ,Chronic pain ,medicine.disease ,Anxiety Disorders ,Anesthesiology and Pain Medicine ,Neurology ,Cohort ,Anxiety ,Neurology (clinical) ,Chronic Pain ,medicine.symptom ,business ,Somatization ,030217 neurology & neurosurgery - Abstract
Traditional classification and prognostic approaches for chronic pain conditions focus primarily on anatomically based clinical characteristics not based on underlying biopsychosocial factors contributing to perception of clinical pain and future pain trajectories. Using a supervised clustering approach in a cohort of temporomandibular disorder cases and controls from the Orofacial Pain: Prospective Evaluation and Risk Assessment study, we recently developed and validated a rapid algorithm (ROPA) to pragmatically classify chronic pain patients into 3 groups that differed in clinical pain report, biopsychosocial profiles, functional limitations, and comorbid conditions. The present aim was to examine the generalizability of this clustering procedure in 2 additional cohorts: a cohort of patients with chronic overlapping pain conditions (Complex Persistent Pain Conditions study) and a real-world clinical population of patients seeking treatment at duke innovative pain therapies. In each cohort, we applied a ROPA for cluster prediction, which requires only 4 input variables: pressure pain threshold and anxiety, depression, and somatization scales. In both complex persistent pain condition and duke innovative pain therapies, we distinguished 3 clusters, including one with more severe clinical characteristics and psychological distress. We observed strong concordance with observed cluster solutions, indicating the ROPA method allows for reliable subtyping of clinical populations with minimal patient burden. The ROPA clustering algorithm represents a rapid and valid stratification tool independent of anatomic diagnosis. ROPA holds promise in classifying patients based on pathophysiological mechanisms rather than structural or anatomical diagnoses. As such, this method of classifying patients will facilitate personalized pain medicine for patients with chronic pain.
- Published
- 2020
25. COMTGenotype and Efficacy of Propranolol for TMD Pain: A Randomized Trial
- Author
-
Samuel J. Arbes, Richard Ohrbach, Janet Willis, Roger B. Fillingim, Holly Hadgraft, Inna E. Tchivileva, and Gary D. Slade
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Analgesic ,Placebo ,Gastroenterology ,law.invention ,Clinical ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,placebos ,Genetic model ,genetic polymorphism ,Medicine ,adrenergic beta-antagonists ,General Dentistry ,pharmacogenetics ,business.industry ,Chronic pain ,Area under the curve ,Repeated measures design ,Research Reports ,medicine.disease ,030104 developmental biology ,facial pain ,chronic pain ,business ,030217 neurology & neurosurgery ,rs4680 - Abstract
Propranolol is a nonselective β-adrenergic receptor antagonist that is efficacious in reducing facial pain. There is evidence that its analgesic efficacy might be modified by variants of the catechol-O-methyltransferase ( COMT) gene. We tested the hypothesis in a subset of 143 non-Hispanic Whites from a randomized controlled trial of patients with painful temporomandibular disorder (TMD). Patients were genotyped for rs4680, a single nucleotide polymorphism of COMT, and randomly allocated to either propranolol 60 mg twice daily or placebo. During the 9-wk follow-up period, patients recorded daily ratings of facial pain intensity and duration; the product was computed as an index of facial pain. Postbaseline change in the index at week 9 (the primary endpoint) was analyzed as a continuous variable and dichotomized at thresholds of ≥30% and ≥50% reduction. Mixed models for repeated measures tested for the genotype × treatment group interaction and estimated means, odds ratios (ORs), and 95% confidence limits (95% CLs) of efficacy within COMT genotypes assuming an additive genetic model. In secondary analysis, the cumulative response curves were plotted for dichotomized reductions ranging from ≥20% to ≥70%, and genotype differences in area under the curve percentages (%AUC) were calculated to signify efficacy. Mean index reduction did not differ significantly ( P = 0.277) according to genotype, whereas the dichotomized ≥30% reduction revealed greater efficacy among G:G homozygotes (OR = 10.9, 95%CL = 2.4, 50.7) than among A:A homozygotes (OR = 0.8, 95%CL = 0.2, 3.2) with statistically significant interaction ( P = 0.035). Cumulative response curves confirmed greater ( P = 0.003) efficacy for G:G homozygotes (%AUC difference = 43.7, 95%CL = 15.4, 72.1) than for A:A homozygotes (%AUC difference = 6.5, 95%CL = -30.2, 43.2). The observed antagonistic effect of the A allele on propranolol’s efficacy was opposite the synergistic effect hypothesized a priori. This unexpected result highlights the need for better knowledge of COMT’s role in pain pathogenesis if the gene is to be used for precision-medicine treatment of TMD (ClinicalTrials.gov NCT02437383).
- Published
- 2020
26. Circulating Omega-6 and Omega-3 Polyunsaturated Fatty Acids in Painful Temporomandibular Disorder and Low Back Pain
- Author
-
Anne E. Sanders, E. Diane Weatherspoon, Brandie M. Ehrmann, Paul S. Soma, Saame R. Shaikh, John S. Preisser, Richard Ohrbach, Roger B. Fillingim, and Gary D. Slade
- Subjects
Adult ,Inflammation ,Analgesics ,Docosahexaenoic Acids ,Arachidonic Acids ,Temporomandibular Joint Disorders ,Anesthesiology and Pain Medicine ,Cross-Sectional Studies ,Neurology ,Fatty Acids, Omega-6 ,Fatty Acids, Omega-3 ,Fatty Acids, Unsaturated ,Humans ,Neurology (clinical) ,Chronic Pain ,Low Back Pain - Abstract
Preclinical studies demonstrate opposing effects of long-chain polyunsaturated fatty acid (PUFA) metabolites on inflammation and nociception. Omega-6 (n-6) PUFAs amplify both processes while omega-3 (n-3) PUFAs inhibit them. This cross-sectional study examined relationships between PUFAs in circulating erythrocytes and 2 chronic idiopathic pain conditions: temporomandibular disorder (TMD) and low back pain in a community-based sample of 503 U.S. adults. Presence or absence of TMD and low back pain, respectively, were determined by clinical examination and by responses to established screening questions. Liquid chromatography-tandem mass spectrometry quantified PUFAs. In multivariable logistic regression models, a higher ratio of n-6/n-3 long-chain PUFAs was associated with greater odds of TMD (odds ratio ((OR) = 1.75, 95% confidence limits (CL): 1.16, 2.64) and low back pain (OR = 1.63, 95% CL: 1.07, 2.49). Higher levels of the pronociceptive n-6 long-chain arachidonic acid (AA) were associated with a greater probability of both pain conditions for women, but not men. Higher levels of the antinociceptive long-chain n-3 PUFAs eicosapentaenoic and docosahexaenoic acids were associated with a lower probability of both pain conditions for men, but not women. As systemic inflammation is not a hallmark of these conditions, PUFAs may influence idiopathic pain through other mechanisms. PERSPECTIVE: This cross-sectional clinical study found that a higher ratio of circulating n-6/n-3 long-chain PUFAs was associated with greater odds of 2 common chronic overlapping pain conditions. This suggests that the pro and antinociceptive properties of n-6 and n-3 PUFAs, respectively, influence pain independently of their well-established inflammatory pathways.
- Published
- 2022
27. Editorial: The Co-Occurrence of Diseases
- Author
-
Richard Ohrbach
- Subjects
medicine.medical_specialty ,Anesthesiology and Pain Medicine ,business.industry ,Co-occurrence ,Medicine ,Dentistry (miscellaneous) ,Neurology (clinical) ,business ,Dermatology - Published
- 2021
28. Efficacy and safety of propranolol for treatment of temporomandibular disorder pain: a randomized, placebo-controlled clinical trial
- Author
-
Richard Ohrbach, Massimiliano Di Giosia, Robert James, Gary D. Slade, Pei Feng Lim, Holly Hadgraft, Margarete C. Ribeiro-Dasilva, Janet Willis, Roger B. Fillingim, Samuel J. Arbes, John H. Campbell, Marcus Herman-Giddens, and Inna E. Tchivileva
- Subjects
myalgia ,Sleep disorder ,Randomization ,business.industry ,Propranolol ,Temporomandibular Joint Disorders ,Placebo ,medicine.disease ,Clinical trial ,Alcoholism ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Propranolol Hydrochloride ,Double-Blind Method ,Neurology ,Anesthesia ,Clinical endpoint ,Humans ,Medicine ,Female ,Neurology (clinical) ,medicine.symptom ,business ,medicine.drug - Abstract
Propranolol is a nonselective beta-adrenergic receptor antagonist. A multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 2b trial enrolled participants aged 18 to 65 years with temporomandibular disorder myalgia to evaluate efficacy and safety of propranolol compared with placebo in reducing facial pain. Participants were randomized 1:1 to either extended-release propranolol hydrochloride (60 mg, BID) or placebo. The primary endpoint was change in facial pain index (FPI = facial pain intensity multiplied by facial pain duration, divided by 100). Efficacy was analyzed as a mean change in FPI from randomization to week 9 and as the proportion of participants with ≥30% or ≥50% reductions in FPI at week 9. Regression models tested for treatment-group differences adjusting for study site, sex, race, and FPI at randomization. Of 299 participants screened, 200 were randomized; 199 had at least one postrandomization FPI measurement and were included in intention-to-treat analysis. At week 9, model-adjusted reductions in mean FPI did not differ significantly between treatment groups (-1.8, 95% CL: -6.2, 2.6; P = 0.41). However, the proportion with a ≥30% reduction in FPI was significantly greater for propranolol (69.0%) than placebo (52.6%), and the associated number-needed-to-treat was 6.1 (P = 0.03). Propranolol was likewise efficacious for a ≥50% reduction in FPI (number-needed-to-treat = 6.1, P = 0.03). Adverse event rates were similar between treatment groups, except for more frequent fatigue, dizziness, and sleep disorder in the propranolol group. Propranolol was not different from placebo in reducing mean FPI but was efficacious in achieving ≥30% and ≥50% FPI reductions after 9 weeks of treatment among temporomandibular disorder participants.
- Published
- 2020
29. Biopsychosocial assessment and management of persistent orofacial pain
- Author
-
Richard Ohrbach and Chris Penlington
- Subjects
Biopsychosocial model ,Orofacial pain ,medicine.medical_specialty ,Self-management ,business.industry ,medicine ,Physical therapy ,Surgery ,Oral Surgery ,medicine.symptom ,business - Published
- 2020
30. Associations of Sleep Disturbance, Atopy, and Other Health Measures with Chronic Overlapping Pain Conditions
- Author
-
Joel D. Greenspan, Anne E. Sanders, Richard Ohrbach, Nuvan Rathnayaka, Roger B. Fillingim, and Gary D. Slade
- Subjects
medicine.medical_specialty ,Sleep disorder ,business.industry ,Atopic dermatitis ,Odds ratio ,medicine.disease ,Low back pain ,Article ,Obstructive sleep apnea ,Atopy ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Internal medicine ,Fibromyalgia ,medicine ,Dentistry (miscellaneous) ,030212 general & internal medicine ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Irritable bowel syndrome - Abstract
Aims To quantify the contributions of atopic disorders, sleep disturbance, and other health conditions to five common pain conditions. Methods This cross-sectional analysis used data from 655 participants in the OPPERA study. The authors investigated the individual and collective associations of five chronic overlapping pain conditions (COPCs) with medically diagnosed atopic disorders and self-reported sleep disturbance, fatigue, and symptoms of obstructive sleep apnea. Atopic disorders were allergies, allergic rhinitis, atopic dermatitis, allergic asthma, urticaria, allergic conjunctivitis, and food allergy. Logistic regression models estimated odds ratios as measures of association with temporomandibular disorders, headache, irritable bowel syndrome, low back pain, and fibromyalgia. Measures of sleep and atopy disorders were standardized to z scores to determine the relative strength of their associations with each COPC. Sociodemographic characteristics and body mass index were covariates. Random forest regression analyzed all variables simultaneously, computing importance metrics to determine which variables best differentiated pain cases from controls. Results Fatigue and sleep disturbance were strongly associated with each COPC and with the total number of COPCs. An increase of one standard deviation in fatigue or sleep disturbance score was associated with approximately two-fold greater odds of having a COPC. In random forest models, atopic disorders contributed more than other health measures to differentiating between cases and controls of headache, whereas other COPCs were best differentiated by measures of fatigue or sleep. Conclusion Atopic disorders, previously recognized as predictors of poor sleep, are associated with COPCs after accounting for sleep problems.
- Published
- 2020
31. Overlap of Five Chronic Pain Conditions: Temporomandibular Disorders, Headache, Back Pain, Irritable Bowel Syndrome, and Fibromyalgia
- Author
-
Gary D. Slade, Richard Ohrbach, Joel D. Greenspan, Sonia Sharma, William Maixner, and Roger B. Fillingim
- Subjects
Adult ,medicine.medical_specialty ,Fibromyalgia ,Cross-sectional study ,Comorbidity ,Article ,Irritable Bowel Syndrome ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Internal medicine ,medicine ,Back pain ,Humans ,Dentistry (miscellaneous) ,Irritable bowel syndrome ,Fatigue Syndrome, Chronic ,business.industry ,Headache ,Chronic pain ,Odds ratio ,Temporomandibular Joint Disorders ,medicine.disease ,Low back pain ,Cross-Sectional Studies ,Anesthesiology and Pain Medicine ,Back Pain ,Neurology (clinical) ,Chronic Pain ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Aims To assess cohort retention in the OPPERA project and to compare the degree of overlap between pairs of chronic overlapping pain conditions (COPCs) using a cross-sectional analysis of data from 655 adults who completed follow-up in the OPPERA study. Methods Subjects were classified for the absence or presence of each of the five COPCs. The extent of overlap beyond chance was quantified using odds ratios, which were calculated using binary logistic regression models. Results While overlap was the norm, its magnitude varied according to COPC: 51% of people with headache had one or more overlapping COPCs, and this proportion increased to 90% for people with fibromyalgia. The degree of overlap between pairs of COPCs also varied considerably, with odds ratios being greatest for associations between musculoskeletal conditions (fibromyalgia, temporomandibular disorders, and low back pain) and less pronounced for overlap involving headache or IBS. Furthermore, univariate associations between some pairs of COPCs were nullified after adjusting for other COPCs. Conclusion There was greater overlap between fibromyalgia and either temporomandibular disorders or low back pain than between other pairs of COPCs. While musculoskeletal conditions exhibited some features that could be explained by a single functional syndrome, headache and irritable bowel syndrome did not.
- Published
- 2020
32. Clinical Characteristics of Pain Among Five Chronic Overlapping Pain Conditions
- Author
-
Gary D. Slade, Joel D. Greenspan, Jonathan D. Rosen, Roger B. Fillingim, Richard Ohrbach, and Sonia Sharma
- Subjects
Adult ,medicine.medical_specialty ,Fibromyalgia ,Comorbidity ,Article ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Back pain ,Humans ,Medicine ,Dentistry (miscellaneous) ,Irritable bowel syndrome ,business.industry ,Headache ,Chronic pain ,Pain free ,medicine.disease ,Low back pain ,Anesthesiology and Pain Medicine ,Bodily pain ,Chronic Disease ,Physical therapy ,Neurology (clinical) ,Chronic Pain ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
AIMS: To describe the pain characteristics of five index chronic overlapping pain conditions (COPCs) and to assess each COPC separately in order to determine whether the presence of comorbid COPCs is associated with bodily pain distribution, pain intensity, pain interference, and high-impact pain of the index COPC. METHODS: Data were from a convenience sample of 655 US adults, of whom 388 had one or more of the five COPCs: painful temporomandibular disorders, headache, low back pain, irritable bowel syndrome, and/or fibromyalgia. Data were collected using pain location checklists and self-report questions regarding pain attributes. The contributions of the COPCs to reported pain intensity and interference were assessed using multivariable regression models. RESULTS/CONCLUSION: Heat maps from a pain body manikin illustrated that very little of the body was pain free within these COPCs. All pain attributes were the most severe for fibromyalgia and the least severe for irritable bowel syndrome. Within each index COPC, pain intensity, pain interference, and the proportion of participants with high-impact pain increased with each additional comorbid COPC up to four or more COPCs (including the index COPC) (P < .01). High-impact pain associated with an index COPC was influenced by type and number of comorbid COPCs, largely in a gradient-specific manner.
- Published
- 2020
33. Experimental Pain Sensitivity in Subjects with Temporomandibular Disorders and Multiple Other Chronic Pain Conditions: The OPPERA Prospective Cohort Study
- Author
-
William Maixner, Roger B. Fillingim, Gary D. Slade, Joel D. Greenspan, Nuvan Rathnayaka, and Richard Ohrbach
- Subjects
Pain Threshold ,medicine.medical_specialty ,Fibromyalgia ,Pressure pain ,Article ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Dentistry (miscellaneous) ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Irritable bowel syndrome ,Univariate analysis ,business.industry ,Chronic pain ,Temporomandibular Joint Disorders ,medicine.disease ,Low back pain ,Anesthesiology and Pain Medicine ,Nociception ,Physical therapy ,Neurology (clinical) ,Chronic Pain ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Aims To investigate associations between experimental pain sensitivity and five chronic pain conditions among 655 participants in the OPPERA study. Methods Quantitative sensory tests were used to measure sensitivity to three modalities of nociception: blunt pressure pain, mechanical pinprick pain, and thermal heat pain. Participants were also classified according to the presence or absence of five chronic pain conditions: temporomandibular disorders, headache, low back pain, irritable bowel syndrome, and fibromyalgia. Results Univariate analyses found each modality to be significantly associated with at least one pain condition, most consistently for pressure pain sensitivity (8 of 15 instances) and least consistently for heat pain sensitivity (5 of 35 instances). Yet, multivariable analyses that evaluated the independent contributions of all five pain conditions found few significant associations (12 of 75 instances). Instead, pain sensitivity consistently varied according to the total number of pain conditions a person experienced, implying that the combination of pain conditions influences each nociceptive modality. Conclusion When evaluating nociceptive sensitivity in a chronic pain patient, comorbid pain conditions should be considered, as the more salient feature underlying sensitivity is likely the number rather than the type(s) of pain conditions.
- Published
- 2020
34. Management of painful temporomandibular disorders: Methods and overview of The National Dental Practice-Based Research Network prospective cohort study
- Author
-
Ana Miriam, Velly, Gary C, Anderson, John O, Look, Joseph L, Riley, D Bradley, Rindal, Kimberly, Johnson, Qi, Wang, James, Fricton, Kevin, Huff, Richard, Ohrbach, Gregg H, Gilbert, and Eric, Schiffman
- Subjects
Adult ,Male ,Self Care ,Facial Pain ,Headache ,Humans ,Female ,Prospective Studies ,Middle Aged ,Temporomandibular Joint Disorders ,Article - Abstract
BACKGROUND. Patients often seek consultation with dentists for temporomandibular disorders (TMDs). The objectives of this article were to describe the methods of a large prospective cohort study of painful TMD management, practitioners’ and patients’ characteristics, and practitioners’ initial treatment recommendations conducted by The National Dental Practice-Based Research Network (the “network”). METHODS. Participating dentists recruited into this study treated patients seeking treatment for painful TMDs. The authors developed self-report instruments based on well-accepted instruments. The authors collected demographics, biopsychosocial characteristics, TMD symptoms, diagnoses, treatments, treatment adherence, and painful TMDs and jaw function outcomes through 6 months. RESULTS. Participating dentists were predominately White (76.8%) and male (62.2%), had a mean age of 52 years, and were general practitioners (73.5%) with 23.8% having completed an orofacial pain residency. Of the 1,901 patients with painful TMDs recruited, the predominant demographics were White (84.3%) and female (83.3%). Patients’ mean age was 44 years, 88.8% self-reported good to excellent health, and 85.9% had education beyond high school. Eighty-two percent had pain or stiffness of the jaw on awakening, and 40.3% had low-intensity pain. The most frequent diagnoses were myalgia (72.4%) and headache attributed to TMDs (51.0%). Self-care instruction (89.4%), intraoral appliances (75.4%), and medications (57.6%) were recommended frequently. CONCLUSIONS. The characteristics of this TMD cohort include those typical of US patients with painful TMDs. Network practitioners typically managed TMDs using conservative treatments. PRACTICAL IMPLICATIONS. This study provides credible data regarding painful TMDs and TMD management provided by network practitioners across the United States. Knowledge acquired of treatment recommendations and patient reports may support future research and improve dental school curricula.
- Published
- 2021
35. A commentary on Temporomandibular disorders: priorities for research and care - bridging from the US to the UK
- Author
-
Justin Durham, Charles Greene, and Richard Ohrbach
- Subjects
Humans ,Temporomandibular Joint Disorders ,General Dentistry ,Delivery of Health Care ,United Kingdom ,United States - Abstract
In January 2019, the United States National Academy of Medicine initiated a comprehensive study of the status of current knowledge and clinical practices associated with temporomandibular disorders (TMDs). The National Academy of Sciences, which includes the National Academy of Medicine, was chartered by the US Government in the late 1800s as a non-profit institution working outside of government in order to provide unbiased, objective opinions on matters including healthcare. In this brief paper, we will discuss the open access 2020 report Temporomandibular disorders: priorities for research and care, available online. While the main focus of this report was the situation of TMDs in the US, the evidence base, authorship, expertise and literature scope was international and the findings therefore are at least in part generalisable to and important for the UK.The authors of this commentary were directly involved in the National Academy process, with RO a panel member, JD a consultant and CG one of 15 reviewers of the draft report. There was a wide variety of clinical and research fields involved in gathering the evidence and constructing the report. In addition, there was extensive involvement from affected patients with TMDs and their families, which is critical because their perspective is typically omitted in textbooks and professional consensus meetings.
- Published
- 2021
36. Commentary on Temporomandibular Disorders: Priorities for Research and Care: State-of-the-science for both general dentists and specialists
- Author
-
Richard, Ohrbach and Charles, Greene
- Subjects
Facial Pain ,Dentists ,Humans ,Temporomandibular Joint Disorders - Published
- 2021
37. New curriculum standards for teaching temporomandibular disorders in dental schools: A commentary
- Author
-
James, Fricton, Hong, Chen, Jeffrey R, Shaefer, Jay, Mackman, Jeffrey P, Okeson, Richard, Ohrbach, Gary D, Klasser, James, Hawkins, Robert, Hasel, and Gary, Heir
- Subjects
Surveys and Questionnaires ,Teaching ,Humans ,Schools, Dental ,Curriculum ,Temporomandibular Joint Disorders - Published
- 2021
38. Guest Editorial: Major US scientific academy proposes significant changes in understanding and managing TMDs
- Author
-
Charles S, Greene and Richard, Ohrbach
- Subjects
Societies, Scientific ,Humans ,Temporomandibular Joint Disorders - Published
- 2021
39. Graded Chronic Pain Scale: Validation of 1-Month Reference Frame
- Author
-
Michael A Kallen, Richard Ohrbach, and Sonia Sharma
- Subjects
Cross-Cultural Comparison ,medicine.medical_specialty ,Psychometrics ,Intraclass correlation ,business.industry ,Chronic pain ,Construct validity ,Reproducibility of Results ,Audiology ,medicine.disease ,Article ,Intensity (physics) ,Disability Evaluation ,Cross-Sectional Studies ,Cronbach's alpha ,Consistency (statistics) ,Surveys and Questionnaires ,medicine ,Humans ,Chronic Pain ,business ,Reliability (statistics) ,Kappa ,Pain Measurement - Abstract
Objectives The 1-month Graded Chronic Pain Scale (GCPS) commonly used in clinical studies has never been validated. This study compares the GCPS 1-month with the 6-months version for reliability and validity. Methods The Validation Project included 521 subjects with at least one temporomandibular disorder for cross-sectional data and 74 subjects for test-retest data. Internal reliability, stability, and construct validity were used for testing the 1-month version. Comparisons were made between the two versions for characteristic pain intensity (CPI), interference, and chronic pain grade (CPG). Results For GCPS 1-month, internal consistency for pain intensity and interference was high (Cronbach's alpha=0.87 and 0.94, respectively), and temporal stability was high for CPI (intraclass correlation coefficient (ICC)=0.91), interference (ICC=0.85), and CPG (weighted kappa=0.88). ICC or kappa between the two versions was 0.78 (CPI), 0.66 (interference), and 0.69 (CPG); high-impact pain, in contrast, was 0.50. Construct validity exhibited higher correlations with predictor variables for 1-month version attributes of CPI, interference, and CPG. Modified Bland-Altman plots indicated that both versions measure CPI well. Discussion Overall, reliability of the 1-month GCPS is equal to or better than the 6-months version for pain intensity, disability days, pain interference, CPG, and high-impact pain. However, consistency between versions is lower for measures of disability days and interference, and for the derived measures of CPG and high-impact pain; highly skewed distributions and increasing disagreement in reported status over the time periods affect the measures of function. Therefore, we recommend that GCPS-1 month only be used to calculate pain intensity and pain interference.
- Published
- 2021
40. The prevalence of comorbid chronic pain conditions among patients with temporomandibular disorders: A systematic review
- Author
-
Bethea A, Kleykamp, McKenzie C, Ferguson, Ewan, McNicol, Ida, Bixho, Lesley M, Arnold, Robert R, Edwards, Roger, Fillingim, Hanna, Grol-Prokopczyk, Richard, Ohrbach, Dennis C, Turk, and Robert H, Dworkin
- Subjects
Fibromyalgia ,Prevalence ,Humans ,Comorbidity ,Chronic Pain ,Temporomandibular Joint Disorders - Abstract
This systematic review was designed to evaluate the presence of comorbid conditions among patients with temporomandibular disorders (TMDs).The authors reviewed studies that reported the prevalence or incidence of chronic pain conditions or psychiatric disorders (anxiety, mood, personality disorders) among patients with any type of TMD. The authors calculated sample size-weighted prevalence estimates when data were reported in 2 or more studies for the same comorbid condition.A total of 9 prevalence studies and no incidence studies were eligible for review; 8 of the studies examined chronic pain comorbidities. Weighted estimates showed high prevalence of pain comorbidities across studies, including current chronic back pain (66%), myofascial syndrome (50%), chronic stomach pain (50%), chronic migraine headache (40%), irritable bowel syndrome (19%), and fibromyalgia (14%). A single study examined psychiatric disorders and found that current depression was the most prevalent disorder identified (17.5%).There is a high prevalence of comorbid chronic pain conditions among patients with TMDs, with more than 50% of patients reporting chronic back pain, myofascial syndrome, and chronic stomach pain. Psychiatric disorders among patients with different types of TMDs were studied less commonly in this pain population. Knowledge of the distribution of these and other comorbid disease conditions among patients with different types of TMDs can help dentists and other health care providers to identify personalized treatment strategies, including the coordination of care across medical specialties.
- Published
- 2021
41. Challenges in the clinical implementation of a biopsychosocial model for assessment and management of orofacial pain
- Author
-
Ben Brönnimann Lambelet, Thomas List, Christopher C. Peck, Richard Ohrbach, Frank Lobbezoo, Donald R. Nixdorf, Yoshihiro Tsukiyama, Sonia Sharma, Jin Woo Chung, Matthew Breckons, and Juan Fernando Oyarzo
- Subjects
Biopsychosocial model ,Orofacial pain ,Chronic pain ,Health literacy ,030206 dentistry ,Disease ,Patient Acceptance of Health Care ,Temporomandibular Joint Disorders ,medicine.disease ,Mental health ,03 medical and health sciences ,Distress ,0302 clinical medicine ,Nursing ,Facial Pain ,medicine ,Humans ,Self Report ,Chronic Pain ,medicine.symptom ,Psychology ,General Dentistry ,Curriculum ,030217 neurology & neurosurgery - Abstract
Distress, suffering and care-seeking behaviour are characteristics of pain-related disease and illness. Pain that transitions from an acute to a chronic phase carries with it the potential of further effects: these include a worsening of the disease or illness; high-impact chronic pain; and substantial personal, societal and economic burden. The biopsychosocial model directly addresses these multiple processes, yet clinical frameworks supporting this model are not universally implemented. This paper explores barriers to clinical implementation of a full biopsychosocial framework for temporomandibular disorders (TMD) and other oro-facial pain (OFP) conditions. In June 2016, INfORM invited OFP researchers to a workshop designed to optimise the DC/TMD Axis-II. Workshop groups identified five sources of implementation barriers: (1) cultures and societies, (2) levels-of-care settings, (3) health services, (4) cross-cultural validity of self-report instruments and (5) provider and patient health literacy. Three core problems emerged: (A) mental health aspects are seldom fully considered, thus impairing the recognition of illness, (B) training in use of validated multi-axial assessment protocols is under-rated and insufficiently used, and (C) clinical assessment often fails to recognise that sensory and emotional dimensions are fundamental aspects of pain. To improve patient care, these barriers and problems require action. Most importantly, TMD/OFP educators and researchers need to coordinate globally and (i) be educated in the biopsychosocial model, (ii) implement evidence-based biopsychosocial guidelines for assessment and management of OFP conditions at their institutions, (iii) incorporate this model in undergraduate and postgraduate dental curricula and (iv) be responsive to stakeholders, including regulatory authorities and practitioners.
- Published
- 2019
42. Jaw Exercises in the Treatment of Temporomandibular Disorders—An International Modified Delphi Study
- Author
-
Ambra Michelotti, Alan G. Glaros, Yrsa Le Bell, Frank Lobbezoo, Anders Wänman, Frauke Müller, Taro Arima, Merete Bakke, Antonio Sérgio Alfredo Guimarães, Lene Baad-Hansen, Richard Ohrbach, Erik Lindfors, Antoon De Laat, Malin Ernberg, Anders Johansson, Nikolaos Nikitas Giannakopoulos, Tomas Magnusson, Lindfors, E., Arima, T., Baad-Hansen, L., Bakke, M., De Laat, A., Giannakopoulos, N. N., Glaros, A., Guimaraes, A. S., Johansson, A., Le Bell, Y., Lobbezoo, F., Michelotti, A., Muller, F., Ohrbach, R., Wanman, A., Magnusson, T., Ernberg, M., and Oral Kinesiology
- Subjects
myalgia ,medicine.medical_specialty ,Consensus ,Delphi Technique ,education ,Modified delphi ,MEDLINE ,Delphi method ,CLINICAL-TRIAL ,physical treatment ,03 medical and health sciences ,0302 clinical medicine ,stomatognathic system ,NECK-CANCER ,Delphi technique ,Humans ,Medicine ,Dentistry (miscellaneous) ,030212 general & internal medicine ,MYOFASCIAL PAIN ,dentistry ,JOINT ,business.industry ,orofacial pain ,RADIOTHERAPY-INDUCED TRISMUS ,jaw exercises ,Exercise therapy ,Myalgia ,030206 dentistry ,Temporomandibular Joint Disorders ,RANDOMIZED CONTROLLED-TRIAL ,DISC-DISPLACEMENT ,ddc:617.6 ,Exercise Therapy ,RHEUMATOID-ARTHRITIS ,stomatognathic diseases ,Anesthesiology and Pain Medicine ,Jaw ,Exercices ,Physical therapy ,Neurology (clinical) ,medicine.symptom ,FOLLOW-UP ,business ,PHYSICAL-THERAPY - Abstract
AIMS: To investigate whether an international consensus exists among TMD experts regarding indications, performance, follow-up, and effectiveness of jaw exercises. METHODS: A questionnaire with 31 statements regarding jaw exercises was constructed. Fourteen international experts with some geographic dispersion were asked to participate in this Delphi study, and all accepted. The experts were asked to respond to the statements according to a 5-item verbal Likert scale that ranged from "strongly agree" to "strongly disagree." The experts could also leave free-text comments, which was encouraged. After the first round, the experts received a compilation of the other experts' earlier responses. Some statements were then rephrased and divided to clarify the essence of the statement. Subsequently, the experts were then asked to answer the questionnaire (32 statements) again for the second round. Consensus was set to 80% agreement or disagreement. RESULTS: There is consensus among TMD experts that jaw exercises are effective and can be recommended to patients with myalgia in the jaw muscles, restricted mouth opening capacity due to hyperactivity in the jaw closing muscles, and disc displacement without reduction. The patients should always be instructed in an individualized jaw exercise program and also receive both verbal advice and written information about the treatment modality. CONCLUSION: This Delphi study showed that there is an international consensus among TMD experts that jaw exercises are an effective treatment and can be recommended to patients with TMD pain and disturbed jaw function. ispartof: JOURNAL OF ORAL & FACIAL PAIN AND HEADACHE vol:33 issue:4 pages:389-398 ispartof: location:United States status: published
- Published
- 2019
43. Incident injury is strongly associated with subsequent incident temporomandibular disorder: results from the OPPERA study
- Author
-
Jean Wactawski-Wende, Gary D. Slade, Jiwei Zhao, Eric Bair, Joel D. Greenspan, Richard Ohrbach, Michael J. LaMonte, Sonia Sharma, William Maixner, and Roger B. Fillingim
- Subjects
Adult ,Male ,myalgia ,medicine.medical_specialty ,Adolescent ,Cross-sectional study ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,030202 anesthesiology ,Surveys and Questionnaires ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,Young adult ,Prospective cohort study ,business.industry ,Proportional hazards model ,Incidence ,Incidence (epidemiology) ,Hazard ratio ,Temporomandibular Joint Disorders ,United States ,Confidence interval ,stomatognathic diseases ,Cross-Sectional Studies ,Anesthesiology and Pain Medicine ,Jaw ,Socioeconomic Factors ,Neurology ,Case-Control Studies ,Wounds and Injuries ,Female ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Cross-sectional studies confirm, as expected, a positive association between jaw injury and painful temporomandibular disorders (TMDs), but prospective evaluations are lacking. We prospectively assessed incident jaw injury, injury type, and development of TMD in adults aged 18 to 44 years. Data were collected from 3258 individuals from communities surrounding 4 US academic institutes between 2006 and 2008. At enrollment, participants reported no TMD history and no facial injuries in the previous 6 months. Quarterly, follow-up questionnaires assessed incident jaw injury, which was classified as intrinsic (attributed to yawning or prolonged mouth opening) or extrinsic (attributed to other causes). Examiners classified incident TMD during a median follow-up period of 2.8 years (range 0.2-5.2 years). Cox regression models used jaw injury as a time-dependent covariate to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association with incident TMD. Among 1729 participants with complete data, 175 developed TMD. Eighty percent of injuries were intrinsic. Temporomandibular disorder annual incidence was nearly twice as high in those experiencing jaw injury (5.37%) compared with those who did not (3.44%). In the Cox model that accounted for timing of injury, the corresponding HR was 3.94 (95% CI = 2.82-5.50) after adjusting for study site, age, race, and sex. Hazard ratios did not differ (P = 0.91) for extrinsic injuries (HR = 4.03, 95% CI = 2.00-8.12) and intrinsic injuries (HR = 3.85, 95% CI = 2.70-5.49). Jaw injury was strongly associated with incident TMD. If surveillance and intervention after jaw injury is to be effective in preventing TMD, they should focus on both intrinsic and extrinsic injuries.
- Published
- 2019
44. Characteristics Associated With High-Impact Pain in People With Temporomandibular Disorder: A Cross-Sectional Study
- Author
-
Ding Geng Chen, Charles Poole, Richard Ohrbach, Roger B. Fillingim, Joel D. Greenspan, Yvonne M. Golightly, Deborah Barrett, Vanessa Miller, and Gary D. Slade
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Cross-sectional study ,Psychological Distress ,Logistic regression ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Facial Pain ,Predictive Value of Tests ,030202 anesthesiology ,Adaptation, Psychological ,medicine ,Humans ,Receiver operating characteristic ,business.industry ,Catastrophization ,Temporomandibular disorder ,Chronic pain ,Models, Theoretical ,Temporomandibular Joint Disorders ,medicine.disease ,Confidence interval ,Cross-Sectional Studies ,Anesthesiology and Pain Medicine ,Neurology ,Case-Control Studies ,Predictive value of tests ,Quality of Life ,Physical therapy ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
High-impact (disabling) pain diminishes the quality of life and increases health care costs. The purpose of this study was to identify the variables that distinguish between high- and low-impact pain among individuals with painful temporomandibular disorder (TMD). Community-dwelling adults (N = 846) with chronic TMD completed standardized questionnaires that assessed the following: 1) sociodemographic characteristics, 2) psychological distress, 3) clinical pain, and 4) experimental pain. We used high-impact pain, classified using the Graded Chronic Pain Scale, as the dependent variable in logistic regression modeling to evaluate the contribution of variables from each domain. Cross-validated area under the receiver operating characteristic curve (AUC) quantified model discrimination. One-third of the participants had high-impact pain. Sociodemographic variables discriminated weakly between low- and high-impact pain (AUC = .61, 95% confidence interval [CI] = 0.57, 0.65), with the exception of race. An 18-variable model encompassing all 4 domains had good discrimination (AUC = 0.79, 95% CI = 0.75, 0.82), as did a simplified model (sociodemographic variables plus catastrophizing, jaw limitation, and number of painful body sites) (AUC = 0.79, 95% CI = 0.76, 0.82). Duration of pain, sex, and experimental pain testing results were not associated. The characteristics that discriminated most effectively between people with low- and high-impact TMD pain included clinical pain features and the ability to cope with pain. Perspective This article presents the results of a multivariable model designed to discriminate between people with high- and low-impact pain in a community-based sample of people with painful chronic TMD. The findings emphasize the importance of catastrophizing, jaw limitation, and painful body sites associated with pain-related impact.
- Published
- 2019
45. Commentary on Temporomandibular Disorders: Priorities for Research and Care
- Author
-
Richard Ohrbach and Charles Greene
- Subjects
General Dentistry - Published
- 2022
46. Temporomandibular Disorders and Their Association with Sleep Disorders in Adults: A Systematic Review
- Author
-
Thikriat Al-Jewair, Richard Ohrbach, and Dina Shibeika
- Subjects
Adult ,Male ,Sleep Wake Disorders ,medicine.medical_specialty ,MEDLINE ,Sleep Bruxism ,Medicine ,International Classification of Sleep Disorders ,Humans ,Dentistry (miscellaneous) ,Prospective Studies ,Prospective cohort study ,Sleep disorder ,business.industry ,Clinical study design ,Temporomandibular Joint Disorders ,medicine.disease ,Sleep in non-human animals ,Obstructive sleep apnea ,stomatognathic diseases ,Anesthesiology and Pain Medicine ,Cross-Sectional Studies ,Physical therapy ,Female ,Neurology (clinical) ,business - Abstract
Aims To investigate the associations between temporomandibular disorders (TMDs) and sleep disorders in adult subjects. Methods The PubMed, Embase, Evidence-Based Medicine Reviews, and ProQuest Dissertations & Theses databases were searched for studies published in English up to September 2019. Unpublished/gray literature and reference lists of identified articles were also examined. Inclusion criteria were male and female adults, presence or absence of a TMD based on the RDC/TMD or DC/TMD criteria, presence or absence of a sleep disorder according to the International Classification of Sleep Disorders, and any of the following study designs: cross-sectional, case-control, or longitudinal. Methodologic quality assessment was conducted using the National Heart, Lung, and Blood Institute quality assessment tools. Results Twenty-two studies (11 cross-sectional, 9 case-control, 1 prospective cohort, and 1 mixed design) met the inclusion criteria. TMDs were assessed independently in relation to sleep bruxism (SB), obstructive sleep apnea (OSA), and sleep quality (SQ). All studies but one assessed TMDs using the RDC/TMD criteria. The relation between the TMD and the different sleep disorders was conflicting for SB and positive for OSA and SQ. Five studies were of good quality, and 17 were of fair quality. Conclusions The evidence is inconclusive regarding the relationship between TMDs and SB and insufficient regarding the relationship with OSA. There is consistently fair evidence to support an association between TMD and SQ. This study highlights the need for higher-quality longitudinal studies to clarify the association between TMDs and sleep disorders.
- Published
- 2021
47. Clinical, psychological, and sensory characteristics associated with headache attributed to temporomandibular disorder in people with chronic myogenous temporomandibular disorder and primary headaches
- Author
-
Roger B. Fillingim, Feng-Chang Lin, Samuel J. Arbes, Inna E. Tchivileva, Gary D. Slade, Pei Feng Lim, and Richard Ohrbach
- Subjects
myalgia ,Adult ,Orofacial pain ,medicine.medical_specialty ,Neurology ,Pain medicine ,Migraine Disorders ,03 medical and health sciences ,0302 clinical medicine ,Facial Pain ,medicine ,Humans ,Migraine ,Univariate analysis ,business.industry ,Headache ,030206 dentistry ,General Medicine ,Temporomandibular Joint Disorders ,medicine.disease ,Tension-type headache ,stomatognathic diseases ,Anesthesiology and Pain Medicine ,Cross-Sectional Studies ,Physical therapy ,Medicine ,International Classification of Headache Disorders ,Neurology (clinical) ,medicine.symptom ,Headaches ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
BackgroundHeadache attributed to Temporomandibular Disorder (HATMD) is a secondary headache that may have features resulting in diagnostic overlap with primary headaches, namely, tension-type (TTH) or migraine. This cross-sectional study of people with both chronic myogenous TMD and primary headaches evaluated characteristics associated with HATMD.MethodsFrom a clinical trial of adults, baseline data were used from a subset with diagnoses of both TMD myalgia according to the Diagnostic Criteria for TMD (DC/TMD) and TTH or migraine according to the International Classification of Headache Disorders, 3rd edition. HATMD was classified based on the DC/TMD. Questionnaires and examinations evaluated 42 characteristics of facial pain, headache, general health, psychological distress, and experimental pain sensitivity. Univariate regression models quantified the associations of each characteristic with HATMD (present versus absent), headache type (TTH versus migraine), and their interaction in a factorial design. Multivariable lasso regression identified the most important predictors of HATMD.ResultsOf 185 participants, 114 (61.6%) had HATMD, while the numbers with TTH (n = 98, 53.0%) and migraine (n = 87, 47.0%) were similar. HATMD was more likely among migraineurs (61/87 = 70.1%) than participants with TTH (53/98 = 54.1%; odds ratio = 2.0; 95%CL = 1.1, 3.7). In univariate analyses, characteristics associated with HATMD included pain-free jaw opening and examination-evoked pain in masticatory muscles and temporomandibular joints (TMJ) as well as frequency and impact of headache, but not frequency or impact of facial pain. Lowered blood pressure but not psychological or sensory characteristics was associated with HATMD. Multiple characteristics of facial pain, headache, general health, and psychological distress differed between TTH or migraine groups. Few interactions were observed, demonstrating that most characteristics’ associations with HATMD were consistent in TTH and migraine groups. The lasso model identified headache frequency and examination-evoked muscle pain as the most important predictors of HATMD.ConclusionsHATMD is highly prevalent among patients with chronic myogenous TMD and headaches and often presents as migraine. In contrast to primary headaches, HATMD is associated with higher headache frequency and examination-evoked masticatory muscle pain, but with surprisingly few measures of facial pain, general health, and psychological distress. A better understanding of HATMD is necessary for developing targeted strategies for its management.Trial identification and registrationSOPPRANO;NCT02437383. Registered May 7, 2015.
- Published
- 2021
48. Developing a research diagnostic criteria for burning mouth syndrome:Results from an international Delphi process
- Author
-
Satu K. Jääskeläinen, Tan Huann, Richard Ohrbach, Charlotte C. Currie, Heli Forssell, Cibele Nasri-Heir, Michail Koutris, Yoshiki Imamura, Justin Durham, Peter Svensson, Reny de Leeuw, Tara Renton, Academic Centre for Dentistry Amsterdam, and Oral Kinesiology
- Subjects
burning mouth syndrome ,medicine.medical_specialty ,education ,Delphi method ,Research Diagnostic Criteria ,Physical examination ,Burning Mouth Syndrome ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,oral dysaesthesia glossodynia ,Medicine ,ANXIETY ,Humans ,Medical physics ,TEMPOROMANDIBULAR DISORDERS RDC/TMD ,VALIDITY ,General Dentistry ,medicine.diagnostic_test ,business.industry ,digestive, oral, and skin physiology ,orofacial pain ,Expert consensus ,030206 dentistry ,Burning mouth syndrome ,DEPRESSION ,Test (assessment) ,AXIS I ,PREVALENCE ,stomatognathic diseases ,SEVERITY ,ORAL LICHEN-PLANUS ,RELIABILITY ,research diagnostic criteria ,stomatodynia ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
© 2020 John Wiley & Sons LtdObjective: To develop a beta version of a preliminary set of empirically derived research diagnostic criteria (RDC) for burning mouth syndrome (BMS) through expert consensus, which can then be taken into a test period before publication of a final RDC/BMS. Design: A 6 round Delphi process with twelve experts in the field of BMS was used. The first round formed a focus group during which the purpose of the RDC and the definition of BMS was agreed upon, as well as the structure and contents. The remaining rounds were carried out virtually via email to achieve a consensus of the beta version of the RDC/BMS. Results: The definition of BMS was agreed to be ‘an intraoral burning or dysaesthetic sensation, recurring daily for more than 2 hours per day over more than 3 months, without evident causative lesions on clinical examination and investigation’. The RDC was based upon the already developed and validated RDC/TMD and formed three main parts: patient self-report; examination; and psychosocial self-report. A fourth additional part was also developed listing aspirational biomarkers which could be used as part of the BMS diagnosis where available, or to inform future research. Conclusion: This Delphi process has created a beta version of an RDC for use with BMS. This will allow future clinical research within BMS to be carried out to a higher standard, ensuring only patients with true BMS are included. Further validation studies will be required alongside refinement of the RDC as trialling progresses.
- Published
- 2021
49. Multi-ethnic GWAS and meta-analysis of sleep quality identify MPP6 as a novel gene that functions in sleep center neurons
- Author
-
Shad B. Smith, Tamar Sofer, Samuel A. McLean, Joel D. Greenspan, Dmitri V. Zaykin, Sarah D. Linnstaedt, Gary D. Slade, Hans Markus Munter, Luda Diatchenko, Richard Ohrbach, Marc Parisien, Eija Kalso, Jiwon Lee, Andrea G. Nackley, Tin Louie, Andrew S. Tungate, Mari A. Kaunisto, Samar Khoury, Andrey V. Bortsov, Pavel Gris, Qiao-Ping Wang, William Maixner, Roger B. Fillingim, G. Gregory Neely, Susan Redline, Department of Diagnostics and Therapeutics, University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine, Eija Kalso / Principal Investigator, and Anestesiologian yksikkö
- Subjects
LOCI ,Basic Science of Sleep and Circadian Rhythms ,Locus (genetics) ,Single-nucleotide polymorphism ,Genome-wide association study ,Bioinformatics ,Polymorphism, Single Nucleotide ,3124 Neurology and psychiatry ,Pittsburgh Sleep Quality Index ,ENVIRONMENTAL-INFLUENCES ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Ethnicity ,Animals ,Humans ,BREAST-CANCER ,TOOL ,Genetic Predisposition to Disease ,GENOME-WIDE ASSOCIATION ,DISTURBANCE ,030304 developmental biology ,Chromosome 7 (human) ,Neurons ,0303 health sciences ,Gene knockdown ,genome-wide association study ,biology ,MPP6 ,HERITABILITY ,1184 Genetics, developmental biology, physiology ,Membrane Proteins ,PAIN ,sleep quality ,biology.organism_classification ,humanities ,sleep centers ,INDIVIDUALS ,Drosophila melanogaster ,ATHEROSCLEROSIS ,Meta-analysis ,Neurology (clinical) ,Sleep ,030217 neurology & neurosurgery - Abstract
Poor sleep quality can have harmful health consequences. Although many aspects of sleep are heritable, the understandings of genetic factors involved in its physiology remain limited. Here, we performed a genome-wide association study (GWAS) using the Pittsburgh Sleep Quality Index (PSQI) in a multi-ethnic discovery cohort (n = 2868) and found two novel genome-wide loci on chromosomes 2 and 7 associated with global sleep quality. A meta-analysis in 12 independent cohorts (100 000 individuals) replicated the association on chromosome 7 between NPY and MPP6. While NPY is an important sleep gene, we tested for an independent functional role of MPP6. Expression data showed an association of this locus with both NPY and MPP6 mRNA levels in brain tissues. Moreover, knockdown of an orthologue of MPP6 in Drosophila melanogaster sleep center neurons resulted in decreased sleep duration. With convergent evidence, we describe a new locus impacting human variability in sleep quality through known NPY and novel MPP6 sleep genes.
- Published
- 2021
50. Effect of comorbid migraine on propranolol efficacy for painful TMD in a randomized controlled trial
- Author
-
Roger B. Fillingim, Janet Willis, Gary D. Slade, Massimiliano Di Giosia, Pei Feng Lim, Samuel J. Arbes, John H. Campbell, Margarete C. Ribeiro-Dasilva, Holly Hadgraft, Richard Ohrbach, and Inna E. Tchivileva
- Subjects
Drug ,Adult ,Male ,Sympathetic nervous system ,Adolescent ,media_common.quotation_subject ,Migraine Disorders ,Propranolol ,Adrenergic beta-Antagonists ,law.invention ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Randomized controlled trial ,Double-Blind Method ,law ,Facial Pain ,medicine ,Humans ,Adrenergic beta-antagonists ,030212 general & internal medicine ,media_common ,Aged ,sympathetic nervous system ,business.industry ,autonomic nervous system ,Chronic pain ,General Medicine ,Original Articles ,Middle Aged ,Temporomandibular Joint Disorders ,medicine.disease ,Autonomic nervous system ,medicine.anatomical_structure ,Treatment Outcome ,Migraine ,Anesthesia ,Female ,Neurology (clinical) ,Chronic Pain ,business ,headache ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Introduction The migraine-preventive drug propranolol is efficacious in reducing pain from temporomandibular disorder, suggesting potential modifying or mediating effects of comorbid migraine. Methods In this randomized controlled trial, myofascial temporomandibular disorder patients were treated with propranolol or placebo for 9 weeks. The primary endpoint was change in a facial pain index derived from daily symptom diaries. Linear and logistic regression models tested for a migraine × treatment-group interaction in reducing facial pain index. Counterfactual models explored changes in headache impact and heart rate as mediators of propranolol's efficacy. Results Propranolol's efficacy in reducing facial pain index was greater among the 104 migraineurs than the 95 non-migraineurs: For example, for the binary ≥ 30% reduction in facial pain index, odds ratios were 3.3 (95% confidence limits: 1.4, 8.1) versus 1.3 (0.5, 3.2), respectively, although the interaction was statistically non-significant ( p = 0.139). Cumulative response curves confirmed greater efficacy for migraineurs than non-migraineurs (differences in area under the curve 26% and 6%, respectively; p = 0.081). While 9% of the treatment effect was mediated by reduced headache impact, 46% was mediated by reduced heart rate. Conclusions Propranolol was more efficacious in reducing temporomandibular disorder pain among migraineurs than non-migraineurs, with more of the effect mediated by reduced heart rate than by reduced headache impact. Study identification and registration SOPPRANO; NCT02437383; https://clinicaltrials.gov/ct2/show/NCT02437383
- Published
- 2021
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.