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Difference between revisions of "Orofacial Pain"
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{{ArtBy|autore=Gianni Frisardi}} | {{ArtBy|autore=Gianni Frisardi}} | ||
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=== Introduction === | |||
As usual in the presentation of new sections of specific chapters, it is advisable to introduce recent and documented references on the subject which in this case is 'Orofacial Pain' and Temporomandibular Disorders. In this sense we can partially report a brief introduction by Martina Ferrillo et al.<ref>Martina Ferrillo, Amerigo Giudice, Nicola Marotta, Francesco Fortunato,Daniela Di Venere,Antonio Ammendolia, Pietro Fiore, and Alessandro de Sire. Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review. Int J Mol Sci. 2022 Oct; 23(20): 12164. Published online 2022 Oct 12. doi: 10.3390/ijms232012164. PMCID: PMC9602546. PMID: 36293017</ref> on which we will make the first conceptual reflections reported by our thoughtful Linus before proceeding to the presentation of the clinical cases. | |||
[[File:Question 2.jpg|center|50x50px|link=https://wiki.masticationpedia.org/index.php/File:Question_2.jpg]]The author points out that orofacial and neck pain comorbidities are often associated with TMD.<ref>Plesh O., Adams S.H., Gansky S.A. Temporomandibular joint and muscle disorder-type pain and comorbid pains in a national US sample. J. Orofac. Pain. 2011;25:190–198.</ref> These coexisting conditions (particularly headaches, migraines, and neck pain) are not only highly associated with chronic pain-related TMDs, but also increase the risk of their development.<ref>Bender S.D. Orofacial pain and headache: A review and look at the commonalities. Curr Pain Headache Rep. 2014;18:400. doi: 10.1007/s11916-013-0400-5.</ref><ref name=":0">Botros J., Gornitsky M., Samim F., der Khatchadourian Z., Velly A.M. Back and neck pain: A comparison between acute and chronic pain-related Temporomandibular Disorders. Can. J. Pain. 2022;6:112–120. doi: 10.1080/24740527.2022.2067032. </ref><ref>Ohrbach R., Fillingim R.B., Mulkey F., Gonzalez Y., Gordon S., Gremillion H., Lim P.-F., Ribeiro-Dasilva M., Greenspan J.D., Knott C. Clinical findings and pain symptoms as potential risk factors for chronic tmd: Descriptive data and empirically identified domains from the opera case-control study. J. Pain. 2011;12:T27–T45. doi: 10.1016/j.jpain.2011.09.001</ref> The International Classification of Headaches (ICHD)<ref>Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders; 3rd edition (beta version) Cephalalgia. 2013;33:629–808. doi: 10.1177/0333102413485658.</ref> and DC/TMD<ref name=":4">Schiffman E., Ohrbach R., Truelove E., Look J., Anderson G., Goulet J.P., List T., Svensson P., Gonzalez Y., Lobbezoo F., et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group† J. Oral Facial Pain Headache. 2014;28:6–27. doi: 10.11607/jop.1151</ref> consider the main characteristics of pain in headache and TMD, respectively. There are several hypotheses that attempt to explain the association between TMD and headache, including neuronal convergence, central sensitization, and inhibition of descending pain downregulatory mechanisms.<ref name=":1">Matre D., Knardahl S. ‘Central sensitization’ in chronic neck/shoulder pain. Scand. J. Pain. 2012;3:230–235. doi: 10.1016/j.sjpain.2012.04.003. </ref><ref name=":2">Su M., Yu S. Chronic migraine: A process of dysmodulation and sensitization. Mol. Pain. 2018;14:1744806918767697. doi: 10.1177/1744806918767697.</ref> The close relationship between TMD, headache and neck pain has recently been evaluated, not only in terms of sharing common pathogenetic mechanisms and clinical features, but also considering that one condition might influence or promote the development of another.<ref>Chaves T.C., Dach F., Florencio L.L., Carvalho G.F., Gonçalves M.C., Bigal M.E., Speciali J.G., Bevilaqua-Grossi D. Concomitant Migraine and Temporomandibular Disorders are Associated With Higher Heat Pain Hyperalgesia and Cephalic Cutaneous Allodynia. Clin. J. Pain. 2016;32:882–888. doi: 10.1097/AJP.0000000000000369.</ref><ref name=":0" /><ref>Gonçalves D.A., Camparis C.M., Speciali J.G., Franco A.L., Castanharo S.M., Bigal M.E. Temporomandibular disorders are differentially associated with headache diagnoses: A controlled study. Clin. J. Pain. 2011;27:611–615. doi: 10.1097/AJP.0b013e31820e12f5.</ref> These conditions can cause facial pain and are frequently associated with the development of craniofacial allodynia during painful exacerbation.<ref name=":3">Greenspan J.D., Slade G.D., Bair E., Dubner R., Fillingim R.B., Ohrbach R., Knott C., Diatchenko L., Liu Q., Maixner W. Pain sensitivity and autonomic factors associated with development of TMD: The OPPERA prospective cohort study. J. Pain. 2013;14:T63–T74.e746. doi: 10.1016/j.jpain.2013.06.007.</ref> Indeed, pain in both conditions has been attributed to common dysfunctions of central pain regulation mechanisms..<ref>Furquim B.D., Flamengui L.M., Conti P.C. TMD and chronic pain: A current view. Dental Press J. Orthod. 2015;20:127–133. doi: 10.1590/2176-9451.20.1.127-133.sar.</ref><ref>Bevilaqua-Grossi D., Lipton R.B., Napchan U., Grosberg B., Ashina S., Bigal M.E. Temporomandibular disorders and cutaneous allodynia are associated in individuals with migraine. Cephalalgia. 2010;30:425–432. doi: 10.1111/j.1468-2982.2009.01928.x.</ref> On the other hand, the concomitant TMD and migraine showed worse levels of cutaneous hyperalgesia and allodynia, probably due to central and peripheral nervous system sensitization and impairment of descending pain modulatory pathways.<ref>Conti P.C., Costa Y.M., Gonçalves D.A., Svensson P. Headaches and myofascial temporomandibular disorders: Overlapping entities, separate managements? J. Oral Rehabil. 2016;43:702–715. doi: 10.1111/joor.12410.</ref><ref>Furquim B.D., Flamengui L.M., Conti P.C. TMD and chronic pain: A current view. Dental Press J. Orthod. 2015;20:127–133. doi: 10.1590/2176-9451.20.1.127-133.sar.</ref> | |||
<blockquote>[[File:Question 2.jpg|50x50px|link=https://wiki.masticationpedia.org/index.php/File:Question_2.jpg|left]]'''<math>K_{brain}</math>: The uncertainty of the measurement ''' | |||
All true and, among other things, the arguments are very engaging from an intellectual point of view, but we should take into account the series of assertions such as neuronal convergence, the inhibition of downregulation mechanisms of descending pain,<ref name=":1" /><ref name=":2" /> allodynia,<ref name=":3" /> and the concept of measure that inevitably incorporates an uncertainty. We reported a very interesting study (Exploring electroencephalography with a model inspired by quantum mechanics) which demonstrated the existence of an error in the measurement of the EEG by defining a similar Heisenberg uncertainty principle called 0 quasi-quantum model which led to a constant minimum value of uncertainty in the EEG measurement at 0 and 0 of 0. Note that the unit of 0 is the result of sampling the EEG at 250 Hz and taking mass as the unit. This should make us reflect in interpreting the results of laboratory research because, as we will see in the presentation of subsequent clinical cases, the diagnostic error is around the corner. Enough 0 error in the specific measurement of the neuronal district under examination to make a diagnosis of Orofacial Pain when instead there is a brain tumor that involved the same nervous district and simulates the symptoms of Orofacial Pain from Temporomandibular Disorders. | |||
Tutto vero e tra l'altro molto coinvolgenti gli argomenti da un punto di vista intellettuale ma bisognerebbe tener in conto delle serie di asserzioni poste come la convergenza neuronale, l'inibizione dei meccanismi di downregulation del dolore discendente, | Tutto vero e tra l'altro molto coinvolgenti gli argomenti da un punto di vista intellettuale ma bisognerebbe tener in conto delle serie di asserzioni poste come la convergenza neuronale, l'inibizione dei meccanismi di downregulation del dolore discendente, la allodinia, ed il concetto di misura che inevitabilmente incorpora una incertezza. Abbiamo riportato uno studio ([[Esplorare l'elettroencefalografia con un modello ispirato alla meccanica quantistica]]) molto interessante che ha dimostrato l'esistenza di un errore nella misura dello EEG definendo un analogo principio di indeterminazione di Heisenberg denominato <math>K_{brain}</math> modello quasi-quantistico che ha portato a un valore minimo costante di incertezza nella misura EEG su <math>\Delta x(t)\Delta p_x(t)</math> e<math>\Delta y(t)\Delta p_y(t)</math> di <math>0,78\pm0,41\tfrac{cm^2}{4ms}</math>. Si noti che l'unità di <math>\tfrac{cm^2}{4ms}</math> è il risultato del campionamento dell'EEG a 250 Hz e della massa considerata come unità. | ||
Ciò ci dovrebbe far riflettere nel interpretare i risultati delle ricerche di laboratorio perchè, come vedremo nella presentazioni dei successivi casi clinici, l'errore diagnostico è dietro l'angolo. Bastano <math>0,78\pm0,41\tfrac{cm^2}{4ms}</math> di errore nella misura specifica del distretto neuronale in esame per fare una diagnosi di Dolore Orofacciale quando invece si è in presenza di un tumore cerebrale che coninvolgeva lo stesso distretto nervoso e simula la sintomatologia del Dolore Orofacciale da Disordini Temporomandibolari.</blockquote>Ci vuole, dunque, obiettività, umiltà scientifica e un cambio di forma mentis nell'interpretazione dei fenomeni biologici, argomento che affronteremo nella sezione 'Scienza Straordinaria' | Ciò ci dovrebbe far riflettere nel interpretare i risultati delle ricerche di laboratorio perchè, come vedremo nella presentazioni dei successivi casi clinici, l'errore diagnostico è dietro l'angolo. Bastano <math>0,78\pm0,41\tfrac{cm^2}{4ms}</math> di errore nella misura specifica del distretto neuronale in esame per fare una diagnosi di Dolore Orofacciale quando invece si è in presenza di un tumore cerebrale che coninvolgeva lo stesso distretto nervoso e simula la sintomatologia del Dolore Orofacciale da Disordini Temporomandibolari.</blockquote>Ci vuole, dunque, obiettività, umiltà scientifica e un cambio di forma mentis nell'interpretazione dei fenomeni biologici, argomento che affronteremo nella sezione 'Scienza Straordinaria' | ||