Kevin I. Reid

psychological and physiological parameters of masticatory muscle pain

&NA; The objective of this research was to identify the psychological and physiological variables that differentiate persons reporting masticatory muscle pain (MMP) from normal controls (NC). This study examined the characteristics of 35 MMP patients in comparison to 35 age‐, sex‐, and weight‐matched NCs. All subjects completed a series of standardized questionnaires prior to undergoing a laboratory evaluation consisting of a psychosocial stressor and pressure pain stimulation at multiple body sites. During the evaluation, subjects’ emotional and physiological responses (heart rate, blood pressure, respiration, skin temperature, and muscle activity) were monitored. Results indicated that persons with MMP reported greater fatigue, disturbed sleep, depression, anxiety, menstrual symptoms, and less self‐deception (P’s<0.05) than matched controls. At rest, MMPs had lower end tidal carbon dioxide levels (P<0.04) and lower diastolic blood pressures than the NCs (P<0.02). During laboratory challenge, both groups responded to the standard stressor with significant physiological activity and emotional responding consistent with an acute stress response (P<0.01), but there were no differences between the MMPs and NCs. Muscle pain patients reported lower pressure pain thresholds than did NCs at the right/left masseter and right temporalis sites (P’s<0.05); there were no differences in pressure pain thresholds between MMPs and NCs for the left temporalis (P<0.07) and right/left middle finger sites (P’s>0.93). These results are discussed in terms of the psychological and physiological processes that may account for the development of muscle pain in the masticatory system.

Evaluation of iontophoretically applied dexamethasone for painful pathologic temporomandibular joints

The effects of iontophoretically applied dexamethasone in a lidocaine vehicle were compared with those of saline placebo in 53 patients with one of three diagnoses of painful temporomandibular joint pathologic conditions: disk displacement with reduction, disk displacement without reduction, and osteoarthritis. Both dexamethasone and the saline placebo produced a significant reduction in pain scores from baseline levels after the first two of three treatments. There were no observed differences, however, in pain report or mandibular range of motion between the dexamethasone and placebo groups. A trend for pain relief was noted in the subgroup that received dexamethasone with a diagnosis of osteoarthritis. Results may reflect varying degrees of inflammation or central nervous system hyperexcitability, or both, in this heterogeneous study sample. Potential confounding variables were lack of knowledge of actual drug penetration, the effects of electric current transmitted by the iontophoresor, and pain reduction caused by cyclic fluctuations in symptoms. These data suggest that iontophoretically applied dexamethasone is no more effective than saline placebo in providing pain relief in patients with temporomandibular joint pain.

Readability of state-sponsored advance directive forms in the United States: a cross sectional study

BackgroundState governments provide preprinted advance directive forms to the general public. However, many adults in the United States (US) lack the skills necessary to read and comprehend health care-related materials. In this study, we sought to determine the readability of state government-sponsored advance directive forms.MethodsA cross sectional study design was used. The readability of advance directive forms available online from all 50 US states and the District of Columbia was determined using 6 validated readability scales.ResultsOverall, 62 advance directive forms were obtained. For 47 states, forms were available by way of government-sponsored Web sites. The average (SD) readability (with the Flesch-Kincaid score) of all forms was grade level 11.9 (2.6). Similar results were obtained with the other readability scales. No form had a readability score at the 5th grade level or lower, the level recommended by the National Work Group on Literacy and Health. The readability of the forms exceeded this level by an average of 6.9 grade levels (95% confidence interval, 6.3-7.6; P < .001). Only 5 of the forms had a readability score at 8th grade level or lower, the average reading skill level of US adults. The readability of the forms exceeded this level by an average of 3.9 grade levels (95% confidence interval, 3.3-4.6; P < .001).ConclusionsThe readability of US state government-sponsored advance directive forms exceeds the readability level recommended by the National Work Group on Literacy and Health and the average reading skill level of most US adults. Such forms may inhibit advance care planning and therefore patient autonomy.

Impact of tobacco use on the symptoms of painful temporomandibular joint disorders.

ABSTRACT This study examines the relationship between the severity of painful temporomandibular joint disorders (TMD) symptoms and current tobacco use in patients evaluated at a specialized orofacial pain clinic. Medical records, including responses to the Chronic Pain Grading Scale (CPGS), from 606 consecutive patients evaluated at the Mayo Clinic orofacial pain clinic with TMD by RDC‐TMD criteria were retrospectively reviewed. Univariate analyses were performed comparing tobacco users and non‐users. Analysis of covariance and multiple logistic regression models were used to adjust for demographic variables. A p value ⩽ 0.05 was accepted as the level of significance. Current tobacco use was reported by 91 subjects (15.1%). Tobacco users were younger (p < 0.01), less frequently married or widowed (p < 0.01), more frequently unemployed (p < 0.01), and less educated (p < 0.01). In univariate analysis, tobacco users were more likely to have moderate to severe pain interference defined as GPGS III–IV (OR = 1.94, 95% CI 1.16–3.22 for tobacco users compared to non‐users), but this difference was not significant after adjustment for demographic variables. In the subset of subjects who lacked a myofascial component of pain (N = 333) this difference remained significant in the adjusted analysis (adjusted OR = 4.56, 95% CI 1.46–14.24). Current tobacco use was associated with unfavorable demographic background variables and more pain interference in subjects with TMD presenting to a specialized orofacial pain clinic. These effects were more pronounced in cases where myofascial pain was not present.

Psychological and physiological correlates of a brief intervention to enhance self-regulation in patients with fibromyalgia

Objectives The main objectives of this study were to determine whether training and practice of a brief focused breathing technique is associated with improvements in physiological reactivity to a standard laboratory stressor [cold pressor test] and improvements in affect [anxiety, depression], self-efficacy, fatigue, sleep quality, and pain measures. Methods The patients for this study were diagnosed with fibromyalgia syndrome [N = 20]. Study patients completed an initial laboratory assessment including a diaphragmatic breathing training session. Patients were instructed to practice the technique for three 10-min sessions daily and returned to the lab for a second assessment after two weeks. Results All study patients showed significant improvements in pain severity, fatigue, pain self-efficacy, cold pressor tolerance, and heart rate variability indices between the two laboratory assessments. Conclusions The study results suggest that the practice of a brief diaphragmatic breathing technique is associated with significant changes in a number of areas of physiological and psychological functioning in patients with fibromyalgia. In particular, the increase in the heart rate variability total power may represent a significant change in post-training self-regulatory ability. The greater improvements in somatic symptoms suggest that using this diaphragmatic breathing technique daily may enhance the inhibitory ability of sympathetic tone, achieving improved autonomic balance, physiological reactivity, and daily functioning.

Influence of a sympathomimetic amine on masticatory and trapezius pain/pressure thresholds and electromyographic levels

OBJECTIVES This study examined the influence of terbutaline, a beta-adrenergic sympathomimetic amine on pain/pressure thresholds in the index fingers and masseter and trapezius muscles and electromyographic activity in trapezii. STUDY DESIGN In a randomized and double-blind controlled trial, 20 asymptomatic female subjects were assigned to receive either an injection of terbutaline or sterile water before collection of pain/pressure thresholds and electromyographic levels. Repeated analysis of variance and paired t tests were calculated to test for baseline and postinjection differences between groups. RESULTS No significant baseline or postinjection group differences in pain/pressure thresholds or electromyographic were detected. CONCLUSIONS beta-adrenergic sympathomimetic stimulation does not influence pain/pressure thresholds or electromyographic activity in the masselet and trapezius muscles or pain/pressure thresholds in the index fingers. These results suggest that development of painful muscle conditions is not caused by elevations of sympathetic activity.