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Yoshiki Imamura Takahiro Shinozaki Akiko Okada‐Ogawa Noboru Noma Masahiro Shinoda Koichi Iwata Akihiko Wada Osamu Abe Kelun Wang Peter Svensson 《Journal of oral rehabilitation》2019,46(6):574-587
Burning mouth syndrome (BMS) is a chronic oro‐facial pain disorder of unknown cause. It is more common in peri‐ and post‐menopausal women, and sex hormone dysregulation is believed to be an important causative factor. Psychosocial events often trigger or exacerbate symptoms, and persons with BMS appear to be predisposed towards anxiety and depression. Atrophy of small nerve fibres in the tongue epithelium has been reported, and potential neuropathic mechanisms for BMS are now widely investigated. Historically, BMS was thought to comprise endocrinological, psychosocial and neuropathic components. Neuroprotective steroids and glial cell line–derived neurotrophic factor family ligands may have pivotal roles in the peripheral mechanisms associated with atrophy of small nerve fibres. Denervation of chorda tympani nerve fibres that innervate fungiform buds leads to alternative trigeminal innervation, which results in dysgeusia and burning pain when eating hot foods. With regard to the central mechanism of BMS, depletion of neuroprotective steroids alters the brain network–related mood and pain modulation. Peripheral mechanistic studies support the use of topical clonazepam and capsaicin for the management of BMS, and some evidence supports the use of cognitive behavioural therapy. Hormone replacement therapy may address the causes of BMS, although adverse effects prevent its use as a first‐line treatment. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) may have important benefits, and well‐designed controlled studies are expected. Other treatment options to be investigated include brain stimulation and TSPO (translocator protein 18 kDa) ligands. 相似文献
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目的 探讨脑卒中后偏瘫肩痛患者生活质量的直接和间接影响因素,以期为临床症状管理提供参考信息。 方法 采用一般资料调查表、脑卒中后偏瘫肩痛症状评估表、简易疲乏量表、医院焦虑抑郁量表、Fugl-Meyer上肢功能评分量表和脑卒中生活质量专用量表对205例脑卒中后偏瘫肩痛患者进行调查。结果 偏瘫肩痛患者的生活质量总分为(144.48±27.69),整体处于中等水平。生活质量的主要影响因素是肩痛困扰、肩痛频度、肩外旋、疲乏程度和抑郁,可以解释总变异的63.3%。路径分析结果显示,疲乏程度、肩痛频度和肩痛困扰可直接影响患者的生活质量(β_(疲乏程度-生活质量)=-0.252,P<0.001;β_(肩痛频度-生活质量)=-0.147,P<0.001;β_(肩痛困扰-生活质量)=-0.317,P<0.001);疲乏程度和肩痛频度亦可通过肩痛困扰来间接影响患者的生活质量( β_(疲乏程度-肩痛困扰-生活质量)=-0.066,P<0.001;β_(肩痛频度-肩痛困扰-生活质量)=-0.064,P<0.001)。结论 临床上应同时关注脑卒中患者疲乏和偏瘫肩痛症状,关注抑郁和疲乏对症状体验的协同作用,提高医护人员症状管理的效率,从而提高脑卒中偏瘫肩痛患者的生活质量。 相似文献
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ObjectivesThis study aimed to investigate the efficacy of a vacuum myofascial therapy device (VT) for improving pressure pain thresholds (PPTs), range of motion (ROM), neck pain-related disability, pain, and quality of life in patients with non-specific neck pain.MethodsA randomized controlled trial in which thirty-eight participants with non-specific neck pain (NP) were randomly assigned to either an experimental (VT) or a comparison physical therapy program (PTP) group. The VT group (n = 19) received five sessions of treatment with a vacuum myofascial therapy device while the PTP group (n = 19) received five sessions of massage, ultrasound therapy (US), and transcutaneous electric nerve stimulation (TENS) over two weeks. The outcome measures were the numerical pain rating scale (NPRS), range of motion, quality of life (SF-12), neck disability Index (NDI), and PPTs at the end of treatment and at one-month follow-up.ResultsAlthough both groups experienced improvements in pain, neck disability, range of motion, and pressure pain, these only were statistically significant in the VT group. At one-month follow-up, the VT group still showed improvements in pain, neck disability, and range of motion.DiscussionVacuum myofascial therapy applied with a device offers similar results to other vacuum-based techniques such as cupping therapy. Moreover, in this device the parameters are digitally controlled, which allows for the precise reproduction of treatment. 相似文献
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Alisson R. Teles Don Daniel Ocay Abdulaziz Bin Shebreen Andrew Tice Neil Saran Jean A. Ouellet Catherine E. Ferland 《The spine journal》2019,19(4):677-686
BACKGROUND CONTEXT
Although 40% of adolescent idiopathic scoliosis (AIS) patients present with chronic back pain, the pathophysiology and underlying pain mechanisms remain poorly understood. We hypothesized that development of chronic pain syndrome in AIS is associated with alterations in pain modulatory mechanisms.PURPOSE
To identify the presence of sensitization in nociceptive pathways and to assess the efficacy of the diffuse noxious inhibitory control in patients with AIS presenting with chronic back pain.STUDY DESIGN
Cross-sectional study.PATIENT SAMPLE
Ninety-four patients diagnosed with AIS and chronic back pain.OUTCOME MEASURES
Quantitative sensory testing (QST) assessed pain modulation and self-reported questionnaires were used to assess pain burden and health-related quality of life.METHODS
Patients underwent a detailed pain assessment using a standard and validated quantitative sensory testing (QST) protocol. The measurements included mechanical detection thresholds (MDT), pain pressure threshold (PPT), heat pain threshold (HPT), heat tolerance threshold (HTT), and a conditioned pain modulation (CPM) paradigm. Altogether, these tests measured changes in regulation of the neurophysiology underlying the nociceptive processes based on the patient's pain perception. Funding was provided by The Louise and Alan Edwards Foundation and The Shriners Hospitals for Children.RESULTS
Efficient pain inhibitory response was observed in 51.1% of patients, while 21.3% and 27.7% had sub-optimal and inefficient CPM, respectively. Temporal summation of pain was observed in 11.7% of patients. Significant correlations were observed between deformity severity and pain pressure thresholds (p=.023) and CPM (p=.017), neuropathic pain scores and pain pressure thresholds (p=.015) and temporal summation of pain (p=.047), and heat temperature threshold and pain intensity (p=.048).CONCLUSIONS
Chronic back pain has an impact in the quality of life of adolescents with idiopathic scoliosis. We demonstrated a high prevalence of impaired pain modulation in this group. The association between deformity severity and somatosensory dysfunction may suggest that spinal deformity can be a trigger for abnormal neuroplastic changes in this population contributing to chronic pain syndrome. 相似文献69.
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目的 评价缺血修饰性白蛋白(ischemia modified albumin,IMA)对急性缺血性胸痛(ICP)的早期诊断价值。方法 时206例发病〈12h、表现为急性胸痛的患者立即行12导联心电图(ECG)检查,并抽血进行IMA、肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB)测定。将ECG、IMA、cTnI、CK-MB的结果单独或结合与最终诊断为非缺血性胸痛(NICP)及ICP的相互关系进行比较。结果 最后诊断为ICP98例,NICP108例,ICP发病〈3h和3-6h组IMA水平明显升高,与NICP组比较差异有统计学意义(P〈0.001);ICP发病〉6h组IMA水平与NICP组比较差异无统计学意义(P〉0.05)。IMA诊断发病〈3hICP的敏感性和阴性预测值(NPV)为89.1%和88.8%,明显高于ECG、cTnI和CK-MB,四者结合为97.6%和96.9%;IMA诊断发病3~6hICP的敏感性和NPV为71.7%和74.5%,也高于ECG、cTnI、CK-MB,四者结合为95.5%和94.2%;但IMA对于发病〉6h的ICP则无诊断作用。结论 IMA是诊断ICP的早期敏感生化指标,对于发病〈6h(尤其是〈3h)的ICP诊断具有较高的敏感性和NPV,优于ECG、CK-MB、cTnI;将IMA与其他指标结合,可进一步提高对ICP的诊断价值。 相似文献