Table Of ContentOrofacial Pain
From Basic Science to Clinical Management
SecondEdition
Orofacial Pain
From Basic Science to Clinical Management
The Transfer of Knowledge in Pain Research to Education
Second Edition
Edited by
Barry J. Sessle, MDS,PhD,DSc(hc),FRSC,FCAHS
Gilles J. Lavigne, DMD,FRCD(C),PhD
James P. Lund, BDS,PhD,FCAHS
Ronald Dubner, DDS,PhD
Quintessence Publishing Co, Inc
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Orofacialpain:frombasicsciencetoclinicalmanagement:thetransferof
knowledgeinpainresearchtoeducation/BarryJ.Sessle...[etal.].--
2nded.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-86715-458-0(hardcover)
1. Orofacialpain.2. Temporomandibularjoint--Diseases. I.Sessle,
BarryJ.,1941-
[DNLM:1. FacialPain.2. FacialPain--therapy.3. Temporomandibular
JointDisorders. WE705O7422008]
RK322.O7652008
617.5'206--dc22
2008016356
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Table of Contents
PrefacetotheSecondEdition viii
PrefacetotheFirstEdition ix
Contributors x
Section I Orofacial Pain: Classification, Epidemiology, and Beliefs
1
What Is Pain and How Do We Classify Orofacial Pain? 3
CharlesMcNeill,RonaldDubner,andAlainWoda
2
Epidemiology of Orofacial Pain: Prevalence, Incidence,
and Risk Factors 13
LindaLeRescheandMarkDrangsholt
3
Current Beliefs and Educational Guidelines 19
CharlesG.Widmer
Section II Neurobiology of Pain
4
Peripheral Mechanisms of Orofacial Pain 27
BruceMatthewsandBarryJ.Sessle
5
Central Nociceptive Pathways 35
BarryJ.Sessle,KoichiIwata,andRonaldDubner
6
Neurochemical Factors in Injury and Inflammation of
Orofacial Tissues 45
AsmaA.Khan,KeRen,andKennethM.Hargreaves
7
Mechanisms of Neuropathic Pain 53
AlainWodaandMichaelW.Salter
8
Pain Modulatory Systems 61
WilliamMaixner
9
Pain and Genetics 69
Ze’evSeltzerandJeffreyS.Mogil
Section III Pain and Behavior
10
Measurement of Pain 79
PierreRainville
11
Psychologic State and Pain Perception 87
PetraSchweinhardt,MarcoL.Loggia,ChantalVillemure,andM.CatherineBushnell
12
Psychosocial Factors 93
SamuelF.Dworkin
13
Pain and Gender 101
ThuanT.T.Dao
14
Pain and Motor Reflexes 109
JamesP.Lund,GregMurray,andPeterSvensson
15
Persistent Pain and Motor Dysfunction 117
JamesP.Lund
16
Pain and Sleep Disturbances 125
GillesJ.Lavigne,TakafumiKato,andPierreMayer
Section IV Management of Orofacial Pain: Principles and Practices
17
The Path to Diagnosis 135
Jean-PaulGouletandSandroPalla
18
Evidence-Based Pain Management 145
JocelyneS.Feine
19
Management of Persistent Orofacial Pain 153
ChristianS.Stohler
20
Management of Dental Pain 161
G.RexHolland
21
Management of Inflammatory Pain 171
SharonM.GordonandRaymondA.Dionne
22
Management of Masticatory Myalgia and Arthralgia 179
JamesR.FrictonandEricL.Schiffman
23
Management of Mucosal Pain 187
EdmondTruelove
24
Management of Neuropathic Pain 195
EliEliavandMitchellB.Max
25
Management of Orofacial Pain Related to Headache 203
JeffreyP.Okeson
26
Management of Movement Disorders Related to
Orofacial Pain 211
FrankLobbezoo,PierreBlanchet,andGillesJ.Lavigne
27
Illustrative Case Reports 219
AntoonDeLaat,SandroPalla,JoséTadeuTesserolideSiqueira,andYoshikiImamura
28
Science Transfer in Orofacial Pain: Problems and Solutions 229
CharlesS.Greene
Index 237
Preface to the Second Edition
Someofthemostcommonpainsoccurintheoro- accomplishedthesegoalsbyprovidingupdatedin-
facialregion.Becausethisregionofthebodyhas formation in the relevant chapters and by adding
specialimportanceineating,drinking,speech,and four new chapters. New cases have also been
theexpressionofourfeelings,painoccurringinthis added to illustrate how orofacial pain conditions
region has particular significance to the orofacial maybedifferentiallydiagnosedandmanaged(see
painpatient.Theeffectofchronicorofacialpainon chapter27).
a patient is particularly serious because it can be Thephilosophyofthissecondeditionremains
associatedwithemotional,psychologic,andsocial truetothatofitspredecessor,namelytoprovidea
disturbancesthatcompromisethepatient’squality comprehensive,integrated,concise,andevidence-
oflifeandwell-being.Furthermore,changingpop- based synthesis of the topic of orofacial pain
ulationdemographicswilllikelyincreasetheirbear- through a translational bridging from molecules
ing on dental practice in most countries over the and cellular mechanisms to diagnostic and man-
comingdecadesasmorepeoplebecomemiddle- agementapproaches.Themaintargetaudienceof
agedorelderly—theagerangewhenchronicoro- the book is still dental students and clinicians; in
facialpainconditionsaremostprevalent. addition,itwillundoubtedlyproveavaluablesource
Thus, there is a rapidly growing interest in the ofinformationforneurosciencegraduatestudents
fieldoforofacialpain.Inthe8yearssincethefirst and medical residents who want to learn more
edition of this book was published, new ap- aboutorofacialpainprocessesandtheirclinicalcor-
proaches have been developed in the diagnosis relates,andforthosescientistsandcliniciansinter-
andmanagementoforofacialpainconditions,and estedintranslationalresearchusingpainmodels.
our knowledge of the neurobiologic, molecular, We are grateful to Fong Yuen (University of
and genetic processes involved in orofacial pain TorontoFacultyofDentistry)forherexcellentwork
hasadvanced.However,thedecisiontopublisha aseditorialassistantforthissecondeditionofthe
second edition was based on a need not only to book and to the staff at Quintessence Publishing
update the basic science and clinical information, for their dedication and help in bringing it to
but also to expand the book’s reach by including fruition.Wealsothanktheauthorsofthechapters,
newtopicsrelatedtopaingenetics,painandmotor who have worked with the editors to ensure that
controlanddysfunction,andmanagementofhead- eachchapterprovidesanup-to-dateandevidence-
aches and pain-related movement disorders. We basedoverviewofitstopic.
viii
Preface to the First Edition
ThemodelforthisbookistheStudiesinPhysiology ular,wemadesurethatacutepainandchronicpain
SeriespublishedbytheBritishPhysiologicalSociety statesotherthanTMDsarecovered.Weaskedeach
(CodyFWJ[ed];PortlandPress,London,1995).The oftheauthors,whowerechosenfortheirexpertise
purpose of these publications is to present a sum- in the field, to distinguish between data and anec-
mary of current knowledge in a particular field to dote; if they could find no good evidence for or
teachers of physiology. Contributing authors are againstcurrentpractice,theywereaskedtostateso.
askedtokeeptheirpapersshortandsimple,sothat Eachofustookresponsibilityforoneofthefoursec-
theyarereadilyaccessibletoundergraduatestudents. tions (Section I,TheClinicalProblem and Epidemi-
Theyarealsotoldtousesummaryfiguresanddia- ology; Section II, Neurobiology of Pain; Section III,
gramsratherthancomplexreportsofdata,tokeep Pain and Behavior; and Section IV, Management of
thenumberofreferencessmall,andtocitereviews OrofacialPain)andworkedwiththecontributingau-
ratherthanresearchreportswheneverpossible. thorstoensureauniformityofexpressionandconti-
DrsJamesLundandGillesLavignesawthatthis nuityofcontentwithinandbetweenthesections.We
approach would be useful for teachers of oral biol- havetriedtomakesurethatthebookprovidesacom-
ogy, oral medicine, and facial pain; for students in prehensive,integratedsynthesisofthetopicandthat
facultiesofdentistryandmedicine;andforclinicians itisnotjustaseriesoflooselyconnectedchapters.
whowanttobebetterinformed.Whilescientistsand Mostofthechaptersinthisbookwerefirstpre-
graduatestudentsuseoriginalreportsandsophisti- sentedaspapersatasymposiumforteachersoforo-
catedliteraturereviewsofthetypepublishedinCrit- facialpainheldinVancouveronMarch10,1999,in
icalReviewsinOralBiologyandMedicinefortheir conjunctionwiththeAmericanandCanadianAsso-
researchandcoursework,thereisapaucityofmate- ciationsofDentalSchoolsandtheInternationalAs-
rialondentalandorofacialresearchsuitableforthe sociationforDentalResearch.WewishtothankDean
nonexpert. This problem is of growing importance EdwardYenoftheFacultyofDentistryoftheUniver-
because, as many dental faculties heed the call to sity of British Columbia for facilitating the organiza-
improve the teaching of basic and applied science tionoftheconferenceandMmesChristianeManzini
andinparticulartointegrateemergingscientificevi- andFrancineGuitardfortheirassistanceinVancouver.
denceintopatientcare,appropriatematerialsarenot MmeLucilleGendronwasoureditorialassistantand
availabletotheirstudents.DrsLundandLavignerec- coordinatedthearrangementsfortheconference.
ognizedthattherewasaparticularneedforconcise Wealsoacknowledgethefinancialsupportofthe
summaries of knowledge about orofacial pain and Canadian Medical Research Council, Block Drug
askedtwoofthepre-eminentexpertsinthefieldto Company Inc, the Quebec Oral Health Network of
jointhemascoeditors:DrRonaldDubner,chiefed- the Fonds de Recherche en Santé du Québec, the
itorofthejournalPain,andDrBarrySessle,editor- AssociationofCanadianFacultiesofDentistry,theIn-
in-chiefoftheJournalofOrofacialPainandpresident ternationalAssociationforDentalResearch—Neuro-
oftheInternationalAssociationfortheStudyofPain. scienceGroup,theCanadianAssociationforDental
Some of you may ask, why another volume on Research,theAmericanAcademyofOrofacialPain,
orofacialpain?Aren’tthereenoughpublishedreviews the Association of University Teachers of Orofacial
andtextbooksonthesubjectalready?Itistruethat PainPrograms,andtheOralPhysiologyCommission
muchhasbeenwritten,particularlyabouttemporo- oftheInternationalUnionofPhysiologicalSciences.
mandibular disorders (TMDs), but the best of the Weowespecialthankstotheauthors,whohadto
newerpublicationsarewrittenfortheresearcherand put up with more interference than usual from the
graduatestudent.Mostofthosebooksthatarewrit- editors,andfinallytoQuintessencefortheirhelpwith
tenforthedentalstudentandclinicianareheavyon theproductionofthebook,whichwehopeisonly
opinionbutlightonevidence.Inpreparingthisbook, thefirstinaseries.Wehavealreadybeguntoplan
wehavetriedtoincludethemajortopicsthatwould thenextonnormalandabnormalmovementsofthe
befoundinanundergraduatecurriculum.Inpartic- orofacialregionandupperaerodigestivetract.
ix
