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Palla, S (2003). Myoarthropathischer Schmerz: oft verkannt. Der Schmerz, 17(6):425-431.

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Abstract

Deutsch: Der myoarthropathische Schmerz, der meistens durch eine Tendomyopathie der Kaumuskulatur verursacht wird, ist eine häufige Ursache orofazialer Schmerzen. Die Schmerzintensität wechselt oft zwischen schmerzfreien und schmerzhaften Perioden. Vor allem leichte bis mäßig starke myoarthropathische Schmerzen haben die Tendenz, spontan zu verschwinden. Jedenfalls können sie mit einfachen, reversiblen Maßnahmen (Aufklärung, Selbstbeobachtung, Analgetika, Physiotherapie und okklusale Schienen) gelindert werden. Nur bei einem kleinen Teil der Patienten chronifiziert der Schmerz, sodass ein multimodaler therapeutischer Ansatz notwendig wird, um sowohl die somatische als auch die nichtsomatische, d. h. die affektive, emotionale, kognitive und verhaltensbezogene Schmerzkomponente zu behandeln. Zur Behandlung der somatischen Komponente können trizyklische Antidepressiva eingesetzt werden, während die Therapie der nichtsomatischen Komponente eine kognitive, verhaltensorientierte Therapie benötigt.

English: Myoarthropathic pain, most often due to masticatory myalgia, is the major source of orofacial pain. Its diagnosis is not always easy because the diagnostic signs are not pathognomonic and they may occur also with other pain disorders. The pain intensity fluctuates, and mild to medium intensity pain has the tendency to subside spontaneously or can be alleviated with simple, non-invasive therapies such as counseling, self-control, analgesics, physiotherapy, and occlusal appliances. For most patients a combination of counseling, self-control and physiotherapy (home program) is sufficient to relieve the pain. Occlusal appliances should, therefore, be used only if these modalities fail or if pain is present on awakening. Only in a small percentage of patients the myoarthropathic pain persists and becomes chronic. The factors that determine pain chronicity are complex and most likely due to the interaction of biomedical factors - such as the persistence of peripheral nociceptive input, neuroplastic changes at spinal and supraspinal levels (cortical reorganisation)- with psychosocial factors, in addition, possibly, to a polymorphism of the catechol-o-methyltransferase gene. Patients with chronic myogenic pain need a multimodal therapy, according to the biopsychosocial pain model. In addition to the modalities just described, the treatment must address also the affective, emotional, cognitive and behavioural pain component and be tailored to the single patient based on his/her psychosocial and constitutional characteristics. The goal is not pain relief but improvement of the quality of life by teaching the patient more efficient pain coping strategies by means of behavioural and relaxation techniques. In addition, tricyclic antidepressants may be used in order to treat the somatic pain component caused by the neuroplastic changes that take place in the central nervous system in chronic pain conditions.

Citations

6 citations in Web of Science®
9 citations in Scopus®
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Additional indexing

Other titles:Muscular-arthroscopic pain: often unappreciated
Item Type:Journal Article, refereed
Communities & Collections:04 Faculty of Medicine > Center for Dental Medicine > Clinic for Masticatory Disorders and Complete Dentures, Geriatric and Special Care Dentistry
DDC:610 Medicine & health
Language:German
Date:1 December 2003
Deposited On:11 Feb 2008 12:23
Last Modified:27 Nov 2013 18:34
Publisher:Springer
ISSN:0932-433X
Publisher DOI:10.1007/s00482-003-0254-6
PubMed ID:14648315

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