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Naganawa T.,Tokyo Womens Medical University | Sakuma K.,Tokyo Womens Medical University | Kumar A.,University of Aarhus | Kumar A.,Scandinavian Center for Orofacial Neuroscience | And 3 more authors.
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology | Year: 2015

Disseminated intravascular coagulation (DIC) is a condition causing severe bleeding, which requires hemostatic measures be taken after surgical treatment. However, there is no clear method to assess coagulation and bleeding after surgical treatment. Here, we describe a rare case of intracranial hemorrhage after tooth extraction in a patient with chronic DIC associated with aortic dissection. A 76-year old Japanese male reported spontaneous pain in the upper front teeth region. Tooth extraction was performed based on a diagnosis of severe periodontitis. Four hours after the extraction, re-bleeding from the tooth socket was reported. Moreover, 10 and 20 h after extraction, bleeding occurred from the tooth socket again. In both situations, the bleeding was successfully controlled by pressure hemostasis. Three and 5 days after the extraction, the patient reported to the emergency outpatient care with post extraction hemorrhage. Twelve days after the extraction, the patient complained of spontaneous severe headache. Computed tomography (CT) of the head was taken and hemorrhage was observed in his left frontal lobe. Thirty-eight days after tooth extraction, brain hemorrhage was spontaneously evoked again. It must be noted that bleeding may occur in any part of the body in patients with DIC and not only at the surgical site. © 2015 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Source


Naganawa T.,Tokyo Womens Medical University | Naganawa E.,Tokyo Womens Medical University | Kumar A.,University of Aarhus | Kumar A.,Scandinavian Center for Orofacial Neuroscience | And 6 more authors.
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology | Year: 2016

Motivational interviewing (MI) is a technique for helping clients to recognize and address their problems. This approach is useful for clients who are reluctant to change or who are ambivalent about changing their behaviors. We describe a case of medication non-adherence in a patient with chronic intraoral neuropathic pain. A 54-year-old man visited the Tokyo Women's Medical University Hospital with spontaneous pain on the gingiva and tongue. Although, pharmacotherapy was initiated, pain management was inadequate. The patient was unwilling to take any more medications (medication non-adherence) because of his previous experience, where the medications prescribed were non-effective in controlling his pain. MI was performed for his ambivalent condition (unwilling to take medicine vs. willing to achieve pain relief). The patient's behavior changed after three MI sessions, and then 2 weeks of pharmacotherapy (amitriptyline, 10 mg/day) decreased the pain score from 8 to 4 on the numerical rating scale (0-10). Another 8 weeks on amitriptyline at 20 mg/day further improved pain score from 4 to 0. MI may be effective as a psychological approach for addressing non-adherence to medication in the management of chronic intraoral pain. © 2015 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Source


Louca S.,Karolinska Institutet | Louca S.,Scandinavian Center for Orofacial Neuroscience | Christidis N.,Karolinska Institutet | Christidis N.,Scandinavian Center for Orofacial Neuroscience | And 9 more authors.
Journal of Headache and Pain | Year: 2014

Background: Chronic myalgia is associated with higher muscle levels of certain algesic biomarkers. The aim of this study was to investigate if hypertonic saline-induced jaw myalgia also leads to release of such biomarkers and if there were any sex differences in this respect.Methods: Healthy participants, 15 men and 15 aged-matched women (25.7 ± 4.3 years) participated. Intramuscular microdialysis into masseter muscles was performed to sample serotonin (5-HT), glutamate, lactate, pyruvate, glucose and glycerol. After 2 hours 0.2 mL hypertonic saline (58.5 mg/mL) was injected into the masseter on one side and 0.2 mL isotonic saline (9 mg/mL) into the contralateral masseter close to the microdialysis catheter. Microdialysis continued for 1 hour after the injections. Pressure pain thresholds (PPT) and pain were assessed before and after injections.Results: The median (IQR) peak pain intensity (0–100 visual analogue scale) after hypertonic saline was 52.5 (38.0) and after isotonic saline 7.5 (24.0) (p < 0.05). 5-HT, glutamate and glycerol increased after hypertonic saline injection (p < 0.05). Lactate, pyruvate and glucose showed no change. PPT after microdialysis was reduced on both sides (p < 0.05) but without side differences. Pain after hypertonic saline injection correlated positively to 5-HT (p < 0.05) and negatively to glycerol (p < 0.05).Conclusions: 5-HT, glutamate and glycerol increased after a painful hypertonic saline injection into the masseter muscle, but without sex differences. Since increased levels of 5-HT and glutamate have been reported in chronic myalgia, this strengthens the validity of the pain model. Glycerol warrants further investigations. © 2014, Louca et al.; licensee Springer. Source


Naganawa T.,University of Aarhus | Naganawa T.,Tokyo Medical University | Baad-Hansen L.,University of Aarhus | Baad-Hansen L.,Scandinavian Center for Orofacial Neuroscience | And 4 more authors.
Experimental Brain Research | Year: 2015

The aim of this study was to investigate temporal and spatial aspects of somatosensory changes after topical application of capsaicin, menthol and local anesthetics (LA) on the gingiva with the use of intraoral palpometers and thermal devices. Sixteen healthy volunteers (eight male, eight female) participated. Four topical preparations (capsaicin, menthol, LA and Vaseline as a control) were randomly applied to the gingiva around the first premolar in the upper jaw via individual oral templates, which allowed spatial mapping of somatosensory changes at and adjacent to the site of application. The topical drugs were applied for 15 min in a randomized and balanced sequence. The perceived preparation-evoked pain intensity was recorded with the use of 0–10 visual analog scales (VAS). Standardized mechanical and thermal stimuli were applied before, during and up to 30 min after the topical applications, and numerical rating scales (NRS) were used to score the perceived intensity of the stimuli. Peak VAS, area under the curve and mean VAS preparation-evoked pain scores for capsaicin, menthol, LA and control were compared with paired t tests. NRS scores for mechanical and thermal test stimuli were analyzed with four-way repeated measurements analyses of variance. Capsaicin evoked significantly higher VAS pain parameters as well as higher NRS scores to heat stimuli than control (P < 0.029). There were no significant differences in stimulus-evoked NRS scores between the menthol and control conditions (P = 0.518), but LA caused significantly lower stimulus-evoked NRS scores compared with control (P < 0.001). Post hoc tests showed that capsaicin caused sensitization to heat stimuli at and adjacent to the application area. In conclusion, this study for the first time demonstrates the time course of capsaicin-evoked heat hyperalgesia in and outside the site of application at the oral mucosa (primary and secondary hyperalgesia). © 2015, Springer-Verlag Berlin Heidelberg. Source


Sato H.,Keio University | Castrillon E.E.,University of Aarhus | Castrillon E.E.,Scandinavian Center for Orofacial Neuroscience | Cairns B.E.,University of British Columbia | And 9 more authors.
European Journal of Pain (United Kingdom) | Year: 2016

Background This study was conducted to determine whether glutamate-evoked jaw muscle pain is modulated by the acidity and temperature of the solution injected. Methods Thirty two participants participated and received injections of high-temperature acidic (HT-A) glutamate (pH 4.8, 48 C), high-temperature neutral (HT-N) glutamate (pH 7.0, 48 C) and neutral temperature neutral (NT-N) glutamate (pH 7.0, 38 C) solutions (0.5 mL) into the masseter muscle. Pain intensity was assessed with an electronic visual analogue scale (eVAS). Numerical rating scale (NRS) scores of unpleasantness and temperature perception, pain-drawing areas, mechanical sensitivity and pressure pain thresholds (PPT) were also measured. Participants filled out the McGill Pain Questionnaire (MPQ). One or two way ANOVAs were used for data analyses. Results Injection of HT-A glutamate solutions significantly increased the area under the VAS-time curve compared with injection of HT-N glutamate and NT-N glutamate solution (p < 0.040). The duration of glutamate-evoked pain was significantly longer when HT-A glutamate was injected than when NT-N glutamate was injected (p < 0.017). No significant effects of acidity were detected on pain drawings, NRS unpleasantness and heat perception, but there was a significant effect of acidity on MPQ scores and mechanical sensitivity. Conclusion Acidity and temperature modulate glutamate-evoked jaw muscle pain suggesting an interaction between acid sensing and glutamate receptors which could be of importance for understanding clinical muscle pain conditions. © 2015 European Pain Federation - EFIC®. Source

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