The following are abstracts from studies in the October 1999 issue of JNMS. reprinted with the publishers's permission.
Review at Craniofacial Pain
FACIAL, HEAD, AND NECK PAINS are very common complaints in Western society and are highly prevalent in chiropractic practice. The physiologic basis of the association between neck pain and headaches (if not also some forms of facial and/or jaw pain) lies in the fact that the nociceptive afferents from upper cervical and posterior cranial structures terminate in the same second-order neuron pool, termed the "medullary dorsal horn" by Gobel et al. and the "trigemino-cervical nucleus" by Bogduk. A series of experiments beginning in the mid-1980s by Sessle and his colleagues has investigated these interactions in an exploration of craniofacial pain mechanisms. This article first presents a review of current pain physiology as a background to a serial review of the relevant experiments by Sessle and his colleagues. These studies are reviewed qualitatively, in order to inform the reader about their breadth and scope. Our work has confirmed that complex patterns of sensorimotor processing underlie the phenomena associated with craniofacial pain, and that various named clinical syndromes such as "upper cervical dysfunction," "greater occipital neuralgia," "cervicogenic headache," "necktongue syndrome," and some forms of temporomandibular joint pain may all share at least some aspects of this common mechanism. The clinical manifestations of disturbances in this mechanism are likely to include referred pain and muscular hypertonicity, which are so common in myofascial pain syndromes in the craniofacial region. The astute clinician is then presented with much greater diagnostic complexity, but is also given expanded opportunities for therapeutic intervention In the challenging area of craniofacial pain. (JNMS.- Journal of the Neuromuseuloskeletal System 7:51-64,1999) 7:51-64, 1999)
A Case History: Hip Pathology
CHIROPRACTORS ARE PRIMARY CONTACT HEALTH CARE PRACTITIONERS and must be aware of conditions that are not within the scope of chiropractic practice. Careful history and examination are key factors in determining conditions that can be managed by chiropractors and those that require referral. A case is presented of a geriatric patient with osteonecrosis of the femoral head. The patient had prior history of vulvar squamous cell carcinoma and was treated surgically and with irradiation therapy. Recently, the patient developed right hip and buttock pain, which was subsequently diagnosed as "sciatica and osteoarthiritis of the right hip," respectively. Initial radiographs of the hip were read as normal and the patient was treated conservatively, but failed to improve. She presented to our clinic and, after a careful history and examination, was diagnosed with a nonmechanical hip pathology. The patient was immediately sent for a radiographic study of the right hip, which demonstrated findings consistent with avascular necrosis of the right hip (osteonecrosis). She was subsequent]y referred and underwent hip replacement with an uneventful outcome. (JNMS: Journal of the Neuromuseculoskeletal Sysstem 7:65-69,1999)
A Case History: Spinal Epidural Abscess
SPINAL EPIDURAL ABSCESS is a relatively rare condition that often presents initially xvith low-back pain. Early diagnosis is imperative with this infectious process, as it frequently leads to rapid progression of neurologic deficit, with death often following shortly after. A case is presented of a patient with chronic, recurrent low-back pain in whom spinal epidural abscess was detected, and early treatment led to full resolution. The clinical picture and diagnostic indicators for this condition are discussed. (JA, 1IS: Journal,?f the Neuromusculoskeletal System 7:70-73,1999)
Discussants (in alphabetical order): Kimberly Harbaugh, MD, Thomas E. Hyde, DC, DACBSP, and Rand S. Swenson, DC, MD, PhD (XV,IWS.-trm# the Neuromusculoskeltal System 7:78-86.1999)
Copyright American Chiropractic Association Jan 2000
Provided by ProQuest Information and Learning Company. All rights Reserved
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