ABSTRACT
Concomitant use of tobacco and opioids represents a growing public health concern. In fact, the mortality rate due to smoking-related illness approaches 50% among SUD patients. Cumulative evidence demonstrates that the vulnerability to drugs of abuse is influenced by behavioral, environmental, and genetic factors. This review explores the contribution of genetics and neural mechanisms influencing nicotine and opioid reward, respiration, and antinociception, emphasizing the interaction of cholinergic and opioid receptor systems. Despite the substantial evidence demonstrating nicotine-opioid interactions within the brain and on behavior, the currently available pharmacotherapies targeting these systems have shown limited efficacy for smoking cessation on opioid-maintained smokers. Thus, further studies designed to identify novel targets modulating both nicotinic and opioid receptor systems may lead to more efficacious approaches for co-morbid nicotine dependence and opioid use disorder.
Subject(s)
Opioid-Related Disorders , Receptors, Nicotinic , Tobacco Use Disorder , Analgesics, Opioid/pharmacology , Analgesics, Opioid/therapeutic use , Humans , Nicotine/pharmacology , Nicotine/therapeutic use , Opioid-Related Disorders/drug therapy , Receptors, Nicotinic/therapeutic use , Tobacco Use Disorder/drug therapyABSTRACT
AIM: To evaluate the impact of cigarette smoking on the sleep quality of patients with masticatory myofascial pain and to determine whether the association between smoking and impaired sleep is influenced by other factors such as demographic, psychological, and behavioral variables. METHODS: Data from a retrospective case series of 529 patients diagnosed with masticatory myofascial pain according to group I of the Research Diagnostic Criteria for Temporomandibular Disorders were obtained. Patients completed a standardized pain questionnaire and psychometric tests. Differences between smokers and nonsmokers were evaluated using independent samples t tests and chi-square tests. Hierarchical linear multiple regression models were used to examine predictors of sleep disturbances. RESULTS: Of the entire sample, 170 (32%) reported that they were smokers. Smokers reported higher pain severity and more sleep disturbances and psychological distress than nonsmokers. Cigarette smoking significantly predicted sleep disturbance (ß = 0.229, P < .001), but this relationship was attenuated after controlling for pain severity and psychological distress (ß = 0.122, P < .001). CONCLUSION: Cigarette smoking is associated with numerous adverse health outcomes, including pain severity, alterations in mood, and disrupted sleep, and seems to be a significant predictor of sleep quality in patients with masticatory myofascial pain.
Subject(s)
Sleep/physiology , Temporomandibular Joint Dysfunction Syndrome/physiopathology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Employment , Facial Pain/physiopathology , Facial Pain/psychology , Female , Humans , Male , Marital Status , Middle Aged , Mood Disorders/etiology , Mood Disorders/psychology , Pain Measurement/methods , Retrospective Studies , Sleep Wake Disorders/etiology , Smoking/adverse effects , Smoking/physiopathology , Smoking/psychology , Stress, Psychological/psychology , Temporomandibular Joint Dysfunction Syndrome/complications , Temporomandibular Joint Dysfunction Syndrome/psychology , Young AdultABSTRACT
OBJECTIVE: This study, through a systematic literature review, aims to analyze the effectiveness of Botulinum Toxin as a treatment for masticatory myofascial pain and muscles temporomandibular disorders (TMD). METHODS: Survey in research bases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs and BBO, between the years of 1966 and April 2011, with focus in randomized or quasi-randomized controlled clinical trials, blind or double-blind. RESULTS: After applying the inclusion criteria, 4 articles comprised the final sample: 3 were double-blind randomized controlled clinical trials and 1 was single-blind randomized controlled clinical trial. CONCLUSIONS: According to the literature, there is lack of evidence about the real effectiveness of botulinum toxin in the treatment of masticatory myofascial pain and muscular TMD. Thus, further randomized controlled clinical trials, with representative samples and longer follow-up time, to assess the real effectiveness of the technique are needed.
OBJETIVO: este trabalho, por meio de uma revisão sistemática da literatura, teve como objetivo analisar a efetividade da toxina botulínica como tratamento para dor miofascial mastigatória e disfunções temporomandibulares (DTM) musculares. MÉTODOS: pesquisa nas bases de dados Medline, Cochrane, Embase, Pubmed, Lilacs e BBO, no período entre 1966 e abril de 2011, com enfoque em estudos clínicos controlados randomizados ou quase-randomizados, cegos ou duplo-cegos. RESULTADOS: após a aplicação dos critérios de inclusão, chegou-se a 4 artigos, sendo que 3 eram estudos clínicos controlados randomizados duplo-cego e 1 era estudo clínico controlado randomizado simples-cego. CONCLUSÕES: pela análise da literatura, verificou-se um número reduzido de evidências significativas sobre a real efetividade da toxina botulínica no tratamento da dor miofascial e de DTM musculares. Assim, são necessários novos estudos clínicos controlados randomizados, com amostras representativas e tempo de acompanhamento longo, para avaliar a real efetividade da técnica.
ABSTRACT
JUSTIFICATIVA E OBJETIVOS: As formas de tratamento consideradas não invasivas para as alterações internas das articulações temporomandibulares (ATM) descritas na literatura são muitas, incluindo aconselhamento,farmacoterapia, fisioterapia e dispositivos interoclusais. No entanto, alguns pacientes tornam-se refratários aos tratamentos conservadores, sendo indicados procedimentos como artrocentese, artroscopia e cirurgias das ATM. A viscossuplementação é uma abordagem pouco invasiva, de baixo custo e com bons resultados em curto e médio prazo. O objetivo deste estudofoi discutir a técnica de viscossuplementação como tratamento das alterações internas da ATM, com relato de 2 casos clínicos com acompanhamento de 12 meses.RELATOS DOS CASOS: Duas pacientes com artralgia das ATM e refratárias à tratamento conservador foram submetidas a uma infiltração semanal de hialuronato de sódio por três semanas. Observou-se melhora da dor e da amplitude de abertura mandibular nas duas primeiras semanas, resultado que se manteve constante ao longo de um ano de acompanhamento.CONCLUSÃO: A viscossuplementação das ATM mostrou ser eficiente no controle da dor articular, melhorando também a função mandibular nos casos clínicos apresentados. Ensaios clínicos controlados com amostras significativas devem ser realizados para compreensão de sua real eficácia no tratamento das DTM.
BACKGROUND AND OBJECTIVES: There are several noninvasive treatments described in the literature for internal temporomandibular joint (TMJ) disorders, including counseling, drug therapy, physical therapy and interocclusal devices. However, some patients become refractory to conservative treatments, and procedures such as arthrocentesis, arthroscopy and ATM surgeries are indicated. Viscossuplementation is a less invasive, inexpensive and effective approach in the short and medium run. This study aimed at discussing viscossuplementation to treat internal TMJ disorders with 2 clinical case reports end 12-month follow-up.CASE REPORTS: Two patients with TMJ arthralgia and refractory to conservative treatment were submitted to weekly infiltrations of sodium hialorunate for three weeks. Pain and mouth opening amplitude were improved in the first two weeks, and remained constant throughout the 12-month follow-up. CONCLUSION: TMJ viscossuplementation was an effective approach to control articular pain, also improving mandibular function in our cases. Controlled clinical trials with significant samples should be carried out to understand its actual effectiveness to treat TMD.
