RESumo:A "Associação Internacional para o Estudo da dor" conceitua dor como uma experiência sensitiva e emocional desagradável, única, particular e intransferível, descrita em termos de lesão tecidual real ou potencial. A dor, especialmente quando crônica, afeta todas as áreas da vida do indivíduo, dependendo assim, de uma abordagem física, psíquica e social. Dentre as formas de enfrentamento da dor, a religiosidade e espiritualidade têm se mostrado importantes nos doentes, e estão relacionadas à redução do estresse envolvido. Foram revisados na literatura através da base de dados Medline o papel e os mecanismos da religiosidade e espiritualidade no enfrentamento da dor crônica. A religiosidade caracteriza-se como a primeira ou segunda estratégia de enfrentamento utilizada contra a dor. Indivíduos religiosos e espiritualizados apresentam redução da queixa de dor, da concentração de ACTH (hormônio adenocorticotrófico) e cortisol séricos, diminuição da pressão arterial sistólica, frequência cardíaca e respiratória. Atividades religiosas desencadeiam um aumento da ativação do córtex pré-frontal, ocorrendo uma maior eficiência e interatividade do sistema hipotálamo-pituitária-adrenal. Ocorre também a elevação dos mediadores envolvidos na dor: GABA, serotonina e dopamina. Indivíduos mais espiritualizados enfrentam melhor a dor, principalmente a dor crônica, devido a alterações fisiológicas e neurais decorrentes das crenças individuais.

Objective To identify temporomandibular disorders (TMD) symptoms in two groups of fibromyalgia patients according to the temporal relation between the onset of facial pain (FP) and generalized body pain (GBP). Cross-sectional study design: Fifty-three consecutive women with fibromyalgia and FP were stratified according to the onset of orofacial pain: Group-A (mean age 47.30 ± 14.20 years old), onset of FP preceded GBP; Group-B (mean age 51.33 ± 11.03 years old), the FP started concomitant or after GBP. Clinical assessment Research Diagnostic Criteria for Temporomandibular Disorders and the Visual Analogue Scale. Results Myofascial pain with mouth opening limitation (p = 0.038); right disc displacement with reduction (p = 0.012) and jaw stiffness (p = 0.004) were predominant in Group A. Myofascial pain without mouth opening limitation (p = 0.038) and numbness/burning were more common in Group B. Conclusion All patients had temporomandibular joint symptoms, mainly muscle disorders. The prevalence of myofascial pain with limited mouth opening and right TMJ disc displacement with reduction were higher in Group A.

At a single-night PSG, SB/TMD patients with widespread pain presented lower PSG sleep efficiency and higher mean age.

Objective Trigeminal neuralgia is defined as a sudden severe shock-like pain within the distribution of the trigeminal nerve. Pain is a subjective experience that is influenced by gender, culture, environment, psychological traits, and genes. Sodium channels and nerve growth factor play important roles in the transmission of nociceptive signals and pain. The aim of this study was to investigate the occurrence of Nav1.7 sodium channel and nerve growth factor receptor TrkA gene polymorphisms (SCN9A/rs6746030 and NTRK1/rs633, respectively) in trigeminal neuralgia patients. Methods Ninety-six subjects from pain specialty centers in the southeastern region of Brazil were divided into 2 groups: 48 with classical trigeminal neuralgia diagnosis and 48 controls. Pain was evaluated using the visual analog scale and multidimensional McGill Pain Questionnaire. Genomic DNA was obtained from oral swabs in all individuals and was analyzed by real-time polymerase chain reaction. Results No association was observed between evaluated polymorphisms and trigeminal neuralgia. For allele analyses, patients and controls had similar frequencies for both genes. Genotype distribution or allele frequencies of polymorphisms analyzed here did not correlate to pain scores. Conclusions Although no association of evaluated polymorphisms and trigeminal neuralgia diagnosis or pain severity was observed, our data do not exclude the possibility that other genotypes affecting the expression of Nav1.7 or TrkA are associated with the disease. Further studies should investigate distinct genetic polymorphisms and epigenetic factors that may be important in expression of these molecules.

Coping strategies are necessary to deal with pain, one of the most disabling conditions. Treatments are often refractory, and the elaboration of existential meaning is necessary to live with residual pain. The objective of this study was to discuss the relevance of the meaning of life in coping with refractory chronic neuropathic facial pain according to singular cases. Each patient is unique and needs a singular approach to understand and treat the pain phenomenon. Self-transcendence, existential issues and philosophical values are central concepts to assess chronic conditions and should be highlighted in medical practice these days.

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Orofacial pain and temporomandibular dysfunction may cause chronic facial pain, which may interfere with the emotional state and food intake of patients with eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN). Sixty-four patients were assigned to four groups: Group A (AN - restricting subtype): 07; Group B (AN - purging subtype ): 19; Group C (BN): 16; and Group D (control): 22. Complaints of pain are more prevalent in individuals with eating disorders (p<0.004). There are differences between the presence of myofascial pain and the number of hospitalizations (p = 0.046) and the presence of sore throat (p=0.05). There was a higher prevalence of masticatory myofascial pain and complaints of pain in other parts of the body in ED patients; however, there was no difference between ED subgroups. There was no difference in the number of self-induced vomiting between ED patients with and without myofascial pain.

Dear readers,We are in the International Year against Orofacial Pain, undoubtedly an area with the most pain-related diagnoses, because it has more than 300 causes. The prevalence is between 10% and 30% of general population and, if this were not enough, it includes highly complex and important anatomic and histological structures for social living and survival, which calls for several specialists such as dental surgeons, ENT specialists, ophthalmologists, speech therapists, in addition to other professionals who are part of interdisciplinary pain teams 1 . In spite of this relevance, academic curricula to qualify health professionals in pain are still poor still during graduation, and Dentistry is not different in this aspect. This year, for the first time, we have an optional discipline contemplating the subject in the Dentistry School, University of São Paulo, resulting from the vision of Prof. Victor Arana Chavez about this need. We wish that such initiative becomes mandatory and is spread to all universities. Traditionally, Revista Dor reserves its space to Orofacial Pain, particularly to temporomandibular disorders (TMD), which are contemplated in two articles of this edition. This is a major group of diseases of the masticatory, muscular, articular systems or mixed, which are only second in prevalence to dental-alveolar pain. They may affect different age groups and are comorbidities of other diagnoses such as trigeminal neuralgia, pulpitis, migraine and fibromyalgia 2,3 . So, they need careful evaluation for thorough diagnosis and choice of therapies with scientific evidence. Among treatments, there are invasive and non-invasive procedures including bite plates, acupuncture, physiotherapy, drugs, cognitivebehavioral therapy, surgeries and viscosupplementation. When adequately indicated, treatments are effective and I highlight a retrospective study on viscosupplementation, important technique to treat internal temporomandibular joint (TMJ) disorders 4 . Psychological and psychiatric comorbidities are also part of the set of morbidities associated to facial pain and caregivers should pay special attention to sufferers. Atypical facial pain, for example, has a high prevalence of associated emotional symptoms which have to be addressed 5 . Patients with trigeminal neuralgia are frequently isolated and end up with depression. And common tooth pain, when referred, may take months to be diagnosed and lead patients to total withdrawal from all their family, professional and leisure activities, even in such a short period of time. It also has to be stressed the important role of pain in the elderly in a current aging society which looks for quality of life in any age group. Elderly and children are special groups needing adequate care to their clinical condition and sometimes treatments such as acupuncture may help relieving symptoms with few adverse effects. So, enjoy your reading and let's hope that many scientific and academic advances occur in the Orofacial Pain universe during this International Year. Best ...