Percorrer por autor "Christidis, Nikolaos"
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- Associations between temporomandibular disorders and tinnitus : a systematic reviewPublication . Canales, Giancarlo De La Torre; Christidis, Nikolaos; Grigoriadis, Anastasios; Strandberg, Tilde; Montan, Veronica; Flores, Dyanne Medina; Al-Moraissi, Essam Ahmed; Christidis, MariaObjectives: Temporomandibular disorders (TMD) and tinnitus are highly prevalent conditions, that affects about 10–30% of the adult population and seem to co-exist. The primary objective of this systematic review was to investigate any associations between TMD and tinnitus. The secondary objective was to investigate if the associations differ between painful and non-painful TMDs. Methods: An electronic literature search in five databases was performed, from the inception of the databases until 26th of October 2022. This was to identify clinical trials with prevalence numbers of patients with TMD, with and without tinnitus and vice versa. From 1240 studies, a total number of 32 studies were included in the meta-analysis. A risk of bias analysis was made using the Methodological Evaluation of Observational Research (MORE). Results: Seventeen studies showed low risk of bias, while fifteen studies showed some risk of bias. Among patients with TMD, 57.5% also displayed tinnitus. In contrast, among patients with tinnitus, 92.9% also suffered from TMD. There was a strong association between patients with TMD that also had tinnitus, and patients with tinnitus that also had TMD (p’s < 0.001). The odds ratio for TMD-patients also having tinnitus was 1.556 (p < .05), while it for tinnitus-patients also having TMD was 2.859 (p < .05). Six studies examined the psychological status, and there was a higher degree of psychosocial distress among patients with TMD and TMD/tinnitus. Conclusions: There is a strong significant association between TMD and tinnitus, but further research is needed to unravel the nature of this association and its clinical implication.
- Botulinum toxin type A for the prevention of migraines : an umbrella review of systematic reviewsPublication . Chamani, Goli; Jasim, Hajer; Minston, Ava; Dias, Marlon Ferreira; Poluha, Rodrigo Lorenzi; Gonçalves, Daniela A. Godoi; Christidis, Maria; Al-Moraissi, Essam Ahmed; Christidis, Nikolaos; Canales, Giancarlo De la Torre; Ernberg, MalinBotulinum toxin type A (BoNT-A) is an established preventive therapy for chronic migraines; however, uncertainty remains regarding its comparative efficacy and safety. Thus, we aimed to summarize current evidence from high-quality systematic reviews of the therapeutic effects of BoNT-A in migraine management. An umbrella review was conducted following PRISMA guidelines and registered in PROSPERO. High-quality systematic reviews with meta-analysis evaluating BoNT-A efficacy were identified through five databases up to August 2024. Primary outcomes included monthly headache frequency and severity. Methodological quality and risk of bias were assessed using the umbrella review checklist. Fourteen articles were included. Overall, quantitative evidence indicated favorable effects of BoNT-A compared with placebo for chronic migraines, across headache frequency, headache severity, and acute medication use, but less efficacy than topiramate and the CGRP monoclonal antibodies (CGRPmAbs) galcanezumab and fremanezumab. Though the adverse events were frequent, BoNT-A was generally well-tolerated. Comparative data suggested superior tolerability versus topiramate and a safety profile like CGRPmAbs. Although botulinum toxin type A is widely used as a preventive treatment for chronic migraines, the available evidence supports its efficacy at a moderate level. Further head-to-head and long-term analyses are needed to clarify its comparative role alongside newer biologic treatments.
- Botulinum toxin type A for trigeminal and postherpetic neuralgia : an umbrella review of systematic reviewsPublication . Canales, Giancarlo De la Torre; Dureisseix, Marie-Amélie; Santos, Thiago Germano dos; Cebola, Pedro Miguel Teixeira Carvas; Nascimento, Glauce Crivelaro do; Foscaldo, Tatiana; Poluha, Rodrigo Lorenzi; Durham, Justin; Christidis, NikolaosBackground and Objective: Trigeminal neuralgia (TN) and postherpetic neuralgia (PHN) are severe peripheral neuropathic pain conditions associated with substantial functional impairment. Although pharmacological treatments are available, many patients experience insufficient efficacy or poor tolerability. Botulinum toxin type A (BoNT-A) has emerged as a potential treatment, but uncertainties remain regarding its efficacy, safety, and clinical positioning. This umbrella review aimed to synthesise evidence from systematic reviews evaluating BoNT-A in TN and PHN. Methods: A systematic search was conducted in MEDLINE, Embase, Cochrane Library, Web of Science, and CINAHL from inception to November 2025. Systematic reviews with or without meta-analysis evaluating BoNT-A in adults with TN or PHN were included. Methodological quality was assessed using AMSTAR-2, and only moderate- or high-quality reviews were included. Primary outcomes were pain intensity reduction and responder rates (≥ 50% pain reduction). Secondary outcomes included quality of life and adverse events. Results: Ten systematic reviews (2015–2024) met the inclusion criteria. Botulinum toxin type A was consistently associated with reductions in pain intensity and higher responder rates than placebo, particularly in TN. In PHN, evidence was more limited but supported short-term (1–3 months) improvements in pain intensity. Evidence on quality of life was scarce and inconclusive. Botulinum toxin type A was well tolerated, with mostly mild and transient adverse events. Conclusions: Botulinum toxin type A appears to provide short-term pain relief in selected patients with TN and PHN and is generally well tolerated. Current evidence supports its role as an adjunctive third-line option for focal peripheral neuropathic pain, although heterogeneity and limited long-term data warrant cautious interpretation.
- Botulinum toxin-A for the treatment of myogenous temporomandibular disorders : an umbrella review of systematic reviewsPublication . Canales, Giancarlo De la Torre; Câmara-Souza, Mariana Barbosa; Ernberg, Malin; Al-Moraissi, Essam Ahmed; Grigoriadis, Anastasios; Poluha, Rodrigo Lorenzi; Christidis, Maria; Jasim, Hajer; Lövgren, Anna; Christidis, NikolaosObjective: Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs. Method: An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisal checklist developed by the umbrella review methodology working group. Only high-quality SRs were included. Results: In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments. Conclusion: The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.
- Can poor nutrition and diet influence temporomandibular disorder? A systematic reviewPublication . Lima, Flávio Fidêncio de; Razavian, Artin; Hosokawa, Mai; Foscaldo, Tatiana Ferreira; Koldzo, Melisa; Poluha, Rodrigo Lorenzi; Christidis, Maria; Christidis, Nikolaos; Canales, Giancarlo De la TorreBackground: The relationship between diet, nutrition, and painful temporomandibular disorders (TMD) is not well established, despite increasing interest in lifestyle factors in chronic pain. This systematic review aimed to synthesize available evidence on how dietary patterns and nutritional status may be associated with painful TMD. Methods: An electronic search was conducted in the databases MEDLINE, CINAHL, EMBASE, the Cochrane Central Registry of Controlled Trials (CENTRAL) and Web of Science for clinical and observational trials from the beginning of each database to November 2025. Risk of bias was performed using the Study Quality Assessment Tools from the National Heart, Lung, and Blood Institute (NHLBI). Results: Out of 7,760 records and after the risk of bias assessment, only seven studies judged as having a low risk of bias were included. Overall, the included studies indicate that the association between dietary factors and TMD remains unclear. Prospective cohort studies did not demonstrate that prenatal or adolescent diet quality independently predicted TMD. Cross-sectional studies suggested that specific dietary patterns may be related to TMD-related symptoms. Women with myogenous TMD showed lower intake of several nutrients compared with controls. Experimental evidence indicated that monosodium glutamate ingestion increased pain intensity in myofascial TMD, while the only randomized trial found no significant pain differences between vitamin D supplementation and diclofenac. Conclusions: Current evidence suggests that some dietary components and nutritional factors may be associated with TMD-related symptoms or pain responses; however, the findings are limited, heterogeneous, and insufficient to support firm causal or therapeutic conclusions.
- Exploring botulinum toxin’s impact on masseter hypertrophy : a randomized, triple-blinded clinical trialPublication . Nobre, Bryanne Brissian de Souza; Rezende, Luciana; Câmara-Souza, Mariana Barbosa; Sanchez-Ayala, Alfonso; Blass, Rodrigo; Carbone, Ana Claudia; Manso, Ana Cristina; Ernberg, Malin; Christidis, Nikolaos; Canales, Giancarlo De la TorreThe present study aimed to assess the effectiveness and functional adverse effects of a single and multiple injections of botulinum toxin A (BoNT-A) for masseter hypertrophy (MH). Twenty-six women complaining about lower third facial enlargement due to MH, received 75 U of BoNT-A (abobotulinum toxin) in each masseter muscles. After 3 months, patients were randomly assigned to receive a second treatment session of Saline Solution: (G1; n = 11) or BoNT-A: (G2; n = 12). Muscle thickness (ultrasound), electrical activity (electromyography; EMG), masticatory performance, and subjective perception of MH were evaluated. Follow-up was performed at 1, 3 and 6 months. Muscle thickness, EMG activity, and masticatory performance were analyzed using ANOVA two-way and Sidak test as post-hoc. Masticatory performance was analyzed by the Friedman’s test and Mann–Whitney test. Regarding inter-groups comparisons, there was a significant decrease in the left masseter muscle thickness in the G2 group at the 6 month follow-up (p < 0.02). For EMG, significant differences were evident at the 6 month assessment, with higher masseter activity for G1 (p < 0.05). For masticatory performance, no significant differences were observed throughout the study (p > 0.05) and a higher improvement in subjective perception of MH was observed in the 1 month follow-up for G2 (p < 0.05). In conclusion, BoNT-A is effective for MH, however multiple injections cause functional adverse effects in masseter muscle.
- Game over : unraveling the prevalence and associations between bruxism, TMD and psychosocial factors in the Esports arenaPublication . Cardoso, Flávia Paula Da Silva; Barjandi, Golnaz; Flores, Dyanne Medina; Poluha, Rodrigo Lorenzi; Christidis, Nikolaos; Canales, Giancarlo De la TorreBackground: The professionalization of electronic sports (Esports) and streaming has introduced new challenges to players' physical and mental health, including chronic stress, sleep disruption and pain-related dysfunction. These factors are linked to bruxism and temporomandibular disorders (TMD), yet their prevalence and psychosomatic correlations within this community remain unknown. This study aimed to investigate the occurrence of bruxism and TMD among Esports players and streamers as well as their associations with psychosomatic and gaming-related variables. Methods: This cross-sectional study included 97 Esports players and streamers that completed validated self-report instruments screening for TMD (TMD pain-screener), bruxism, sociodemographic data, oral behaviors, sleep quality, perceived stress, anxiety, somatic symptoms, pain vigilance, and gaming/streaming habits. In addition to standard statistical tests, orthogonal partial least squares-discriminant analysis (OPLS-DA) were applied to identify group differences and multivariate associations. Results: Nearly half of the participants screened positive for TMD (49.5 %) and 78.4 % reported self-reported bruxism. Increased daily gaming hours correlated significantly with higher perceived stress and oral parafunctions. Multivariate analyses further showed that anxiety, somatic symptoms, poor sleep and perceived stress were key factors distinguishing participants with TMD from those without, and those with combined sleep and awake bruxism from those with only awake bruxism. Conclusion: TMD and bruxism are highly prevalent among Esports players and streamers, with greater daily gaming exposure linked to psychosomatic stress and oral parafunctions. Digital athletes with combined sleep and awake bruxism and/or TMD, experience greater psychosocial distress, indicating a subgroup that needs closer attention through early screening and targeted preventive strategies.
- Impact of chewing muscle anesthesia on masticatory performance in healthy participantsPublication . Flores, Dyanne Medina; Karlsson, Tilda; Canales, Giancarlo De La Torre; Kaspo, Natalie; Malmström, Clara; Messerer, Sara; Kumar, Abhishek; Svedenlöf, Johanna; Conti, Paulo Cesar Rodrigues; Christidis, Nikolaos; Grigoriadis, AnastasiosThe impact of the muscle spindles in the masticatory performance remains elucidated. This study aimed to investigate the impact of local anesthesia in the jaw-closing muscles on masticatory performance in healthy participants. Thirty healthy pain-free volunteers underwent in two rounds of chewing tasks involving two types of viscoelastic candies and a two-coloured chewing gum. Lidocaine (3.0 mL) was injected into a total of six points in the masseter and temporalis muscles bilaterally for the second round. Pain intensity, fatigue, the number and area of particles, and the degree of mixing of the chewing gum were assessed at baseline and after each round of chewing. The number of candy particles after injection of lidocaine, was significantly lower (33%) for women compared to the results without anesthesia (p < 0.05). There was no significant difference in the variance of hue of the two-coloured chewing-gum when comparing values before and after anesthesia. None of the participants experienced any pain during the experiment. However, self-reported fatigue increased during the second round, i.e., after anesthesia, with significantly higher values observed at the final assessment point. (p = 0.029). Local anesthesia of the jaw-closing muscles appears to impair the masticatory function in women, leading to reduced efficiency in food comminution compared to normal mastication. The observed sex differences suggest that women may be more vulnerable to neuromuscular control alterations following sensory alterations.
- Is there a link between diet and painful temporomandibular disorders? A cross-sectional studyPublication . Marques, Camila Cury; Cebola, Pedro Miguel Teixeira Carvas; Burusco, Idoya Orradre; González, Maria García; Pedro, Miguel de; Christidis, Nikolaos; Ernberg, Malin; Canales, Giancarlo De la TorreBackground: Nutrition and diet have emerged as potentially modifiable factors in the management of chronic pain, however, there is still limited evidence regarding the direct relationship between diet, nutrition, and Temporomandibular disorders (TMD). The aim of this cross-sectional study was to explore the relationship between dietary patterns and painful TMD, with a particular focus on dietary inflammatory potential, adherence to the Mediterranean diet, and psychosocial predictors. Methods: Ninety-two participants (45 TMD patients and 47 controls) aged 20–50 were recruited in Portugal and Spain. TMD diagnosis was based on the Diagnostic Criteria for TMD (DC/TMD). Psychosocial status was assessed using PHQ-9 (depression), PHQ-15 (somatic symptoms), and the Oral Behavior Checklist (OBC). Dietary data were collected through a 24-hour recall and assessed using the Healthy Eating Index (HEI), Dietary Inflammatory Index (DII), and Mediterranean Diet Adherence Screener (MEDAS). Pressure pain thresholds (PPT) were recorded at the TMJ and masticatory muscles. Data was analyzed using independent t-tests, Mann-Whitney U, and OPLS-DA multivariate modeling. Results: TMD patients showed significantly higher scores for somatic symptoms, depressive symptoms, and maladaptive oral behaviors. While no significant differences were found for DII or MEDAS scores between groups, TMD patients had significantly lower HEI scores and PPTs values in the masseter, temporalis, and TMJ regions. OPLS-DA identified oral behaviors, somatic symptoms, and lower HEI as the strongest predictors distinguishing TMD patients from controls. Conclusions: Painful TMD is associated with higher psychosocial distress and poorer dietary quality. These findings underscore the need to include dietary assessment in the clinical evaluation and management of TMD.
- Living with pain : a systematic review on patients’ subjective experiencesPublication . Christidis, Maria; Al-Moraissi, Essam Ahmed; Miah, Tasnim; Mihasi, Laura; Razavian, Artin; Christidis, Nikolaos; Canales, Giancarlo De la TorreBackground: Understanding the subjective experiences of patients living with chronic, acute, and cancer pain can significantly enhance the selection of treatment approaches, care, and support, ultimately improving their quality of life. This qualitative systematic review aimed to analyze if the patients’ subjective experiences of living with pain differ between acute, chronic, and cancer pain states. Methods: After registration in PROSPERO (CRD42023491745), an electronic search was conducted in the databases Medline (Ovid), Embase (embase.com), Cochrane (Wiley), Web of Science (Clarivate Analytics), and CINAHL (EBSCO) from their inception to 19 April 2024. Out of 8443 articles, 62 articles were included. The inclusion criteria that were applied were as follows: (1) participants aged 18 or older; and (2) participants’ subjective experiences of chronic, acute, or cancer pain. The exclusion criteria were as follows: (a) studies presented in other languages than English, Spanish, Portuguese, Greek, and Scandinavian languages; (b) editorials, letters, legal cases, case series, and case-control studies; (c) studies and articles based on duplicated data; (d) study population with ages below 18 years. Forty-four articles regarding chronic pain, thirteen regarding cancer pain, and five regarding acute pain were included. Methodological limitations were assessed using the CASP tool for quality appraisal in qualitative evidence synthesis. Certainty of evidence was assessed with GRADE-CERQual. All included studies showed moderate (n = 18) to high (n = 44) confidence. Results: Based on the qualitative synthesis in GRADE-CERQual, four main themes were identified: (1) impact of pain on social life, work life, and family life; (2) challenges in healthcare access; (3) psychological impact and emotional struggles from pain; and (4) barriers to effective pain management. Conclusions: Taken together, patients with chronic, acute, or cancer pain face challenges in social, work, and personal lives. They often lack recognition and support from healthcare providers, relying on self-managed methods and facing barriers to effective management. Therefore, future research examining how the different pain types affect the lives of the patients and at the same time exploring personalized and collaborative treatment approaches is warranted. In conclusion, patients’ experiences of living with pain remain unexplored in clinical practice. Understanding the impact of various pain types on mental health, self-esteem, daily life, and relationships is crucial. Also, how personalized treatments, collaborative healthcare access, and long-term management strategies can improve quality of life for patients living with pain.