The same migraine medication may work differently depending on what patients are told. This migraine study shows how expectations and clinical context can shape pain relief. 同じ片頭痛治療薬でも、患者さんへの説明によって効果の出方が変わる可能性があります。痛みの治療では、薬そのものだけでなく臨床的な文脈も重要です。 Source Kam-Hansen S et al. Altered placebo and drug labeling changes the outcome of episodic migraine attacks. Sci Transl Med. 2014 Jan 8;6(218):218ra5. PMID: 24401940; PMCID: PMC4005597. https://pubmed.ncbi.nlm.nih.gov/24401940/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

Can the way we describe a migraine medication change how well it works? In this Article Review, Dr. Akihiro Ando discusses a fascinating study on episodic migraine, rizatriptan, placebo effects, and treatment labeling. The study examined whether patients’ expectations—shaped by labels such as “Maxalt,” “Placebo,” or “Maxalt or Placebo”—could influence headache relief after an acute migraine attack. The findings do not suggest that migraine is “imaginary” or that placebo replaces active medication. Rizatriptan was generally more effective than placebo. However, the study showed that the clinical context and the information given to patients can meaningfully shape treatment outcomes, especially for pain intensity. This paper has important implications beyond migraine, including orofacial pain and other clinical pain conditions. It reminds clinicians that diagnosis, pharmacology, and procedures matter—but so do our words, explanations, and the expectations we help patients form. The key clinical message: active medication matters, but the meaning attached to that medication also matters. Honest, balanced, confidence-building communication may help patients engage with evidence-based treatment more effectively. 片頭痛治療薬の効果は、患者さんにどのように説明されるかによって変わるのでしょうか？ 今回のArticle Reviewでは、Dr. Akihiro Andoが、反復性片頭痛、リザトリプタン、プラセボ効果、そして治療ラベルが症状改善に与える影響について検討した興味深い研究を紹介します。この研究では、薬の封筒に「Maxalt」「Placebo」「Maxalt or Placebo」といった異なるラベルを付けることで、患者さんの期待や治療反応がどのように変化するかが調べられました。 この研究は、片頭痛が「気のせい」である、あるいはプラセボが実薬の代わりになる、ということを示すものではありません。全体としてリザトリプタンはプラセボより有効でした。しかし同時に、患者さんに伝えられる情報や臨床的な文脈が、痛みの改善に影響しうることを示しています。 このテーマは片頭痛だけでなく、口腔顔面痛を含む痛みの診療全般にも関係します。薬理作用、診断、処置はもちろん重要ですが、治療は常に説明、信頼、期待という文脈の中で行われます。 本論文からの臨床的なメッセージは明確です。実薬の効果は重要です。しかし、その治療にどのような意味づけがされるかも重要です。過度な期待をあおるのではなく、正直でバランスが取れ、患者さんの治療参加を支える説明が、エビデンスに基づく治療の効果を最大限に引き出す助けになる可能性があります。 Source Kam-Hansen S et al. Altered placebo and drug labeling changes the outcome of episodic migraine attacks. Sci Transl Med. 2014 Jan 8;6(218):218ra5. PMID: 24401940; PMCID: PMC4005597. https://pubmed.ncbi.nlm.nih.gov/24401940/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

Medication-related oral findings in COVID-19 are signals worth studying, but observational data should not be overinterpreted. COVID-19治療薬と口腔症状の関連は興味深い一方で、観察研究だけで因果関係を断定することはできません。 Source Oyewole SO, Olawuyi AB, Okhuaihesuyi O, Owosho AA. Prevalence and risk of oral adverse outcomes in patients with COVID-19: a retrospective real-world cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2026 Jul;142(1):57-64. PMID: 41651738. https://pubmed.ncbi.nlm.nih.gov/41651738/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

Oral ulcers, dry mouth, and burning symptoms may appear during COVID-19, but this study cautions against assuming direct causation. COVID-19中の口内炎や口腔乾燥、灼熱感をすぐに「コロナのせい」と決めつけないことが大切です。 Source Oyewole SO, Olawuyi AB, Okhuaihesuyi O, Owosho AA. Prevalence and risk of oral adverse outcomes in patients with COVID-19: a retrospective real-world cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2026 Jul;142(1):57-64. PMID: 41651738. https://pubmed.ncbi.nlm.nih.gov/41651738/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

Among oral findings in COVID-19, taste alteration stands out as the most consistent signal. Other oral symptoms need more cautious interpretation. COVID-19に関連する口腔症状の中で、最も明確なサインは味覚異常。その他の口腔病変は慎重に評価する必要があります。 Source Oyewole SO, Olawuyi AB, Okhuaihesuyi O, Owosho AA. Prevalence and risk of oral adverse outcomes in patients with COVID-19: a retrospective real-world cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2026 Jul;142(1):57-64. PMID: 41651738. https://pubmed.ncbi.nlm.nih.gov/41651738/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

In this article review, Dr. Akihiro Ando discusses a large real-world cohort study examining oral adverse outcomes in adults with COVID-19. Oral symptoms such as taste alteration, oral ulcers, dry mouth, herpetic lesions, stomatitis, and burning mouth symptoms have been reported throughout the pandemic. But which findings are truly more common in patients with COVID-19, and which may reflect coincidental illness, stress, medication effects, or other common oral conditions? This study, using the TriNetX Research Network, found that taste alteration was the most clearly COVID-associated oral finding. Recurrent herpetic oral lesions were modestly more frequent, while many other oral mucosal conditions were not increased compared with matched non-COVID controls. The key clinical message is to avoid over-attributing every oral ulcer, dry mouth complaint, or burning symptom to COVID-19. Taste disturbance remains the most reliable oral signal, while other oral findings still require a standard diagnostic assessment and careful differential diagnosis. 今回のArticle Reviewでは、COVID-19患者における口腔関連の有害事象について検討した大規模リアルワールド・コホート研究を取り上げます。 COVID-19では、味覚異常、口内炎、口腔潰瘍、口腔乾燥、ヘルペス性病変、舌痛様症状など、さまざまな口腔症状が報告されてきました。しかし、それらは本当にCOVID-19と関連して増えているのでしょうか。それとも、体調不良、ストレス、薬剤、既存疾患などの影響による偶発的な所見なのでしょうか。 本研究では、TriNetX Research Networkを用いて成人COVID-19患者を解析し、口腔症状の発生頻度を非COVID-19対照群と比較しています。その結果、COVID-19との関連が最も明確だったのは味覚異常でした。一方で、再発性ヘルペス性口腔病変は軽度の増加が示唆されたものの、その他の口腔粘膜病変の多くはCOVID-19患者で増加していませんでした。 臨床的には、COVID-19中またはその後にみられる口腔潰瘍、口腔乾燥、灼熱感、粘膜炎症をすべてCOVID-19由来と決めつけるべきではありません。味覚異常は比較的信頼できる関連所見ですが、その他の口腔症状については通常の鑑別診断を丁寧に行うことが重要です。 Source Oyewole SO, Olawuyi AB, Okhuaihesuyi O, Owosho AA. Prevalence and risk of oral adverse outcomes in patients with COVID-19: a retrospective real-world cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2026 Jul;142(1):57-64. PMID: 41651738. https://pubmed.ncbi.nlm.nih.gov/41651738/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

Could sodium channel biology contribute to anesthetic failure in irreversible pulpitis? This section explains why inflamed pulps may be both more excitable and more difficult to silence. 不可逆性歯髄炎で麻酔が効きにくい理由は手技だけではないかもしれません。炎症によるイオンチャネル変化という視点を解説します。 Source Wells JE et al. Expression of Nav1.9 channels in human dental pulp and trigeminal ganglion. J Endod. 2007 Oct;33(10):1172-6. PMID: 17889684. https://pubmed.ncbi.nlm.nih.gov/17889684/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

One of the most important findings in the paper: painful teeth showed substantially greater Nav1.9 expression than asymptomatic teeth, supporting a biological basis for pulpal sensitization. この研究の重要な発見は、症状のある歯髄でNav1.9発現が大幅に増加していたことです。歯髄の過敏化を裏付ける生物学的根拠となります。 Source Wells JE et al. Expression of Nav1.9 channels in human dental pulp and trigeminal ganglion. J Endod. 2007 Oct;33(10):1172-6. PMID: 17889684. https://pubmed.ncbi.nlm.nih.gov/17889684/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

Severe pulp pain may involve more than inflammation. This study explores whether increased Nav1.9 sodium channel expression helps explain why some painful teeth remain difficult to anesthetize. 激しい歯髄痛は単なる炎症では説明できないかもしれません。Nav1.9ナトリウムチャネルの増加が、なぜ「ホットトゥース」が麻酔しにくいのかを説明する可能性があります。 Source Wells JE et al. Expression of Nav1.9 channels in human dental pulp and trigeminal ganglion. J Endod. 2007 Oct;33(10):1172-6. PMID: 17889684. https://pubmed.ncbi.nlm.nih.gov/17889684/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

Why are some patients with severe pulp pain still difficult to anesthetize, even when the technique appears correct? In this video, I review the 2007 paper “Expression of Nav1.9 Channels in Human Dental Pulp and Trigeminal Ganglion” and discuss its clinical relevance to painful teeth, pulpal hyperalgesia, and local anesthetic failure. The central idea is that inflamed pulp may be biologically different from asymptomatic pulp. In this study, Nav1.9 immunoreactivity was found in both asymptomatic and symptomatic human dental pulp, but it was significantly increased in painful teeth. The paper also demonstrated Nav1.9 expression in human trigeminal ganglion, with stronger labeling in smaller neurons that are likely more relevant to nociception. Clinically, this matters because Nav1.9 is a voltage-gated sodium channel associated with neuronal excitability. If painful pulps express more of this channel, that may help explain why “hot teeth” can be more irritable and, in some cases, more difficult to anesthetize with routine local anesthetic techniques. In this review, I discuss: - why this paper offers a plausible neurobiological explanation for pulpal hyperalgesia - how altered sodium channel expression may contribute to anesthetic resistance - why failed anesthesia in symptomatic pulpitis may reflect biology, not technique alone - what the study adds, and what it does not prove This is not a paper that solves the hot tooth problem on its own. However, it helps connect a familiar clinical frustration with a meaningful mechanistic explanation and supports a more sophisticated view of pain in inflamed dental pulp. なぜ重度の歯髄痛をもつ患者では、術式が適切と思われても十分な局所麻酔が得られにくいのでしょうか。この動画では、2007年の論文 “Expression of Nav1.9 Channels in Human Dental Pulp and Trigeminal Ganglion” を取り上げ、痛みを伴う歯髄、歯髄の過敏化、そして局所麻酔の効きにくさとの関連を臨床的に考察します。 この論文の重要な視点は、炎症を起こした歯髄は、単に「痛みが強い」だけでなく、生物学的にも無症状歯髄とは異なる可能性があるという点です。本研究では、Nav1.9免疫反応性は無症状歯髄と症状のある歯髄の両方で認められましたが、痛みのある歯で有意に増加していました。さらに、ヒト三叉神経節ニューロンにもNav1.9発現が認められ、とくに小径ニューロンで強い染色がみられました。 臨床的に重要なのは、Nav1.9が神経の興奮性に関わる電位依存性ナトリウムチャネルである点です。痛みを伴う歯髄でこのチャネルの発現が増えているなら、いわゆる “hot tooth” が過敏になりやすく、通常の局所麻酔では十分に抑えにくい理由の一つになるかもしれません。 このレビューでは、以下の点を解説します。 - 歯髄過敏の背景として、この論文がどのような神経生物学的説明を与えるのか - ナトリウムチャネル発現の変化が麻酔抵抗性にどう関与しうるのか - 症候性歯髄炎で麻酔が効きにくいのは、術式だけでなく生物学的変化も関係しうること - この研究が示したことと、まだ証明していないこと この論文だけで hot tooth の問題が解決するわけではありません。しかし、日常臨床で経験する「炎症歯髄は麻酔が効きにくい」という現象を、神経生物学的に考えるうえで非常に示唆に富む研究です。 Source Wells JE et al. Expression of Nav1.9 channels in human dental pulp and trigeminal ganglion. J Endod. 2007 Oct;33(10):1172-6. PMID: 17889684. https://pubmed.ncbi.nlm.nih.gov/17889684/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

For patients taking bisphosphonates, diabetes should prompt more careful preoperative assessment and surgical planning—not automatic avoidance of care. 糖尿病があるから治療を避けるのではなく、術前評価、感染管理、治癒への配慮をより丁寧に行うことが重要です。 Source Oliveira AVG et al. Is diabetes a risk factor for bisphosphonate-associated osteonecrosis of the jaws? Systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2026 Jul;142(1):109-120. PMID: 41794596. https://pubmed.ncbi.nlm.nih.gov/41794596/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

This meta-analysis found a higher prevalence of BRONJ in diabetic patients, but the evidence still requires careful clinical interpretation. 糖尿病とBRONJリスクの関連は示されていますが、臨床では因果関係として単純に解釈しない慎重さが必要です。 Source Oliveira AVG et al. Is diabetes a risk factor for bisphosphonate-associated osteonecrosis of the jaws? Systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2026 Jul;142(1):109-120. PMID: 41794596. https://pubmed.ncbi.nlm.nih.gov/41794596/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical