Quantitative sensory testing in trigeminal traumatic neuropathic pain and persistent idiopathic facial pain

The objective of this article was to investigate, with a systematic protocol of quantitative sensory testing, patients with persistent idiopathic facial pain (PIFP) and others with trigeminal traumatic neuropathic pain (TTN) compared to controls. Thirty patients with PIFP, 19 with TTN, and 30 controls were evaluated on subjective numbness and dysesthesia and with a systematic protocol of quantitative sensory testing for thermal evaluation (cold and warm), mechanical detection (touch and pinpricks for mechanical pain), superficial pain thresholds, and corneal reflex. We found that PIFP and TTN had numbness and dysesthesia higher than controls (p<0.001 and p=0.003), and that in both of them mechanical pain by pinpricks detection was abnormal intra and extra orally at the mandibular branch (p<0.001). Cold, warm, and tactile detections and pain thresholds were similar among the groups. Corneal reflex was abnormal in TTN (p=0.005). This study supports neuropathic mechanisms involving pain processing in PIFP and that the criterion on absence of sensorial variations in PIFP should be revised.

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Sensory phenotypes in patients with peripheral neuropathic pain evaluated with quantitative sensory testing

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2012.05.061 ◽

2012 ◽

Vol 3 (3) ◽

pp. 196-196

Author(s):

D. Demant ◽

K. Lund ◽

B. Christensen ◽

M. Segerdahl ◽

N. Sjögren ◽

...

Keyword(s):

Neuropathic Pain ◽

Quantitative Sensory Testing ◽

Sensory Testing ◽

Double Blind ◽

Peripheral Neuropathic Pain ◽

Thermal Pain ◽

Significant Difference ◽

Pain Duration ◽

Underlying Mechanisms ◽

Mechanical Detection

Abstract Background In patients with neuropathic pain, Quantitative Sensory Testing (QST) can define different sensory phenotypes thought to be related to different underlying mechanisms. One phenotype with abnormal sensitization of cutaneous nociceptors has been termed irritable nociceptors. Methods This study is a part of a randomized, double-blind, placebo controlled, crossover trial with the anticonvulsant oxcarbazepine. The study is ongoing. In this report, baseline QST measures from patients with peripheral neuropathic pain due to either polyneuropathy (PNP) or peripheral nerve injury (PNI) are analyzed. QST evaluates thresholds for cold and heat detection (CDT, WDT), thermal pain (CPT, HPT), vibration (VDT), pin prick, mechanical detection and pressure pain. Furthermore, wind-up ratio and dynamic mechanical allodynia (DMA) are evaluated. Patients with irritable nociceptors are defined as patient with normal CDT and WDT and either mechanical or thermal allodynia or hyperalgesia. Results By March 2012, 28 patients with PNI and 24 with PNP were included. There was no difference in pain duration (66.2 (53.7) vs. 64.0 (43.3) months, p = 0.87) or pain intensity (NRS, 0 10) (6.6 (1.6) vs. 6.3 (1.7), p = 0.54), but patients with PNI were significantly younger (48.8 (15.1) years) compared to patients with PNP (62.4 (8.5) years), p < 0.001. The percentage of irritable nociceptors in the PNI group was 39.3% and in the PNP group 29.2% (p = 0.44). The percentage of patients with DMA was 39.3% and 33.3%, respectively (p = 0.66). Significantly more patients with PNI had thermal allodynia (28.6% vs. 0%, p = 0.005), 6 reported cold allodynia and 4 heat allodynia. Conclusion Preliminary results show that there was no significant difference in percentage of irritable nociceptors between the two groups, but more patients with PNI had thermal allodynia.

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Mechanical Quantitative Sensory Testing in A Canine Translational Model of Neuropathic Pain: A Pilot Investigation

10.1055/s-0038-1660886 ◽

2018 ◽

Author(s):

S. Moore ◽

E. Hostnik ◽

L. Cole

Keyword(s):

Neuropathic Pain ◽

Quantitative Sensory Testing ◽

Sensory Testing ◽

Translational Model ◽

Pilot Investigation

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Dorsal Root Ganglion Stimulation Normalizes Measures of Pain Processing in Patients with Chronic Low Back Pain: A Prospective Pilot Study using Quantitative Sensory Testing

Pain Practice ◽

10.1111/papr.12992 ◽

2020 ◽

Author(s):

Kenneth B. Chapman ◽

Bert‐Kristian van Roosendaal ◽

Tariq A. Yousef ◽

Kris C. Vissers ◽

Noud van Helmond

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pilot Study ◽

Dorsal Root Ganglion ◽

Dorsal Root ◽

Quantitative Sensory Testing ◽

Pain Processing ◽

Low Back ◽

Sensory Testing ◽

Prospective Pilot Study

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Reproducibility and influence of test modality order on thermal perception and thermal pain thresholds in quantitative sensory testing

Clinical Neurophysiology ◽

10.1016/j.clinph.2010.03.055 ◽

2010 ◽

Vol 121 (11) ◽

pp. 1878-1885 ◽

Cited By ~ 46

Author(s):

Victoria Heldestad ◽

Jan Linder ◽

Lisa Sellersjö ◽

Erik Nordh

Keyword(s):

Quantitative Sensory Testing ◽

Thermal Perception ◽

Sensory Testing ◽

Pain Thresholds ◽

Thermal Pain

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Cranial neuralgias and persistent idiopathic facial pain

Oxford Textbook of Headache Syndromes ◽

10.1093/med/9780198724322.003.0027 ◽

2020 ◽

pp. 237-247

Author(s):

Aydin Gozalov ◽

Messoud Ashina ◽

Joanna M. Zakrzewska

Keyword(s):

Neuropathic Pain ◽

Trigeminal Neuralgia ◽

Facial Pain ◽

Orofacial Pain ◽

Treatment Modalities ◽

Management Approach ◽

Trigeminal Neuropathy ◽

Facial Region ◽

Persistent Idiopathic Facial Pain ◽

Chronic Orofacial Pain

Orofacial pain is a complex problem and affects up to 7% of the population. Although trigeminal neuralgia has been considered the prime neuralgic condition in the facial region, other forms of neuropathic pain are now being more frequently recognized and require recognition and a different management approach. Many patients with chronic orofacial pain report numerous comorbidities, such as psychiatric or personality disorders, which significantly affect management. Various pain conditions present in the facial region. Some of them rarely present extra-orally (unless as radiating pain) such as atypical odontalgia or persistent dento-alveolar pain disorder and burning mouth syndrome, whereas others will present in both areas such as classical trigeminal neuralgia, post-traumatic trigeminal neuropathy, trigeminal neuropathy attributed to multiple sclerosis, and persistent idiopathic facial pain. Myofascial pain syndrome related to the muscles of mastication is very common and may also be associated with temporomandibular joint problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are similar in quality and characteristics with specific treatment modalities, but differ in pain location. Trigeminal neuropathic pain is caused most frequently by trauma. If no other diagnostic criteria are fulfilled, a diagnosis of persistent idiopathic facial pain is made. It is crucial for these patients to be managed by multidisciplinary teams.

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212 MECHANISM-BASED CLASSIFICATION OF NEUROPATHIC FACIAL PAIN - USE OF CLUSTER ANALYSIS WITH QUANTITATIVE SENSORY TESTING DATA

European Journal of Pain ◽

10.1016/j.ejpain.2007.03.227 ◽

2007 ◽

Vol 11 (S1) ◽

pp. S93-S93

Author(s):

C. Rolko ◽

D. Rasche ◽

C. Farrugia ◽

H.H. Capelle ◽

J.K. Krauss ◽

...

Keyword(s):

Cluster Analysis ◽

Facial Pain ◽

Quantitative Sensory Testing ◽

Sensory Testing ◽

Testing Data

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Peripheral trigeminal nerve field stimulation

Neurosurgical FOCUS ◽

10.3171/2013.7.focus13228 ◽

2013 ◽

Vol 35 (3) ◽

pp. E10 ◽

Cited By ~ 23

Author(s):

Alberto Feletti ◽

Giannantonio Zanata Santi ◽

Francesco Sammartino ◽

Marzio Bevilacqua ◽

Piero Cisotto ◽

...

Keyword(s):

Neuropathic Pain ◽

Peripheral Nerve ◽

Social Relations ◽

Nerve Stimulation ◽

Facial Pain ◽

Field Stimulation ◽

Trigeminal Neuropathic Pain ◽

Persistent Idiopathic Facial Pain ◽

Pain Reporting ◽

Peripheral Nerve Field Stimulation

Object Peripheral nerve field stimulation has been successfully used for many neuropathic syndromes. However, it has been reported as a treatment for trigeminal neuropathic pain or persistent idiopathic facial pain only in the recent years. Methods The authors present a review of the literature and their own series of 6 patients who were treated with peripheral nerve stimulation for facial neuropathic pain, reporting excellent pain relief and subsequent better social relations and quality of life. Results On average, pain scores in these patients decreased from 10 to 2.7 on the visual analog scale during a 17-month follow-up (range 0–32 months). The authors also observed the ability to decrease trigeminal pain with occipital nerve stimulation, clinically confirming the previously reported existence of a close anatomical connection between the trigeminal and occipital nerves (trigeminocervical nucleus). Conclusions Peripheral nerve field stimulation of the trigeminal and occipital nerves is a safe and effective treatment for trigeminal neuropathic pain and persistent idiopathic facial pain, when patients are strictly selected and electrodes are correctly placed under the hyperalgesia strip at the periphery of the allodynia region.

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