scholarly journals Subtle Sensory Abnormalities Detected by Quantitative Sensory Testing in Patients with Trigeminal Neuralgia

2016 ◽  
Vol 7;19 (7;9) ◽  
pp. 507-517
Author(s):  
Joachim K. Krauss
Keyword(s):  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Clinical Examination ◽  
Trigeminal Nerve ◽  
Quantitative Sensory Testing ◽  
University Hospital ◽  
Sensory Testing ◽  
Invasive Treatment ◽  
Sensory Abnormalities ◽  
Routine Clinical Examination

Background: Trigeminal neuralgia (TN) is characterized by paroxysmal pain attacks affecting the somatosensory distributions of the trigeminal nerve. It is thought to be associated with a neurovascular conflict most frequently, but pathomechanisms have not been fully elucidated. In general, no sensory deficit is found in routine clinical examination. There is limited data available, however, showing subtle subclinical sensory deficits upon extensive testing. Objective: We used quantitative sensory testing (QST) to detect abnormalities in sensory processing in patients with TN by comparing the affected and non-affected nerve branches with their contralateral counterparts and by comparing the results of the patients with those of controls. Study Design: Observational study. Setting: University Hospital, Departments of Neurosurgery, Institute for Cognitive and Clinical Neuroscience. Methods: QST was conducted on 48 patients with idiopathic TN and 27 controls matched for age and gender using the standardized protocol of the German Neuropathic Pain Network. Stimulations were performed bilaterally in the distribution of the trigeminal branches. The patients had no prior invasive treatment, and medications at the time of examination were noted. Results: In patients with TN deficits in warm and cold sensory detection thresholds in the affected and also the non-affected nerve branches were found. Tactile sensation thresholds were elevated in the involved nerve branches compared to the contralateral side. Limitations: More data are needed on the correlation of such findings with the length of history of TN and with changes of the morphology of the trigeminal nerve. Conclusions: QST shows subtle sensory abnormalities in patients with TN despite not being detected in routine clinical examination. Our data may provide a basis for further research on the development of TN and also on improvement after treatment. Key words: Quantitative sensory testing, trigeminal neuralgia, facial pain, neuropathic pain, microvascular decompression, cranial nerve

scholarly journals Bilateral Sensory Abnormalities in Patients with Unilateral Neuropathic Pain; A Quantitative Sensory Testing (QST) Study

PLoS ONE ◽  
2012 ◽  
Vol 7 (5) ◽  
pp. e37524 ◽  
Author(s):  
Karl-Heinz Konopka ◽  
Marten Harbers ◽  
Andrea Houghton ◽  
Rudie Kortekaas ◽  
Andre van Vliet ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Quantitative Sensory Testing ◽  
Sensory Testing ◽  
Sensory Abnormalities

Quantitative Sensory Testing in Measurement of Neuropathic Pain Phenomena and Other Sensory Abnormalities

2009 ◽  
Vol 25 (7) ◽  
pp. 641-647 ◽  
Author(s):  
Miroslav-Misha Backonja ◽  
David Walk ◽  
Robert R. Edwards ◽  
Nalini Sehgal ◽  
Toby Moeller-Bertram ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Quantitative Sensory Testing ◽  
Sensory Testing ◽  
Sensory Abnormalities

Subclinical Sensory Abnormalities in Trigeminal Neuralgia

Cephalalgia ◽  
2003 ◽  
Vol 23 (7) ◽  
pp. 541-544 ◽  
Author(s):  
VJ Sinay ◽  
LH Bonamico ◽  
A Dubrovsky
Keyword(s):  
Trigeminal Neuralgia ◽  
Quantitative Sensory Testing ◽  
Sensory Perception ◽  
The Other ◽  
Heat Pain ◽  
Sensory Testing ◽  
Pain Thresholds ◽  
Sensory Abnormalities ◽  
Idiopathic Trigeminal Neuralgia ◽  
Single Nerve

Trigeminal neuralgia is considered as a paroxysmal single nerve phenomenon. Abnormal sensory perception has been previously described in 15-25% of patients with clinical examination. Quantitative sensory testing (QST) was used to evaluate sensory perception in patients with idiopathic trigeminal neuralgia (ITN). Nine patients and 10 normal control subjects were evaluated in all six trigeminal branches. QST abnormalities were found in the symptomatic division and in the other two branches on the same side. Minor contralateral changes were also found. Differences consisted of cold and warm hypoaesthesia and higher cold and heat pain thresholds in patients. All differences proved statistically significant. Our findings suggest that trigeminal neuralgia is not only a paroxysmal single nerve disorder, but also that other higher structures may be involved.

scholarly journals Neuralgias of the Trigeminal Nerve

2000 ◽  
Vol 5 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Allan S Gordon
Keyword(s):  
Neuropathic Pain ◽  
Differential Diagnosis ◽  
Trigeminal Neuralgia ◽  
Clinical Features ◽  
Trigeminal Nerve ◽  
Postherpetic Neuralgia ◽  
Facial Pain ◽  
The Other ◽  
Atypical Facial Pain ◽  
Trigeminal Neuropathic Pain

Practitioners are often presented with patients who complain bitterly of facial pain. The trigeminal nerve is involved in four conditions that are sometimes mixed up. The four conditions - trigeminal neuralgia, trigeminal neuropathic pain, postherpetic neuralgia and atypical facial pain - are discussed under the headings of clinical features, differential diagnosis, cause and treatment. This article should help practitioners to differentiate one from the other and to manage their care.

Neurophysiologic and quantitative sensory testing in the diagnosis of trigeminal neuropathy and neuropathic pain

Pain ◽  
2005 ◽  
Vol 117 (3) ◽  
pp. 349-357 ◽  
Author(s):  
Satu K. Jääskeläinen ◽  
Tuija Teerijoki-Oksa ◽  
Heli Forssell
Keyword(s):  
Neuropathic Pain ◽  
Quantitative Sensory Testing ◽  
Sensory Testing ◽  
Trigeminal Neuropathy

scholarly journals Assessing neuropathic pain in sickle cell disease: How useful is quantitative sensory testing?

2021 ◽  
Author(s):  
Zachary Ramsay ◽  
Damian Francis ◽  
Rachel Bartlett ◽  
Georgiana Gordon-Strachan ◽  
Justin Grant ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Quantitative Sensory Testing ◽  
Sensory Function ◽  
Heat Pain ◽  
Sensory Testing ◽  
Cell Disease ◽  
Pain Site ◽  
Kappa Agreement

Quantitative sensory testing (QST) is a psychophysical test of sensory function which may assist in assessing neuropathic pain (NP). This study compares QST findings with a standardized NP questionnaire to assess their agreement among Jamaicans with sickle cell disease (SCD). A cross sectional study consecutively recruited SCD patients 14 years and older, not pregnant, and without history of clinical stroke or acute illness in Kingston, Jamaica. QST identified thresholds for cold detection, heat detection, heat pain and pressure pain at the dominant thenar eminence, opposite dorsolateral foot and the subject's most frequent pain site. The Douleur Neuropathique 4 (DN4) was interviewer-administered to diagnose NP. Subjects were divided into low and high sensitization groups if below the 5th and above the 95th percentiles, respectively on QST measures. Kappa agreement coefficients, and receiver operator characteristic (ROC) curves were performed to compare QST with the DN4. Two hundred and fifty-seven SCD subjects were recruited (mean age 31.7±12.2 years, 55.7% female, 75% SS genotype). Kappa agreements were fair (0.2-0.4) to good (0.6-0.8) between DN4 individual items of itching, hypoesthesia to touch, hypoesthesia to pinprick and brush allodynia with various QST sensitization groups. However, kappa agreements between the NP overall diagnosis on the DN4 with sensitization groups were poor (<0.2). Only heat detection (0.75) and heat pain (0.75) at the leg as a pain site showed satisfactory area under the curve (>0.7). QST may assist in assessing individual components of NP but its use should be limited as a tool to augment clinical assessments.

scholarly journals Trigeminal Nerve Blocks In Refractory Trigeminal Neuralgia: About 21 Cases Reported At The Limoges University Hospital

2020 ◽  
Author(s):  
Nicolas Jacques ◽  
Simon Karoutsos ◽  
Loïc Marais ◽  
Nathalie Nathan-Denizot
Keyword(s):  
Quality Of Life ◽  
Adverse Effects ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Scientific Evidence ◽  
Conduction Block ◽  
Mean Value ◽  
University Hospital ◽  
Nerve Blocks

AbstractIntroductionDespite limited scientific evidence, trigeminal nerve blocks are alternative therapies for refractory trigeminal neuralgia (RTN). The duration of analgesia far exceeds the length of the conduction block. This study evaluated the quality of life 15 days after performing this block to treat RTN.MethodsThis retrospective study included all patients who, after informed consent, received iterative trigeminal blocks to treat a RTN between 2014 and 2018 in a university hospital. Patients received 0.5% levobupivacaine in combination with clonidine and a corticosteroid (cortivazol or betamethasone according their availability). Data were obtained from patients medical data files and a telephone questionnaire for the SF-12 score. The main criteria of evaluation was the change in quality of life according SF-12 performed at day 15.ResultsTwenty-one patients aged 62 ±14 years were included. All patients exhibited RTN after many different clinical treatments according ICHD-3 criteria. Seventy-one per cent of RTN occurred after trauma or surgery. Before receiving blocks, SF-12 physical (SF12-PS) and mental (SF-12 MS) scores reached respectively 35 ± 14 and 29 ± 11. A mean time of 4 ± 5 years elapsed between the occurrence of RTN and nerve blockade. At day 15, SF-12 PS increased by a 3 point mean value and SF-12 MS by 5 points. Approximately half of the patients (55%) were considered as non-responders with a cut-off value of less than 10% variation of their initial SF-12 score. When excluding these patients, SF-12 PS and SF-12 MS were increased by 17 and 9 points respectively. The mean duration of blocks lasted 15 ± 59 days and no severe adverse effects were observed. Patient satisfaction was correlated with increased SF-12 PS (r2 = 0.3 p = 0.01) and with the length of analgesia (r2 = 0.51 p = 0.001) but not to SF-12 MS variation (p = 0.12).ConclusionTrigeminal nerve blocks are temporarily effective on pain that may increase the quality of life in responder patients. The reason why some patients are unresponsive to this treatment and why durations in efficacy are so variable remain unsolved. However, in responders, trigeminal nerve blocks seem simple, harmless, not excessively cumbersome and without severe adverse effects.

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