Persistent dentoalveolar pain disorder: A putative intraoral chronic overlapping pain condition

Babiloni, Alberto Herrero; Nixdorf, Donald R.; Moana-Filho, E. J.

doi:10.1111/odi.13248

Cited by 13 publications

(8 citation statements)

References 75 publications

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“…Part of the clinical picture is multifocal pain; co-morbidity between chronic pains is frequent. In line with this, PIDAP was recently proposed to be a chronic overlapping pain condition (COPC) (48) although this attribution needs more clinical data. In this context it should be considered that the inconclusive electrophysiological results may also result from the limited field testing of the ICOP criteria as it may be the case that different pathologies lead to the same clinical phenotype.…”

Section: Persistent Orofacial Painmentioning

confidence: 95%

Orofacial pain for clinicians: A review of constant and attack-like facial pain syndromes

May,

Benoliel,

Imamura

et al. 2023

Cephalalgia

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Background Primary headache syndromes such as migraine are among the most common neurological syndromes. Chronic facial pain syndromes of non-odontogenic cause are less well known to neurologists despite being highly disabling. Given the pain localization, these patients often consult dentists first who may conduct unnecessary dental interventions even if a dental cause is not identified. Once it becomes clear that dental modalities have no effect on the pain, patients may be referred to another dentist or orofacial pain specialist, and later to a neurologist. Unfortunately, neurologists are also often not familiar with chronic orofacial pain syndromes although they share the neural system, i.e., trigeminal nerve and central processing areas for headache disorders. Conclusion In essence, three broad groups of orofacial pain patients are important for clinicians: (i) Attack-like orofacial pain conditions, which encompass neuralgias of the cranial nerves and less well-known facial variants of primary headache syndromes; (ii) persistent orofacial pain disorders, including neuropathic pain and persistent idiopathic facial/dentoalveolar pain; and (iii) other differential diagnostically relevant orofacial pain conditions encountered by clinicians such as painful temporomandibular disorders, bruxism, sinus pain, dental pain, and others which may interfere (trigger) and overlap with headache. It is rewarding to know and recognize the clinical picture of these facial pain syndromes, given that, just like for headache, an internationally accepted classification system has been published and many of these syndromes can be treated with medications generally used by neurologists for other pain syndromes.

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Section: Persistent Orofacial Painmentioning

confidence: 95%

Orofacial pain for clinicians: A review of constant and attack-like facial pain syndromes

May,

Benoliel,

Imamura

et al. 2023

Cephalalgia

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“…Furthermore, the injection of lidocaine to the site of pain only partially relieves spontaneous pain, suggesting a contribution of the central mechanisms of sensitization [ 77 ]. AO is also suggested to be a chronic overlapping pain condition: AO occurs more frequently in females and is often comorbid with other chronic pain conditions, such as temporomandibular disorders (TMD; more frequent in females) or headaches, and emotional disorders, such as depression and anxiety [ 78 ].…”

Section: Pathological Painful Conditions and Underlying Neurobiologymentioning

confidence: 99%

Acute and Chronic Pain from Facial Skin and Oral Mucosa: Unique Neurobiology and Challenging Treatment

Chung

Wang

et al. 2021

IJMS

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The oral cavity is a portal into the digestive system, which exhibits unique sensory properties. Like facial skin, the oral mucosa needs to be exquisitely sensitive and selective, in order to detect harmful toxins versus edible food. Chemosensation and somatosensation by multiple receptors, including transient receptor potential channels, are well-developed to meet these needs. In contrast to facial skin, however, the oral mucosa rarely exhibits itch responses. Like the gut, the oral cavity performs mechanical and chemical digestion. Therefore, the oral mucosa needs to be insensitive, to some degree, in order to endure noxious irritation. Persistent pain from the oral mucosa is often due to ulcers, involving both tissue injury and infection. Trigeminal nerve injury and trigeminal neuralgia produce intractable pain in the orofacial skin and the oral mucosa, through mechanisms distinct from those seen in the spinal area, which is particularly difficult to predict or treat. The diagnosis and treatment of idiopathic chronic pain, such as atypical odontalgia (idiopathic painful trigeminal neuropathy or post-traumatic trigeminal neuropathy) and burning mouth syndrome, remain especially challenging. The central integration of gustatory inputs might modulate chronic oral and facial pain. A lack of pain in chronic inflammation inside the oral cavity, such as chronic periodontitis, involves the specialized functioning of oral bacteria. A more detailed understanding of the unique neurobiology of pain from the orofacial skin and the oral mucosa should help us develop novel methods for better treating persistent orofacial pain.

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“…One study revealed decreased brain activations in regions of the frontoparietal attention network in TMD patients subjected to forearm heat [24] while another found no brain activation differences between TMD patients and controls in response to thumbnail pressure pain [33]. In a previous sfMRI study done by our group, noxious dentoalveolar pressure stimuli was applied to patients with persistent dentoalveolar pain disorder (PDAP), a chronic orofacial pain condition affecting the dentoalveolar structures [39] which is commonly comorbid with TMD pain [40]. Compared to controls, PDAP patients exhibited a greater extent of brain activations over several brain areas including SI, SII, insula, prefrontal cortex, and thalamus.…”

Section: Introductionmentioning

confidence: 99%

“…Compared to controls, PDAP patients exhibited a greater extent of brain activations over several brain areas including SI, SII, insula, prefrontal cortex, and thalamus. Given that 50% of PDAP patients are also diagnosed with TMD [40, 41], these findings raise the possibility that chronic TMD pain patients may also present abnormally amplified brain responses following noxious dentoalveolar pressure stimulation, in a similar fashion to PDAP patients, even though this is not a site commonly reported as painful by that patient population.…”

Section: Introductionmentioning

confidence: 99%

Altered Brain Responses to Noxious Dentoalveolar Stimuli in High-Impact Temporomandibular Disorder Pain Patients

Peck

Bereiter

Eberly

et al. 2022

Preprint

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High-impact temporomandibular disorder (TMD) pain may involve brain mechanisms related to central sensitization. We investigated brain responses to stimulation of trigeminal sites not typically associated with TMD pain by applying noxious dentoalveolar pressure to high- and low-impact TMD pain cases and pain-free controls during functional magnetic resonance imaging (fMRI). Fifty female participants were recruited and assigned to one of three groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Graded Chronic Pain Scale: controls (n=17), low-impact (n=17) and high-impact TMD (n=16). Multimodal whole-brain MRI was acquired following the Human Connectome Project protocol, including stimulus-evoked fMRI scans during which painful dentoalveolar pressure was applied to the buccal gingiva of participants. Group analyses were performed using non-parametric permutation tests for parcellated cortical and subcortical neuroimaging data. There were no significant between-group differences for brain activations/deactivations evoked by the noxious dentoalveolar pressure. For individual group mean activations/deactivations, a gradient in the number of parcels surviving thresholding was found according to the TMD pain grade, with the highest number seen in the high-impact group. Among the brain regions activated in chronic TMD pain groups were those previously implicated in sensory-discriminative and motivational-affective pain processing. These results suggest that dentoalveolar pressure pain evokes abnormal brain responses to sensory processing of noxious stimuli in high-impact TMD pain participants, which supports the presence of maladaptive brain plasticity in chronic TMD pain.

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Persistent dentoalveolar pain disorder: A putative intraoral chronic overlapping pain condition

Cited by 13 publications

References 75 publications

Orofacial pain for clinicians: A review of constant and attack-like facial pain syndromes

Orofacial pain for clinicians: A review of constant and attack-like facial pain syndromes

Acute and Chronic Pain from Facial Skin and Oral Mucosa: Unique Neurobiology and Challenging Treatment

Altered Brain Responses to Noxious Dentoalveolar Stimuli in High-Impact Temporomandibular Disorder Pain Patients

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