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

Abstract

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.

Quantitative Sensory Changes Following Gasserian Ganglion Radiofrequency Thermocoagulation in Patients with Medical Refractory Trigeminal Neuralgia: A Prospective Consecutive Case Series

“…[30][31][32] Also, in other facial pain conditions such as persistent idiopathic facial pain and trigeminal traumatic neuropathic pain, tactile threshold increments were already demonstrated. 33,34 Our measurements also revealed pathologic vibration sensing in TN patients preoperatively that contradicts the findings of Flor et al, but this discrepancy may be explained by the heterogeneous characteristics of the study population. 31 The latter trial included only TN subjects without prior invasive treatment that might influence sensory characteristics.…”

Orofacial neuropathic pain

“…Pain is described as deep, diffuse, continuous and persistent and may have burning or pressing sensation. Pain may be triggered by invasive dental 45,46 . Among etiologic factors involved with these conditions, one should stress dental implants, which have increased in frequency in general, and which may trigger PIFP or AO in predisposed patients 47,48 .…”

“…Treatment follows the same orientations of those recommended for NP in general 47,48 . Recent studies have shown that samples of PIFP and PPTPN patients had no significant differences as compared to different sensitivity parameters 45 and also that patients with AO have descending inhibitory pain system impairment 49 .…”

Personality, coping and atypical facial pain. Case reports

“…Subjective psychic factors play a major role in pain chronification and pain crises, especially when pain is located at the head and / or face, because of the psychic and social importance of this body area. Among orofacial pain diagnosis, atypical facial pain or persistent idiopathic facial pain (PIFP) remains as one of the most complex to evaluate and treat, with the compulsory need of psychological assessment 3 . PIFP is characterized as diffuse deep and constant chronic pain (International Headache Association, 2013) 4 that has no etiology behind it and the exclusion of other pathologies is necessary before final diagnosis.…”