Sensory testing associates with pain quality descriptors during acute dental pain

Abstract

Background Pain descriptors capture the multidimensional nature of pain and can elucidate underlying pathophysiological mechanisms. This study determined whether the pain descriptors chosen by subjects experiencing acute dental pain associate with the outcomes of two commonly performed dental sensory tests. The goal of the study is to clarify whether pain descriptors are useful in discriminating the underlying biological processes contributing to dental pain. Methods Participants (n = 228) presenting with acute toothache underwent standardized clinical dental sensory testing and described their pain in reference to 22 pain quality descriptors. Univariate and two‐way ANOVA determined the relationship between groups defined by cold detection (positive or negative) and percussion hypersensitivity (painful or not) on the affected tooth, and pain descriptor reporting. Results Subjects experiencing painful toothache most frequently reported evoked pain to temperature and chewing, and pain descriptors such as “throbbing” and “aching.” They also reported neuropathic pain descriptors such as “tingling” and “electric shock.” Subjects who detected a cold stimulus (thermal) on the affected tooth, frequently reported high intensity paroxysmal shooting pain compared to those that did not detect cold. By contrast, patients with percussion (mechanical) hypersensitivity on the affected tooth, reported higher levels of global pain intensity at rest and in function, and reported significantly higher intensity “radiating” and “throbbing” pain, than subjects with non‐painful percussion. Conclusions The reporting of neuropathic pain descriptors by subjects experiencing acute toothache was more frequent than expected, suggesting that neuropathic mechanisms could contribute to typical toothache pain. Subjects experiencing toothache with mechanical hypersensitivity experience more intense pain overall. Significance In subjects experiencing acute toothache, specific pain descriptors associate with the responses to routine clinical sensory tests performed on the injured tooth. The frequent reporting of neuropathic pain descriptors suggests that neuropathic mechanisms could create a diagnostic challenge to differentiate toothache from intraoral neuropathic conditions. Persons experiencing toothache with mechanical hypersensitivity experience more intense pain overall, suggesting patients with this clinical feature will have distinct clinical pain management needs.

The characteristics and prognostic role of acute abdominal on‐admission pain in acute pancreatitis: A prospective cohort analysis of 1432 cases

“…Obviously, therapy should be tailored to the intensity of pain. The significance of pain type (quality descriptors) in other diseases has also been researched extensively, mostly for chronic pain (Asthana et al, 2020 ; Dworkin et al, 2007 ; Erdogan et al, 2019 ; Galli et al, 2019 ; Rau et al, 2018 ; Sharma et al, 2016 ). Recommendations for acute and chronic pain also suggest pain type‐based phenotyping of patients, since pain is a complex phenomenon and pain type may influence the efficacy of certain drug classes (Chou et al, 2016 ; Dworkin et al, 2005 ; Edwards et al, 2016 ).…”

Evoked and spontaneous pain assessment during tooth pulp injury

“…Pain from the infected tooth pulp (pulpitis) can be unrelenting and many patients report this form of pain as the most intense type of pain they have ever experienced 1 . Mechanical hypersensitivity of the tooth is associated with greater pain intensity ratings overall 2 . Prevailing treatment options for painful pulpitis consists of pulp or tooth removal, which can have lasting consequences for dental function and in some patients there may still be lingering pain 3,4 .…”

“…Clinically, mechanical hypersensitivity and spontaneous pain are particularly problematic for patients [2][3][4] , and there are common behavioral assessment tools for these in rodent models when the pain occurs elsewhere in the body outside of the face. To date, only a handful of studies using the tooth pulp injury model have examined mouse behavior, and these studies have not incorporated some of the common assays used to measure nociception [6][7][8] .…”

Pulpitis in a dens invaginatus presenting as a Trigeminal Neuralgia: A case report

“…Dental pulpal pain is usually described as throbbing, sharp, dull ( 3 ) reflecting inflammatory processes in an enclosed structure. However, neuropathic descriptors, such as shooting, electric-shock, tingling, pins and needles, burning, numbness, are also reported during toothache suggesting that neuropathic mechanisms could contribute to typical toothache pain ( 6 ).…”