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      Continuous neurophatic orofacial pain: A retrospective study of 23 cases

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          Abstract

          Background

          To determine the clinical characteristics of Continuous Neuropathic Orofacial Pain in patients that suffer Persistent Idiopathic Facial Pain (PIFP), Painful Post-Traumatic Trigeminal Neuropathy (PPTTN) or Burning Mouth Syndrome (BMS) and to describe their treatment.

          Material and Methods

          A retrospective observational study was made, reviewing the clinical history of the patients diagnosed with Continuous Neuropathic Orofacial Pain between 2004 and 2011 at the Orofacial Pain Unit of the Master of Oral Surgery and Implantology of the University of Barcelona and at the Orofacial Pain Unit of the Teknon Medical Center of Barcelona.

          Results

          The average age of the patients with Continuous Neuropathic Orofacial Pain was 54.5, with a clear female predominance (86.9%, n=20). Of all patients, 60.9% (n=14) were suffering a PIFP, 21.7% (n=5) had a BMS and 17.4% (n=4) were presenting a PPTTN. The pain quality described by the patients with Continuous Neuropathic Orofacial Pain was oppressive (43.47%, n=10), widely represented by patients with PIFP, and burning (39.13%, n=9) being the only quality that described patients with BMS. The treatment carried out with the patients was only pharmacologic. The most used drugs for the treatment of PIFP and PPTTN were clonazepam (50%, n=9) and amitriptyline (44.44%, n=8). However, a 55.5% (n=10) of the patients with PIFP or PPTTN required the association of two or more drugs for a correct pain control. All the patients with BMS responded satisfactorily to clonazepam.

          Conclusions

          Continuous Neuropathic Orofacial Pain is a little known condition among the general population, physicians and dentists. This favors a late diagnosis and inaccurate treatments which entail unnecessary suffering. It is important to inform both the general population and health professionals concerning this painful condition.

          Key words:Continuous neuropathic orofacial pain, persistent idiopathic facial pain, painful post-traumatic trigeminal neuropathy, burning mouth syndrome, atypical odontalgia.

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          Most cited references29

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          Differential diagnosis of temporomandibular disorders and other orofacial pain disorders.

          Reny de Leeuw, J Okeson (2010)
          There are many types of pain conditions that are felt in the orofacial structures. Most of the conditions treated by the dentist are associated with the teeth, periodontal structures, and associated mucosal tissues. This article focuses on the differential diagnosis of other common pain conditions the dentist will likely face, such as temporomandibular disorders, neuropathic pain disorders, and common headaches; and the clinical presentation of each. Controlling or reducing pain can be accomplished by controlling perpetuating factors such as parafunctional habits and by some simple behavioral modifications. Finally, this article offers some simple treatment considerations. Copyright © 2011 Elsevier Inc. All rights reserved.
          Article 0 comments Cited 43 times – based on 0 reviews     Review now
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            Burning mouth syndrome.

            M Grushka, Meir Gorsky, Norman Epstein (2002)
            Burning mouth syndrome is characterized by a burning sensation in the tongue or other oral sites, usually in the absence of clinical and laboratory findings. Affected patients often present with multiple oral complaints, including burning, dryness and taste alterations. Burning mouth complaints are reported more often in women, especially after menopause. Typically, patients awaken without pain but note increasing symptoms through the day and into the evening. Conditions that have been reported in association with burning mouth syndrome include chronic anxiety or depression, various nutritional deficiencies, type 2 diabetes (formerly known as non-insulin-dependent diabetes) and changes in salivary function. However, these conditions have not been consistently linked with the syndrome, and their treatment has had little impact on burning mouth symptoms. Recent studies have pointed to dysfunction of several cranial nerves associated with taste sensation as a possible cause of burning mouth syndrome. Given in low dosages, benzodiazepines, tricyclic antidepressants or anticonvulsants may be effective in patients with burning mouth syndrome. Topical capsaicin has been used in some patients.
            Article 0 comments Cited 42 times – based on 0 reviews     Review now
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              Pain modulation: expectation, opioid analgesia and virtual pain.

              H Fields (1999)
              To summarize, although there are multiple potential target nuclei for modulating pain transmission and several candidate efferent pathways that exert modulatory control, the most completely described pain modulating circuit includes the amygdala, PAG, DLPT and RVM in the brainstem. Through descending projections, this circuit controls both spinal and trigeminal dorsal horn pain transmission neurons and mediates both opioid and stimulation produced analgesia. Several different neurotransmitters are involved in the modulatory actions of this circuit, which exerts bi-directional control of pain through On cells that facilitate and Off cells that inhibit dorsal horn nociceptive neurons. There is evidence that this circuit contributes to analgesia in humans and may be activated by acute stress or the expectation of relief. Conversely, through the facilitating effect of On cells, this circuit is theoretically capable of generating or enhancing perceived pain intensity. Such an effect could provide a physiological mechanism for the pain enhancing actions of mood, attention and expectation.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Exp Dent
                Journal ID (iso-abbrev): J Clin Exp Dent
                Journal ID (publisher-id): Medicina Oral S.L.
                Title: Journal of Clinical and Experimental Dentistry
                Publisher: Medicina Oral S.L.
                ISSN (Electronic): 1989-5488
                Publication date (Electronic): 1 April 2016
                Publication date Collection: April 2016
                Volume: 8
                Issue: 2
                Pages: e153-e159
                Affiliations
                [1 ]DDS. Student of Oral Surgery and Implantology Department. School of Dentistry, University of Barcelona. Barcelona, Spain
                [2 ]DDS. Student of Oral Surgery and Implantology Department. School of Dentistry, University of Barcelona. Barcelona, Spain
                [3 ]DDS, MS, PhD, EBOS. Professor of Oral Surgery. Professor of Master of Oral Surgery and Implantology, School of Dentistry, University of Barcelona; Researcher of the IDIBELL Institute. Barcelona, Spain
                [4 ]MD, DDS, MS, PhD, EBOS. Chairman and Full Professor of Oral and Maxillofacial Surgery. Director of the Master of Oral Surgery and Implantology, School of Dentistry, University of Barcelona; Researcher/Coordinator of the IDIBELL Institute; Head of Oral and Maxillofacial Surgery Department of the Teknon Medical Center. Barcelona, Spain
                Author notes
                Centre Mèdic Teknon C/ Vilana 12 08022 – Barcelona , E-mail: cgay@ 123456ub.edu
                Article
                Publisher ID: 52560
                DOI: 10.4317/jced.52560
                PMC ID: 4808310
                PubMed ID: 27034755
                SO-VID: efc926e9-da58-4c31-a7b3-53e05ed94329
                Copyright © Copyright: © 2016 Medicina Oral S.L.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date accepted : 9 December 2015
                Date received : 3 May 2015
                Categories
                Subject: Research
                Subject: Orofacial pain-TMJD

                Data availability:

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