title: Altered pain modulation in patients with persistent postendodontic pain.
abstract: Persistent pain may follow nerve injuries associated with invasive therapeutic interventions. About 3% to 7% of the patients remain with chronic pain after endodontic treatment, and these are described as suffering from painful posttraumatic trigeminal neuropathy (PTTN). Unfortunately, we are unable to identify which patients undergoing such procedures are at increased risk of developing PTTN. Recent findings suggest that impaired endogenous analgesia may be associated with the development of postsurgical chronic pain. We hypothesized that patients with PTTN display pronociceptive pain modulation, in line with other chronic pain disorders. Dynamic (conditioned pain modulation, temporal summation) and static (response to mechanical and cold stimulation) psychophysical tests were performed intraorally and in the forearm of 27 patients with PTTN and 27 sex- and age-matched controls. The dynamic sensory testing demonstrated less efficient conditioned pain modulation, suggesting reduced function of the inhibitory endogenous pain-modulatory system, in patients with PTTN, mainly in those suffering from the condition for more than a year. The static sensory testing of patients with PTTN demonstrated forearm hyperalgesia to mechanical stimulation mainly in patients suffering from the condition for less than a year and prolonged painful sensation after intraoral cold stimulus mainly in patients suffering from the condition for more than a year. These findings suggest that PTTN is associated more with the inhibitory rather than the facilitatory arm of pain modulation and that the central nervous system has a role in PTTN pathophysiology, possibly in a time-dependent fashion.
authors.affiliation: Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, NJ, USA Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA Department of Neurology, Rambam Health Care Campus, Haifa, Israel Departments of Oral Biology and Endodontics, Rutgers School of Dental Medicine, Newark, NJ, USA Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Cibele
authors.initials: C
authors.lastname: Nasri-Heir
authors.forename: Junad
authors.initials: J
authors.lastname: Khan
authors.forename: Rafael
authors.initials: R
authors.lastname: Benoliel
authors.forename: Changyong
authors.initials: C
authors.lastname: Feng
authors.forename: David
authors.initials: D
authors.lastname: Yarnitsky
authors.forename: Fengshen
authors.initials: F
authors.lastname: Kuo
authors.forename: Craig
authors.initials: C
authors.lastname: Hirschberg
authors.forename: Gary
authors.initials: G
authors.lastname: Hartwell
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Huang
authors.forename: Gary
authors.initials: G
authors.lastname: Heir
authors.forename: Olga
authors.initials: O
authors.lastname: Korczeniewska
authors.forename: Scott R
authors.initials: SR
authors.lastname: Diehl
authors.forename: Eli
authors.initials: E
authors.lastname: Eliav
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D011601:Psychophysics; D013696:Temperature; D061221:Trigeminal Nerve Injuries / Q000150:complications*