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Somatosensory Investigation of Patients With Orofacial Pain Compared With Controls
Silvia R.D.T. de Siqueira, D.D.S., Ph.D.; Manoel J. Teixeira, M.D., Ph.D.; Jose T. T. de Siqueira, D.D.S., Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;:. doi:10.1176/appi.neuropsych.13030071
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From the School of Arts, Science and Humanities (SRDTdS); Neurology Department, School of Medicine (MJT); and Dentistry Division, Hospital das Clinicas, School of Medicine (JTTdS), University of Sao Paulo, Sao Paulo, Brazil.

Send correspondence to Silvia R.D.T. de Siqueira, D.D.S., Ph.D.; e-mail: silviadowgan@hotmail.com

Copyright © 2014 by the American Psychiatric Association

Received March 27, 2013; Revised March 27, 2013; Revised May 14, 2013; Accepted May 16, 2013.

Abstract

The objective of this study was to investigate the sensorial characteristics of orofacial pain in patients compared with control subjects. A total of 336 subjects (282 patients and 54 control subjects) were evaluated to identify their thermal (cold and warm), tactile, and pain thresholds. Numbness was reported by 61.7% of the patients (p<0.001). Patients with trigeminal postherpetic neuralgia and burning mouth syndrome showed loss of thermal perception; patients with postherpetic neuralgia, burning mouth syndrome, and posttraumatic painful neuropathy had a decrease in tactile perception compared with the control subjects (p<0.001). In conclusion, other sensorial modalities besides pain are affected by neuropathic orofacial pain; these findings can help in the understanding of the pathophysiological mechanisms in orofacial pain.

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FIGURE 1. Impairment of Thermal Detections

[A]: Cold detection. [B]: Warm detection. In both evaluations, patients with PHN and BMS had sensory losses (N=336). [A]: Cold (p<0.001). [B]: Warm (p<0.001). Chi-square and Z tests: p<0.001. BMS: burning mouth syndrome; CH: cervicogenic headache; DN: diabetic neuropathy; ITN: idiopathic trigeminal neuralgia; PHN: trigeminal postherpetic neuralgia; PIFP: persistent idiopathic facial pain; PTN: posttraumatic neuralgia; TMD: temporomandibular disorder.

FIGURE 2. Impairment of Tactile Detection

Patients with PHN, BMS, and PTN had low tactile sensation (N=336). *Chi-square and Z tests: p<0.001. BMS: burning mouth syndrome; CH: cervicogenic headache; DN: diabetic neuropathy; ITN: idiopathic trigeminal neuralgia; PHN: trigeminal postherpetic neuralgia; PIFP: persistent idiopathic facial pain; PTN: posttraumatic neuralgia; TMD: temporomandibular disorder.

FIGURE 3. Mean Superficial Pain Thresholds

Patients with PHN and ITN had higher thresholds (N=336). *One-way analysis of variance, Tukey test: p=0.003. BMS: burning mouth syndrome; CH: cervicogenic headache; DN: diabetic neuropathy; ITN: idiopathic trigeminal neuralgia; PHN: trigeminal postherpetic neuralgia; PIFP: persistent idiopathic facial pain; PTN: posttraumatic neuralgia; TMD: temporomandibular disorder.

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TABLE 1.Orofacial Pain Diagnoses and Laterality in the Study Group (N=282)
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TABLE 2.Distribution of Age, Sex, Side, and Branch Affected According to the Diagnosis (N=282)
Table Footer Note

BMS: burning mouth syndrome; CH: cervicogenic headache; DN: diabetic neuropathy; ITN: idiopathic trigeminal neuralgia; PHN: trigeminal postherpetic neuralgia; PIFP: persistent idiopathic facial pain; PTN: posttraumatic neuralgia; TMD: temporomandibular disorder; V1: ophthalmic branch; V2: maxillary branch; V3: mandibular branch; V1–2: ophthalmic and maxillary branches; V2–3: maxillary and mandibular branches; V1–2–3: ophthalmic, maxillary, and mandibular branches; V1–3: ophthalmic and mandibular braches.

Table Footer Note

a One-way analysis of variance, chi-square and Fisher’s exact tests.

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TABLE 3.Numbness and Dysesthesia According to the Diagnosis (N=336)
Table Footer Note

BMS: burning mouth syndrome; CH: cervicogenic headache; DN: diabetic neuropathy; ITN: idiopathic trigeminal neuralgia; PHN: trigeminal postherpetic neuralgia; PIFP: persistent idiopathic facial pain; PTN: posttraumatic neuralgia; TMD: temporomandibular disorder.

Table Footer Note

a Chi-square and Fisher’s exact tests.

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