Psychophysical Assessment of Patients with Posttraumatic Neuropathic Trigeminal Pain

This article reviews the utility of psychophysical approaches in the assessment of posttraumatic neuropathic trigeminal pain. Methods of quantitative sensory testing are derived from psychophysical principles and provide a widely accepted means for characterizing sensory dysfunction in patients who experience injury to the trigeminal nerve. No published study, however, has sought to compare sensory findings from trigeminal nerve–injured patients who develop neuropathic pain with those from trigeminal nerve–injured patients who remain pain-free. Moreover, sensory testing data from trigeminal nerve–injured patients with pain have been published in only a few reports. As a result, remarkably little is known about sensory factors associated with the development of posttraumatic trigeminal neuralgia. Review of the separate liter-atures suggests that both trigeminal nerve–injured patients with pain and pain-free trigeminal nerve–injured patients exhibit grossly similar impairments in sensory function. In addition, trigeminal nerve–injured patients with pain may be more likely to report cold allodynia than patients without pain and to exhibit signs of central sensitization such as allodynia to light brushing tactile stimuli and abnormal temporal summation of pain. New studies using state-of-the-art psychophysical methods are needed to search for sensory markers that bear on the development of pain. Moreover, the relationship between psychophysical indices of central sensitization and measures of clinical pain should be addressed to obtain a better understanding of the underlying pathophysiology.

allodynia; neuropathic pain; sensitization; sensory testing; trigeminal nerve injury

1. Frost DE, Gregg JM, Terry BC, Fonseca RJ. Mandibular interpositional and onlay bone grafting for treatment of mandibular bony deficiency in the edentulous patient. J Oral Maxillofac Surg 1982;40:353–360.

2. Campbell RL, Shamaskin RG, Harkins SW. Assessment of recovery from injury to inferior alveolar and mental nerves. Oral Surg Oral Med Oral Pathol 1987;64:519–526.

3. Van Boven RW, Johnson KO. A psychophysical study of the mechanisms of sensory recovery following nerve injury in humans. Brain 1994;117:149–167.

4. Westermark A, Bystedt H, von Konow L. Inferior alveolar nerve function after mandibular osteotomies. Br J Oral Maxillofac Surg 1998;36:425–428.

5. Dao TT, Mellor A. Sensory disturbances associated with implant surgery. Int J Prosthodont 1998;11:462–469.

6. Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C. Inferior alveolar nerve damage after lower third molar surgical extraction: A prospective study of 1117 surgical extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:377–383.

7. Essick GK, Austin S, Phillips C, Kiyak HA. Short-term sensory impairment after orthognathic surgery. Oral Maxillofac Surg Clin North Am 2001;13:295–313.

8. Essick GK, Patel S, Trulsson M. Mechanosensory and thermosensory changes across the border of impaired sensitivity to pinprick after mandibular nerve injury. J Oral Maxillofac Surg 2002;60:1250–1266.

9. Teerijoki-Oksa T, Jaaskelainen S, Forssell K, Virtanen A, Forssell H. An evaluation of clinical and electrophysio-logic tests in nerve injury diagnosis after mandibular sagittal split osteotomy. Int J Oral Maxillofac Surg 2003;32: 15–23.

10. Eliav E, Gracely RH, Nahlieli O, Benoliel R. Quantitative sensory testing in trigeminal nerve damage assessment. J Orofac Pain 2004;18:339–344.

11. Jääskeläinen SK. The utility of clinical neurophysiological and quantitative sensory testing for trigeminal neuropathy. J Orofac Pain 2004;18:355–359.

12. Svensson P, Baad-Hansen L, Thygesen T, Juhl GI, Jensen TS. Overview on tools and methods to assess neuropathic trigeminal pain. J Orofac Pain 2004;18:332–338.

13. Merskey H, Bogduk N (eds). Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms, ed 2. Seattle: IASP Press, 1994:1–222.

14. Berge TI. Incidence of chronic neuropathic pain subsequent to surgical removal of impacted third molars. Acta Odontol Scand 2002;60:108–112.

15. Burchiel KJ. Trigeminal Neuropathic Pain. Acta Neurochir Suppl (Wien) 1993;58:145–149.

16. Vickers ER, Cousins MJ. Neuropathic orofacial pain. Part 1—Prevalence and pathophysiology. Aust Endod J 2000;26:19–26.

17. Vickers ER, Cousins MJ. Neuropathic orofacial pain. Part 2—Diagnostic procedures, treatment guidelines and case reports. Aust Endod J 2000;26:53–63.

18. Essick GK. Comprehensive clinical evaluation of perioral sensory function. Oral Maxillofac Surg Clin North Am 1992;4:503–526.

19. Greenspan JD. Quantitative assessment of neuropathic pain. Curr Pain Headache Rep 2001;5:107–113

20. Price DD, Long S, Huitt C. Sensory testing of pathophysiological mechanisms of pain in patients with reflex sympathetic dystrophy. Pain 1992;49:163–173.

21. Gregg JM. Studies of traumatic neuralgia in the maxillofacial region: Symptom complexes and response to microsurgery. J Oral Maxillofac Surg 1990;48:135–141.

22. Pappagallo M, Oaklander AL, Quatrano-Piacentini AL, Clark MR, Raja SN. Heterogenous patterns of sensory dysfunction in postherpetic neuralgia suggest multiple pathophysiologic mechanisms. Anesthesiology 2000;92: 691–698.

23. Meyerson BA, Lindblom U, Linderoth B, Lind G, Herregodts P. Motor cortex stimulation as treatment of trigeminal neuropathic pain. Acta Neurochir Suppl (Wien) 1993;58:150–153.

24. Nurmikko T, Bowsher D. Somatosensory findings in post-herpetic neuralgia. J Neurol Neurosurg Psychiatry 1990;53:135–141.

25. Eide PK, Rabben T. Trigeminal neuropathic pain: pathophysiological mechanisms examined by quantitative assessment of abnormal pain and sensory perception. Neurosurgery 1998;43:1103–1110.

26. Kesarwani A, Antonyshyn O, Mackinnon SE, Gruss JS, Novak C, Kelly L. Facial sensibility testing in the normal and posttraumatic population. Ann Plast Surg 1989;22: 416–425.

27. Stohler CS, Kowalski CJ, Lund JP. Muscle pain inhibits cutaneous touch perception. Pain 2001;92:327–333.

28. Chong MS, Smith TE, Hanna M. Case reports—Reversal of sensory deficit associated with pain relief after treatment with gabapentin. Pain 2002;96:329–333.

29. Eide PK. Wind-up and the NMDA receptor complex from a clinical perspective. Eur J Pain 2000;4:5–17.

30. Magerl W, Wilk SH, Treede RD. Secondary hyperalgesia and perceptual wind-up following intradermal injection of capsaicin in humans. Pain 1998;74:257–268.

31. Zuniga JR. Surgical management of trigeminal neuropathic pain. Atlas Oral Maxillofac Surg Clin North Am 2001;9(2):59–75.

32. Ochoa JL, Yarnitsky D. Mechanical hyperalgesias in neuropathic pain patients: Dynamic and static subtypes. Ann Neurol 1993;33:465–472.

33. Melis M, Zawawi K, al-Badawi E, Lobo Lobo S, Mehta N. Complex regional pain syndrome in the head and neck: A review of the literature. J Orofac Pain 2002;16:93–104.