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Bordeleau M, Vincenot M, Bačkonja M, Cruz-Almeida Y, Forstenpointner J, Gauthier L, Marchand S, Mercier C, Ocay DD, PrudHomme M, Ruel H, Vollert J, Léonard G. Beyond numbers: integrating qualitative analysis into quantitative sensory testing for neuropathic pain. FRONTIERS IN PAIN RESEARCH 2024; 5:1351602. [PMID: 38486872 PMCID: PMC10938582 DOI: 10.3389/fpain.2024.1351602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
This article investigates the benefits of adopting qualitative and quantitative sensory testing (QQST) in sensory assessment, with a focus on understanding neuropathic pain. The innovative QQST method combines participant qualitative experiences with quantitative psychophysical measurements, offering a more varied interpretation of sensory abnormalities and normal sensory function. This article also explores the steps for the optimization of the method by identifying qualitative signs of sensory abnormalities and standardizing data collection. By leveraging the inherent subjectivity in the test design and participant responses, the QQST method contributes to a more holistic exploration of both normal and abnormal sensory experiences. This article positions the QQST approach as a foundational element within the Sensory Evaluation Network, uniting international experts to harmonize qualitative and quantitative sensory evaluation methods.
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Affiliation(s)
- Martine Bordeleau
- Research Center on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Matthieu Vincenot
- Research Center on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Miroslav Bačkonja
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, United States
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida Colleges of Dentistry & Medicine, Gainesville, FL, United States
- Department of Community Dentistry & Behavioral Science, University of Florida College of Dentistry, Gainesville, FL, United States
- Department of Neuroscience, University of Florida College of Medicine, Gainesville, FL, United States
| | - Julia Forstenpointner
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Lynn Gauthier
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Équipe de Recherche Michel-Sarrazin en Oncologie Psychosociale et Soins Palliatifs, Quebec City, QC, Canada
- Oncology Division, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
- Université Laval Cancer Research Center, Quebec City, QC, Canada
| | - Serge Marchand
- Département de chirurgie, Faculté de médecine et des sciences de la santé de l’université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Catherine Mercier
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration sociale, CIUSSS de la Capitale-Nationale, Quebec City, QC, Canada
- École des Sciences de la Réadaptation, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Don Daniel Ocay
- Critical Care, and Pain Medicine, Department of Anesthesiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Michel PrudHomme
- Département de Chirurgie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
- Centre de Recherche du CHU-Université Laval, Quebec City, QC, Canada
| | - Hélène Ruel
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Jan Vollert
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Guillaume Léonard
- Research Center on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
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Kothari SF, Blicher JU, Dagsdottir LK, Kothari M, Kumar A, Sengupta K, Buchholtz PE, Ashkanian M, Svensson P. Facilitatory Effect of Intermittent Repetitive Transcranial Magnetic Stimulation on Perceptual Distortion of the Face. THE JOURNAL OF PAIN 2022; 23:1051-1059. [PMID: 35041936 DOI: 10.1016/j.jpain.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/10/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
Orofacial pain patients often report that the painful facial area is "swollen" without clinical signs - known as perceptual distortion (PD). The neuromodulatory effect of facilitatory repetitive transcranial magnetic stimulation (rTMS) on PD in healthy individuals was investigated, to provide further support that the primary somatosensory cortex (SI) is involved in facial PD. Participants were allocated to active (n = 26) or sham (n = 26) rTMS group in this case-control study. PD was induced experimentally by injecting local anesthesia (LA) in the right infraorbital region. PD was measured at baseline, 6 min after LA, immediately, 20 and 40 min after rTMS. Intermittent theta-burst stimulation (iTBS) as active rTMS and sham rTMS was applied to the face representation area of SI at 10 min after LA. The magnitude of PD was compared between the groups. The magnitude of PD significantly increased immediately after iTBS compared with sham rTMS (P = .009). The PD was significantly higher immediately after iTBS compared to 6 min after LA (P = .004) in the active rTMS group, but not in the sham rTMS group (P = .054). iTBS applied to a somatotopic-relevant cortical region appears to facilitate facial PD further supporting the involvement of SI in the processing of one´s own face and PD. PERSPECTIVE: This study provides information on neural substrate responsible for processing of perceptual distortion of the face which is speculated to contribute to the chronification of orofacial pain. The findings of this study may aid in mechanism-based management of the condition in orofacial pain disorders and possibly other chronic pain states.
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Affiliation(s)
- Simple Futarmal Kothari
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON); Hammel Neurorehabilitation Center and University Research Clinic, Aarhus University, Hammel, Denmark.
| | - Jakob U Blicher
- CFIN, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lilja K Dagsdottir
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON)
| | - Mohit Kothari
- Hammel Neurorehabilitation Center and University Research Clinic, Aarhus University, Hammel, Denmark; JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
| | - Abhishek Kumar
- Scandinavian Center for Orofacial Neurosciences (SCON); Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - Kaushik Sengupta
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Larix A/S, Herlev, Denmark
| | - Poul E Buchholtz
- Department for Depression and Anxiety Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Mahmoud Ashkanian
- Department for Depression and Anxiety Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON); Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmӧ University, Malmӧ, Sweden
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Bordeleau M, Léonard G, Gauthier L, Ferland CE, Backonja M, Vollert J, Marchand S, Jackson P, Cantin L, Prud’Homme M. Classification of Qualitative Fieldnotes Collected During Quantitative Sensory Testing: A Step Towards the Development of a New Mixed Methods Approach in Pain Research. J Pain Res 2021; 14:2501-2511. [PMID: 34434059 PMCID: PMC8380625 DOI: 10.2147/jpr.s301655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Quantitative sensory testing (QST) is a standardized method to assess somatosensory function. The collection of qualitative information, during the QST procedure, could be an interesting way to facilitate the characterization of altered sensory perception and the identification of different pain phenotypes. The aims of this study were 1) to classify qualitative fieldnotes of sensory abnormalities collected during an independent QST study, and 2) to generate a qualitative interview guide that could be included in the traditional QST procedure as a step towards the implementation of a mixed methods approach. PATIENTS AND METHODS QST data were collected from 48 chronic neuropathic pain patients treated with spinal cord stimulation (SCS). Three body areas, with or without SCS, were tested: the painful limb targeted by SCS, the contralateral area, and the ipsilateral upper limb. After each trial of each QST modality, patients were encouraged to report any sensory abnormalities they could identify with a pain quality scale or using their own words. RESULTS Qualitative self-reported sensory abnormalities were dichotomized into two groups: altered sensory intensities and altered sensory perceptions. Altered sensory intensities were classified as sensory loss or sensory gain subgroups. Altered sensory perceptions were classified as paresthesia and dysesthesia subgroups Overall, 630 qualitative fieldnotes of altered sensations were collected: 385 on the painful limb, 173 at the contralateral area, and 72 at the ipsilateral upper limb. Based on these qualitative data, we propose a standardized method to collect qualitative data involving 9 open- and close-ended questions and 21 codes. CONCLUSION Our findings have highlighted the value of qualitative sensory evaluation during QST and constitute an important milestone in the development of a mixed methods protocol in phenotyping research.
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Affiliation(s)
- Martine Bordeleau
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Center on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
| | - Guillaume Léonard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Center on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
| | - Lynn Gauthier
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Équipe de recherche Michel-Sarrazin en oncologie psychosociale et soins palliatifs, Quebec City, QC, Canada
- Oncology Division, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
- Université Laval Cancer Research Center, Quebec City, QC, Canada
| | - Catherine Estelle Ferland
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
- Shriners Hospitals for Children-Canada, Montreal, QC, Canada
| | - Miroslav Backonja
- Department of Neurology, University of Wisconsin, Madison, WI, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Jan Vollert
- Pain Research, MSK lab, Department of Surgery and Cancer, Imperial College London, London, UK
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Serge Marchand
- Research Center on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
- Sherbrooke University Hospital Research Center (CRCHUS), Sherbrooke, QC, Canada
| | - Philip Jackson
- CIRRIS, Quebec City, QC, Canada
- CERVO Brain Research Center, Quebec City, QC, Canada
- School of Psychology, Laval University, Quebec City, QC, Canada
| | - Léo Cantin
- Centre de recherche du CHU de Québec – Université Laval, Axe neurosciences, Quebec City, QC, Canada
- Department of Surgery, Division of neurosurgery, CHU de Québec – Université Laval, Quebec City, QC, Canada
| | - Michel Prud’Homme
- Centre de recherche du CHU de Québec – Université Laval, Axe neurosciences, Quebec City, QC, Canada
- Department of Surgery, Division of neurosurgery, CHU de Québec – Université Laval, Quebec City, QC, Canada
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Costa YM, Bonjardim LR, Conti PCR, Svensson P. Psychophysical evaluation of somatosensory function in oro-facial pain: achievements and challenges. J Oral Rehabil 2021; 48:1066-1076. [PMID: 34213796 DOI: 10.1111/joor.13223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/03/2021] [Indexed: 11/30/2022]
Abstract
AIM This critical review describes key methodological aspects for a successful oro-facial psychophysical evaluation of the somatosensory system and highlights the diagnostic value of somatosensory assessment and management perspectives based on somatosensory profiling. METHODS This topical review was based on a non-systematic search for studies about somatosensory evaluation in oro-facial pain in PubMed and Embase. RESULTS The recent progress regarding the psychophysical evaluation of somatosensory function was largely possible due to the development and application of valid, reliable and standardised psychophysical methods. Qualitative sensory testing may be useful as a screening tool to rule out relevant somatosensory abnormalities. Nevertheless, the patient should preferably be referred to a more comprehensive assessment with the quantitative sensory testing battery if confirmation of somatosensory abnormalities is necessary. Moreover, the identification of relevant somatosensory alterations in chronic pain disorders that do not fulfil the current criteria to be regarded as neuropathic has also increased the usefulness of somatosensory evaluation as a feasible method to better characterise the patients and perhaps elucidate some underpinnings of the so-called 'nociplastic' pain disorders. Finally, an additional benefit of oro-facial pain treatment based on somatosensory profiling still needs to be demonstrated and convincing evidence of somatosensory findings as predictors of treatment efficacy in chronic oro-facial pain awaits further studies. CONCLUSION Psychophysical evaluation of somatosensory function in oro-facial pain is still in its infancy but with a clear potential to continue to improve the assessment, diagnosis and management of oro-facial pain patients.
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Affiliation(s)
- Yuri M Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.,Bauru Orofacial Pain Group, Bauru, Brazil
| | - Leonardo R Bonjardim
- Bauru Orofacial Pain Group, Bauru, Brazil.,Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo, Bauru, Brazil
| | - Paulo César R Conti
- Bauru Orofacial Pain Group, Bauru, Brazil.,Department of Prosthodontics, Bauru School of Dentistry, University of Sao Paulo, Bauru, Brazil
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.,Faculty of Odontology, Malmo University, Malmo, Sweden
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Vaitkus A, Šipylaitė J. Sensory Perception in Lumbosacral Radiculopathy with Radicular Pain: Feasibility Study of Multimodal Bedside-Suitable Somatosensory Testing. Acta Med Litu 2021; 28:97-111. [PMID: 34393632 PMCID: PMC8311840 DOI: 10.15388/amed.2021.28.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 11/22/2022] Open
Abstract
Background Somatosensory testing could be useful in stratifying pain patients and improving pain treatment guidelines. Bedside-suitable techniques are searched for application in daily clinical practice. This study aimed to characterize chronic unilateral lumbosacral radiculopathy (LSR) patients with radicular pain using multimodal bedside-suitable somatosensory testing. Materials and methods We evaluated 50 chronic unilateral LSR patients with radicular pain (LSR group) and 24 controls (Control group). Sensory testing was performed using a battery of bedside sensory tests (10g monofilament, 200–400 mN brush, Lindblom rollers with controlled 25°C and 40°C temperature, and 40g neurological pin and investigator’s finger pressure). Participants had to rate their sensory perceptions on both legs at multiple test points within L3 to S2 dermatomes. Characteristics of the testing process and sensory disturbances were analyzed. Results LSR group showed sensory disturbances in 82% of patients. The Control group showed no sensory disturbances. Sensory testing took longer (p < 0.001) in the LSR group (29.3 ± 6.5 minutes per patient) than in the Control group (20.5 ± 5.2). Nine sensory phenotypes were detected in the LSR group according to individual sensory disturbances within 5 superficial tests. Conclusions The applied multimodal bedside-suitable somatosensory testing battery is suitable for sensory evaluation and characterization of LSR patients. Grouping of allied sensory phenotypes revealed some tendencies in pain intensity characteristics.
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Affiliation(s)
- Alfredas Vaitkus
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jūratė Šipylaitė
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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6
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Vaitkus A, Šipylaitė J. Qualitative Sensory Testing in Outcome Prediction of Transforaminal Epidural Steroid Injection for Chronic Painful Unilateral Lumbosacral Radiculopathy: Prospective Observational Study. Pain Pract 2021; 21:618-629. [PMID: 33502060 DOI: 10.1111/papr.12997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transforaminal epidural steroid injection (TFESI) is widely practiced for the treatment of radicular pain. As its effectiveness is still subject to debate, a better patient selection for TFESI is necessary. We aimed to evaluate the potential of bedside-suitable qualitative sensory testing (QualST) to determine the early effectiveness of TFESI for the treatment of chronic lumbosacral radiculopathy (LSR)-related pain. METHODS Thirty-six patients with chronic painful unilateral LSR were evaluated in a prospective observational study using five standardized sensory tests (10 g monofilament, 200 to 400 mN brush, Lindblom rollers with controlled 25 and 40°C temperature, and 40 g neurological pin). Quality of sensory perceptions on the painful leg was compared to the non-painful leg and rated as normal sensitivity, hyposensitivity, or hypersensitivity. Pain and related characteristics were evaluated before TFESI, 1 week after and 4 weeks after intervention. RESULTS Seven sensory phenotypes were distinguished according to individual sets of sensory disturbances acquired with five sensory tests. Patients were grouped into four groups of allied phenotypes (normal sensitivity, hyposensitivity to 1 to 3 modalities, hyposensitivity to 4 to 5 modalities, and hypersensitivity). The whole study group showed significant improvement in most parameters of outcome measurements. Statistical analysis revealed some significant differences between sensory groups in patient-reported treatment effect scales after 4 weeks. We also detected significant differences between sensory groups in repeated measures after 1 and 4 weeks in some pain intensity characteristics and patient-reported treatment effect scales. CONCLUSION QualST might be clinically applicable for detecting patient subgroups that could differ in the early treatment results of radicular pain by TFESI.
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Affiliation(s)
- Alfredas Vaitkus
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jūratė Šipylaitė
- Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Conti PCR, Bonjardim LR, Stuginski-Barbosa J, Costa YM, Svensson P. Pain complications of oral implants: Is that an issue? J Oral Rehabil 2020; 48:195-206. [PMID: 33047362 DOI: 10.1111/joor.13112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/08/2020] [Accepted: 10/05/2020] [Indexed: 01/03/2023]
Abstract
The use of oral implants as a form of replacing missing teeth in partial or total edentulous patients is considered the gold standard in oral rehabilitation. Although considered a history of success in contemporary dentistry, surgical complications may occur, as excessive bleeding, damage to the adjacent teeth and mandibular fractures. Persistent pain and abnormal somatosensory responses after the surgery ordinary healing time are also potential problems and may lead to the development of a condition named posttraumatic trigeminal neuropathic pain (PTNP). Though relatively rare, PTNP has a profound impact on patient's quality of life. Appropriated previous image techniques, effective anaesthetic procedures and caution during the surgical procedure and implant installation are recommended for the prevention of this condition. In case of the PTNP, different management modalities, including antidepressant and membrane stabilizer medications, as well as peripheral strategies, as the use of topical medication and the botulin toxin are presented and discussed.
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Affiliation(s)
- Paulo César Rodrigues Conti
- Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Brazil.,Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil
| | - Leonardo Rigoldi Bonjardim
- Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.,Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | - Yuri Martins Costa
- Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.,Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmø University, Malmø, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON)
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Van der Cruyssen F, Van Tieghem L, Croonenborghs T, Baad‐Hansen L, Svensson P, Renton T, Jacobs R, Politis C, De Laat A. Orofacial quantitative sensory testing: Current evidence and future perspectives. Eur J Pain 2020; 24:1425-1439. [PMID: 32557971 PMCID: PMC7497080 DOI: 10.1002/ejp.1611] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/07/2020] [Accepted: 05/31/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Orofacial quantitative sensory testing (QST) is an increasingly valuable psychophysical tool for evaluating neurosensory disorders of the orofacial region. Here, we aimed to evaluate the current evidence regarding this testing method and to discuss its future clinical potential. DATA TREATMENT We conducted a literature search in Medline, Embase and Scopus for English-language articles published between 1990 and 2019. The utilized search terms included QST, quantitative, sensory testing and neurosensory, which were combined using the AND operator with the terms facial, orofacial, trigeminal, intraoral and oral. RESULTS Our findings highlighted many methods for conducting QST-including method of levels, method of limits and mapping. Potential stimuli also vary, and can include mechanical or thermal stimulation, vibration or pinprick stimuli. Orofacial QST may be helpful in revealing disease pathways and can be used for patient stratification to validate the use of neurosensory profile-specific treatment options. QST is reportedly reliable in longitudinal studies and is thus a candidate for measuring changes over time. One disadvantage of QST is the substantial time required; however, further methodological refinements and the combination of partial aspects of the full QST battery with other tests and imaging methods should result in improvement. CONCLUSIONS Overall, orofacial QST is a reliable testing method for diagnosing pathological neurosensory conditions and assessing normal neurosensory function. Despite the remaining challenges that hinder the use of QST for everyday clinical decisions and clinical trials, we expect that future improvements will allow its implementation in routine practice.
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Affiliation(s)
- Fréderic Van der Cruyssen
- Department of Oral & Maxillofacial SurgeryUniversity Hospitals LeuvenLeuvenBelgium
- OMFS-IMPATH Research GroupDepartment of Imaging and PathologyFaculty of MedicineUniversity LeuvenLeuvenBelgium
| | - Loes Van Tieghem
- Department of Oral Health SciencesKU Leuven and Department of DentistryUniversity Hospitals LeuvenLeuvenBelgium
| | - Tomas‐Marijn Croonenborghs
- Department of Oral & Maxillofacial SurgeryUniversity Hospitals LeuvenLeuvenBelgium
- OMFS-IMPATH Research GroupDepartment of Imaging and PathologyFaculty of MedicineUniversity LeuvenLeuvenBelgium
| | - Lene Baad‐Hansen
- Section of Orofacial Pain and Jaw FunctionDepartment of Dentistry and Oral HealthAarhus UniversityAarhusDenmark
- Scandinavian Center for Orofacial Neurosciences (SCON)Aarhus University and Malmö UniversityAarhusDenmark
| | - Peter Svensson
- Section of Orofacial Pain and Jaw FunctionDepartment of Dentistry and Oral HealthAarhus UniversityAarhusDenmark
- Scandinavian Center for Orofacial Neurosciences (SCON)Aarhus University and Malmö UniversityAarhusDenmark
| | - Tara Renton
- Department of Oral SurgeryKing’s College London Dental InstituteLondonUK
| | - Reinhilde Jacobs
- OMFS-IMPATH Research GroupDepartment of Imaging and PathologyFaculty of MedicineUniversity LeuvenLeuvenBelgium
- Department of Dental MedicineKarolinska InstitutetStockholmSweden
| | - Constantinus Politis
- Department of Oral & Maxillofacial SurgeryUniversity Hospitals LeuvenLeuvenBelgium
- OMFS-IMPATH Research GroupDepartment of Imaging and PathologyFaculty of MedicineUniversity LeuvenLeuvenBelgium
| | - Antoon De Laat
- Department of Oral Health SciencesKU Leuven and Department of DentistryUniversity Hospitals LeuvenLeuvenBelgium
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Ernberg M, Wieslander Fältmars A, Hajizadeh Kopayeh M, Arzt Wallén S, Cankalp T, Christidis N. The Effect of Granisetron on Sensory Detection and Pain Thresholds in Facial Skin of Healthy Young Males. Front Neurol 2020; 11:237. [PMID: 32328025 PMCID: PMC7161671 DOI: 10.3389/fneur.2020.00237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background: The specific serotonin type 3 (5-HT3)-receptor antagonist granisetron effectively reduces clinical as well as experimental muscle pain and hyperalgesia and with a duration that exceeds that of lidocaine. Hence, it may be an alternative to lidocaine as a local anesthetic. There are also some indications that granisetron in addition to 5-HT3 receptors blocks sodium channels. Thus, the local anesthetic effect by granisetron may resemble that of lidocaine, but this has not been tested. The aim of this study was therefore to compare the effect granisetron has on facial skin sensitivity to the effect of lidocaine and isotonic saline. Methods: This was a randomized, controlled, and double-blind study, in which 1 ml of either granisetron (test-substance), lidocaine (positive control), or isotonic saline (negative control) was injected into the skin over the masseter muscle at three different occasions in 18 healthy males (27.2 ± 5.8 years old). Skin detection thresholds and pain thresholds for thermal stimuli as well as mechanical detection thresholds and sensitivity to a painful mechanical (pinprick) stimulus were assessed before (baseline) and 5, 20, 40, and 60 min after injection. The quality and area of subjective sensory change over the cheek were assessed 20 min after injection. Results: All substances increased the mechanical detection threshold (granisetron: p = 0.011; lidocaine: p = 0.016; saline: p = 0.031). Both granisetron and lidocaine, but not isotonic saline, increased the heat detection thresholds (p < 0.001 and p < 0.02, respectively), but not the cold detection thresholds. Granisetron and lidocaine also reduced pinprick pain (p = 0.001 for each comparison). There were no significant differences between granisetron and lidocaine for any of these variables. There was no effect on thermal pain thresholds for any substance. Conclusion: The similar analgesic patterns on mechanical sensory and pain thresholds as well as thermal sensory thresholds over the facial skin by subcutaneous injection of granisetron and lidocaine shown in this study and the absence of paresthesia, in combination with the reduced pain intensity and pressure pain sensitivity shown in previous studies, indicate that granisetron might be a novel candidate as a local anesthetic.
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Affiliation(s)
- Malin Ernberg
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Anna Wieslander Fältmars
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Milad Hajizadeh Kopayeh
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Sofia Arzt Wallén
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Therese Cankalp
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
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10
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Costa YM, Ferreira DMAO, Conti PCR, Baad‐Hansen L, Svensson P, Bonjardim LR. Topical anaesthesia degree is reduced in temporomandibular disorders patients: A novel approach to assess underlying mechanisms of the somatosensory alterations. J Oral Rehabil 2019; 47:113-122. [DOI: 10.1111/joor.12874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/16/2019] [Accepted: 08/07/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Yuri Martins Costa
- Section of Head and Face Physiology Department of Biological Sciences Bauru School of Dentistry University of Sao Paulo Bauru Brazil
- Bauru Orofacial Pain Group Bauru Brazil
| | - Dyna Mara A. O. Ferreira
- Bauru Orofacial Pain Group Bauru Brazil
- Department of Prosthodontics Bauru School of Dentistry University of Sao Paulo Bauru Brazil
| | - Paulo César R. Conti
- Bauru Orofacial Pain Group Bauru Brazil
- Department of Prosthodontics Bauru School of Dentistry University of Sao Paulo Bauru Brazil
| | - Lene Baad‐Hansen
- Scandinavian Center for Orofacial Neurosciences (SCON) Aarhus Denmark
- Section of Orofacial Pain and Jaw Function Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
| | - Peter Svensson
- Scandinavian Center for Orofacial Neurosciences (SCON) Aarhus Denmark
- Section of Orofacial Pain and Jaw Function Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
- Department of Dental Medicine Karolinska Institutet Huddinge Sweden
| | - Leonardo R. Bonjardim
- Section of Head and Face Physiology Department of Biological Sciences Bauru School of Dentistry University of Sao Paulo Bauru Brazil
- Bauru Orofacial Pain Group Bauru Brazil
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