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Sago T, Costa YM, Ferreira DM, Svensson P, Exposto FG. Referred sensations in the orofacial region are associated with a decreased descending pain inhibition and modulated by remote noxious stimuli and local anesthesia. Pain 2023; 164:2228-2238. [PMID: 37289580 DOI: 10.1097/j.pain.0000000000002921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/03/2023] [Indexed: 06/10/2023]
Abstract
ABSTRACT Referred sensation (RS) as a specific clinical phenomenon has been known for a long time, although the underlying mechanisms remain unclear. The aims of this study were to assess if (1) healthy individuals who experienced RS had a less active endogenous pain system when compared with those who did not; (2) activation of descending pain inhibition mechanisms can modulate RS parameters; and finally, (3) a transient decrease in peripheral afferent input because of a local anesthetic (LA) block in the masseter muscle can modulate RS parameters. To assess these, 50 healthy participants were assessed in 3 different sessions. In the first session, conditioned pain modulation (CPM) as well as mechanical sensitivity and RS at the masseter muscle were assessed. In the same session, participants who experienced RS had their mechanical sensitivity and RS assessed again while undergoing a CPM protocol. In the second and third sessions, participants had their mechanical sensitivity and RS assessed before and after receiving an injection of 2 mL of LA and isotonic saline into the masseter muscle. The main findings of this study were (1) participants who experienced RS during standardized palpation exhibited increased mechanical sensitivity ( P < 0.05, Tukey post hoc test) and decreased CPM ( P < 0.05, Tukey post hoc test) when compared with those who did not; RS incidence ( P < 0.05, Cochran Q test), frequency ( P < 0.05; Friedman test), intensity ( P < 0.05, Tukey post hoc test), and area ( P < 0.05, Tukey post hoc test) were all significantly reduced when assessed (2) during a painful conditioning stimulus and (3) after LA block. These novel findings highlight that RS in the orofacial region are strongly modified by both peripheral and central nervous system factors.
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Affiliation(s)
- Teppei Sago
- Division of Dental Anesthesiology, Department of Science of Physical Functions, Kyushu Dental University, Fukuoka, Japan
| | - Yuri M Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Dyna M Ferreira
- Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
- Faculty of Odontology, Malmo University, Malmo, Sweden
| | - Fernando G Exposto
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
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2
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Bonomini F, Favero G, Castrezzati S, Borsani E. Role of Neurotrophins in Orofacial Pain Modulation: A Review of the Latest Discoveries. Int J Mol Sci 2023; 24:12438. [PMID: 37569811 PMCID: PMC10419393 DOI: 10.3390/ijms241512438] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Orofacial pain represents a multidisciplinary biomedical challenge involving basic and clinical research for which no satisfactory solution has been found. In this regard, trigeminal pain is described as one of the worst pains perceived, leaving the patient with no hope for the future. The aim of this review is to evaluate the latest discoveries on the involvement of neurotrophins in orofacial nociception, describing their role and expression in peripheral tissues, trigeminal ganglion, and trigeminal nucleus considering their double nature as "supporters" of the nervous system and as "promoters" of nociceptive transmission. In order to scan recent literature (last ten years), three independent researchers referred to databases PubMed, Embase, Google Scholar, Scopus, and Web of Science to find original research articles and clinical trials. The researchers selected 33 papers: 29 original research articles and 4 clinical trials. The results obtained by the screening of the selected articles show an interesting trend, in which the precise modulation of neurotrophin signaling could switch neurotrophins from being a "promoter" of pain to their beneficial neurotrophic role of supporting the nerves in their recovery, especially when a structural alteration is present, as in neuropathic pain. In conclusion, neurotrophins could be interesting targets for orofacial pain modulation but more studies are necessary to clarify their role for future application in clinical practice.
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Affiliation(s)
- Francesca Bonomini
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.B.); (G.F.); (S.C.)
- Interdepartmental University Center of Research “Adaptation and Regeneration of Tissues and Organs (ARTO)”, University of Brescia, 25123 Brescia, Italy
- Italian Society of Orofacial Pain (Società Italiana Studio Dolore Orofacciale—SISDO), 25123 Brescia, Italy
| | - Gaia Favero
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.B.); (G.F.); (S.C.)
- Interdepartmental University Center of Research “Adaptation and Regeneration of Tissues and Organs (ARTO)”, University of Brescia, 25123 Brescia, Italy
| | - Stefania Castrezzati
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.B.); (G.F.); (S.C.)
| | - Elisa Borsani
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.B.); (G.F.); (S.C.)
- Interdepartmental University Center of Research “Adaptation and Regeneration of Tissues and Organs (ARTO)”, University of Brescia, 25123 Brescia, Italy
- Italian Society of Orofacial Pain (Società Italiana Studio Dolore Orofacciale—SISDO), 25123 Brescia, Italy
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3
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Exposto FG, Huang M, Haasnoot T, Koutris M, Lobbezoo F, Bendixen KH, Svensson P. Location of mechanically-evoked referred sensations within the trigeminal region are not altered following a heterotopic painful stimulus. Sci Rep 2022; 12:21181. [PMID: 36477455 PMCID: PMC9729233 DOI: 10.1038/s41598-022-24510-0] [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: 12/21/2021] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
To investigate whether the location, area and frequency of referred sensations occurring during palpation of the masseter muscle can be influenced by application of a conditioning painful stimulus to the temporalis muscle. Thirty healthy participants were included in this cross-over study, performed in two sessions with > 48 h in between. At each session, palpation of the masseter muscle was performed before and after 0.2 ml of glutamate (1 mol/L) or isotonic saline (control) were injected into the anterior portion of the temporalis muscle. Palpation of the masseter muscle was done using four different forces (0.5 kg, 1 kg, 2 kg and 4 kg). Participants rated the perceived intensity of the palpation and any referred sensations on a 0-50-100 numeric rating scale, the perceived pain intensity following the injections on an electronic visual analogue scale and drew any referred sensations they experienced. No difference in referred sensations location, area and frequency was shown r during palpation either before or after injections (P > 0.05). A moderate correlation was found between perceived sensation scores and referred sensations intensity for the temporalis muscle following glutamate injection (r = 0.407, P < 0.05). Moreover, significantly more participants reported referred sensations for glutamate injections into the temporalis muscle when compared to isotonic saline (P < 0.05). Finally, a significant decrease in the perceived intensity of palpation of the masseter muscle was seen after glutamate injection in the temporalis muscle (P < 0.05). In the current study, location, area and frequency of referred sensations following mechanical stimulation of the masseter muscle were not altered by the application of a painful stimulus to the temporalis muscle. In addition, there seems to be a positive relationship between painful stimuli and referred sensations frequency and intensity elicited from the temporalis muscle.
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Affiliation(s)
- Fernando G. Exposto
- grid.7048.b0000 0001 1956 2722Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark ,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Miranda Huang
- grid.7177.60000000084992262Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Talita Haasnoot
- grid.7177.60000000084992262Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michail Koutris
- grid.7177.60000000084992262Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- grid.7177.60000000084992262Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karina H. Bendixen
- grid.7048.b0000 0001 1956 2722Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark ,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Peter Svensson
- grid.7048.b0000 0001 1956 2722Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark ,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark ,grid.32995.340000 0000 9961 9487Faculty of Odontology, Malmø University, Malmö, Sweden
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4
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Kubo A, Sugawara S, Iwata K, Yamaguchi S, Mizumura K. Masseter muscle contraction and cervical muscle sensitization by nerve growth factor cause mechanical hyperalgesia in masticatory muscle with activation of the trigemino-lateral parabrachial nucleus system in female rats. Headache 2022; 62:1365-1375. [PMID: 36321946 DOI: 10.1111/head.14406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To establish a new rat model of craniofacial myalgia, and to clarify which central nervous system pathways are activated in the model. BACKGROUND Craniofacial myalgia, represented by myogenous temporomandibular disorder and tension-type headache with pericranial tenderness, is more common in female patients. The pain is thought to be a type of multifactorial disorder with several coexisting causes. To our knowledge, there are no models of craniofacial muscle hyperalgesia caused by multiple types of stimuli. METHODS We injected nerve growth factor into the trapezius muscle of female and male rats and repeatedly stimulated the masseter muscle (MM) electrically for 10 days. We determined the mechanical head-withdrawal threshold of MM and extent of phosphorylated extracellular signal-related kinase 1/2 (pERK) immunoreactivity in various regions of the lower brainstem. We conducted retrograde tract-tracing to determine the projection of mechanosensitive MM-innervating secondary neurons to the lateral parabrachial nucleus. Finally, we administered morphine in rats to determine whether increases of pERK immunoreactivity were dependent on noxious inputs. RESULTS In female rats, but not male rats, the mechanical head-withdrawal threshold was decreased significantly from days 9 to 12. The number of pERK-immunoreactive neurons in the brainstem was increased significantly in female rats in the group with both stimuli compared to rats in other groups with a single stimulus. Mechanosensitive MM-innervating neurons in the brainstem projected to the parabrachial nucleus. Morphine administration blocked the increase in the number of pERK-immunoreactive neurons in both the brainstem and parabrachial nucleus. CONCLUSIONS We established a model of craniofacial myalgia by combining trapezius and MM stimuli in female rats. We found mechanical hyperalgesia of the MM and activation of the pain pathway from the brainstem to parabrachial nucleus. The model reflects the characteristics of patients with craniofacial myalgia and might be helpful to clarify the pathogenic mechanisms underlying these disorders.
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Affiliation(s)
- Asako Kubo
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan.,Division of Cell Signaling, National Institute for Physiological Sciences, Okazaki, Japan.,Department of Oriental Medicine, Saitama Medical University, Saitama, Japan
| | - Shiori Sugawara
- Department of Pharmacology, Nihon University School of Dentistry, Tokyo, Japan
| | - Koichi Iwata
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Satoru Yamaguchi
- Department of Oriental Medicine, Saitama Medical University, Saitama, Japan
| | - Kazue Mizumura
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
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5
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Mechanisms and manifestations in musculoskeletal pain: from experimental to clinical pain settings. Pain 2022; 163:S29-S45. [PMID: 35984370 DOI: 10.1097/j.pain.0000000000002690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 01/18/2023]
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6
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Yang S, Exposto FG, Mahmoodi S, Svensson P. Mechanical sensitivity changes in pericranial muscles after local anesthesia and experimentally induced pain in the temporalis tendon: Implications for headache and facial pain. Cephalalgia 2022; 42:1127-1137. [PMID: 35469481 DOI: 10.1177/03331024221094294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess changes in mechanical sensitivity of the pericranial muscles in healthy individuals after a local anesthetic block of the temporalis tendon. In addition, to assess, if experimentally induced temporalis tendon pain, can lead to an increase in mechanical sensitivity of the pericranial muscles and reports of headache. METHODS 40 healthy participants were recruited for this randomized, double-blinded, controlled experiment, and were randomly injected with mepivacaine and isotonic saline into the dominant-side temporalis tendon in two different sessions, and either nerve growth factor (n = 20) or isotonic saline (n = 20) in a third session. Mechanical sensitivity was assessed in the temporalis, masseter, and trapezius muscles as well as in the temporalis tendon, on the dominant side, before and 10 minutes after each injection, and in a fourth session two days after the third session. Pain drawings and headache diaries were kept for 30 days after the final session to register any developing pain or headache. RESULTS Mepivacaine injection into the temporalis tendon caused a significant decrease in mechanical sensitivity in the temporal tendon (-54.5%) and the masseter (-15.4%) muscle (P < 0.05) but not the temporalis (-12.1%) and trapezius muscles (-12.7%) (P > 0.05). Nerve growth factor injection into the temporalis tendon caused a significant increase in mechanical sensitivity in the tendon (+15.4%) and masseter muscle (+14.4%) (P < 0.05) but not the temporalis (+2.8%) or trapezius muscles (+3.1%) (P > 0.05). A significant increase was found for headache frequency in the first seven days (P < 0.05) after nerve growth factor injection compared to after isotonic saline injection, but not intensity (P > 0.05). CONCLUSION These findings suggest that the therapeutic effect of temporalis tendon anesthetic injections on facial pain and headaches are most likely not only due to a direct effect of the local anesthetic on the temporalis tendon but rather to a more generalized block of the nerves in the area. In addition, the temporal tendon may contribute to the pathophysiological processes of headache.
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Affiliation(s)
- Shuting Yang
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Fernando G Exposto
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | | | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.,Faculty of Odontology, Malmö University, Sweden
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7
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Zhang L, Shimada A, Kusunoki T, Inoue T, Kawamoto A, Takahashi K. Effect of aging and tooth loss on sensory function of alveolar mucosa. J Oral Rehabil 2022; 49:391-397. [PMID: 35119689 DOI: 10.1111/joor.13310] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/12/2022] [Accepted: 01/27/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Maintain Quality of Life of elderly denture wearers is one of the most crucial tasks for dentists in the super-aged society. Although external mechanical load on removable dentures has been investigated to minimize a risk of soreness caused by dentures, sensory perception of the alveolar mucosa remains obscure. OBJECTIVES This study aimed to investigate effect of aging and tooth loss in sensory function on the alveolar mucosa for deep understanding of the characteristics of pain sensitivity in edentulous individuals. METHODS Eighteen edentulous participants(ED), as well as 18 age-matched dentate participants(EC) and 18 young dentate participants(YC), participated in this study. Tactile detection threshold(TDT) and pain threshold(PT) were measured with von Frey filaments (0.125-512 mN). Mechanical pain sensitivity(MPS) after a 2-sec application of 1 kg palpation was assessed with a 0-50-100 Numerical Rating Scale(NRS) (0: no pain, 50: slight pain, and 100: the worst pain imaginable). Furthermore, entropy scores of TDT, PT, and NRS on MPS were calculated. RESULTS In both maxilla and mandible, EC showed significantly higher TDT and PT, compared to YC, whereas ED showed significantly lower TDT and PT, compared to EC. NRS on MPS in ED was significantly higher than that in EC. The entropy scores of all the outcome parameters showed no significant difference between groups. CONCLUSION Both aging and tooth loss can alter tactile and pain perception in the oral mucosa. This suggest that it might be beneficial to assess sensory function of the alveolar mucosa in edentulous patients clinically in prior to denture fabrication.
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Affiliation(s)
- Lei Zhang
- Department of Geriatric Dentistry, Osaka Dental University
| | - Akiko Shimada
- Department of Geriatric Dentistry, Osaka Dental University.,Department of Prosthetic Dentistry, Graduate School of Biomedical Sciences, Nagasaki University
| | | | - Taro Inoue
- Department of Geriatric Dentistry, Osaka Dental University
| | - Akiyo Kawamoto
- Department of Geriatric Dentistry, Osaka Dental University
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8
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Okamoto K, Hasegawa M, Piriyaprasath K, Kakihara Y, Saeki M, Yamamura K. Preclinical models of deep craniofacial nociception and temporomandibular disorder pain. JAPANESE DENTAL SCIENCE REVIEW 2021; 57:231-241. [PMID: 34815817 PMCID: PMC8593658 DOI: 10.1016/j.jdsr.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 01/06/2023] Open
Abstract
Chronic pain in temporomandibular disorder (TMD) is a common health problem. Cumulating evidence indicates that the etiology of TMD pain is complex with multifactorial experience that could hamper the developments of treatments. Preclinical research is a resource to understand the mechanism for TMD pain, whereas limitations are present as a disease-specific model. It is difficult to incorporate multiple risk factors associated with the etiology that could increase pain responses into a single animal. This article introduces several rodent models which are often employed in the preclinical studies and discusses their validities for TMD pain after the elucidations of the neural mechanisms based on the clinical reports. First, rodent models were classified into two groups with or without inflammation in the deep craniofacial tissues. Next, the characteristics of each model and the procedures to identify deep craniofacial pain were discussed. Emphasis was directed on the findings of the effects of chronic psychological stress, a major risk factor for chronic pain, on the deep craniofacial nociception. Preclinical models have provided clinically relevant information, which could contribute to better understand the basis for TMD pain, while efforts are still required to bridge the gap between animal and human studies.
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Affiliation(s)
- Keiichiro Okamoto
- Division of Oral Physiology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakkocho-dori, Chuo-ku, Niigata City, 951-8514, Japan
| | - Mana Hasegawa
- Division of Oral Physiology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakkocho-dori, Chuo-ku, Niigata City, 951-8514, Japan.,Division of Dental Clinical Education, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakkocho-dori, Chuo-ku, Niigata City, 951-8514, Japan
| | - Kajita Piriyaprasath
- Division of Oral Physiology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakkocho-dori, Chuo-ku, Niigata City, 951-8514, Japan
| | - Yoshito Kakihara
- Division of Dental Pharmacology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakkocho-dori, Chuo-ku, Niigata City, 951-8514, Japan
| | - Makio Saeki
- Division of Dental Pharmacology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakkocho-dori, Chuo-ku, Niigata City, 951-8514, Japan
| | - Kensuke Yamamura
- Division of Oral Physiology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakkocho-dori, Chuo-ku, Niigata City, 951-8514, Japan
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9
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A systematic review of porcine models in translational pain research. Lab Anim (NY) 2021; 50:313-326. [PMID: 34650279 DOI: 10.1038/s41684-021-00862-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/27/2021] [Indexed: 11/09/2022]
Abstract
Translating basic pain research from rodents to humans has proven to be a challenging task. Efforts have been made to develop preclinical large animal models of pain, such as the pig. However, no consistent overview and comparison of pig models of pain are currently available. Therefore, in this review, our primary aim was to identify the available pig models in pain research and compare these models in terms of intensity and duration. First, we systematically searched Proquest, Scopus and Web of Science and compared the duration for which the pigs were significantly sensitized as well as the intensity of mechanical sensitization. We searched models within the specific field of pain and adjacent fields in which pain induction or assessment is relevant, such as pig production. Second, we compared assessment methodologies in surrogate pain models in humans and pigs to identify areas of overlap and possible improvement. Based on the literature search, 23 types of porcine pain models were identified; 13 of which could be compared quantitatively. The induced sensitization lasted from hours to months and intensities ranged from insignificant to the maximum attainable. We also found a near to complete overlap of assessment methodologies between human and pig models within the area of peripheral neurophysiology, which allows for direct comparison of results obtained in the two species. In spite of this overlap, further development of pain assessment methodologies is still needed. We suggest that central nervous system electrophysiology, such as electroencephalography, electrocorticography or intracortical recordings, may pave the way for future objective pain assessment.
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10
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Shimada A, Alhilou AM, Svensson P, Ernberg M, Christidis N. Functional Change in Experimental Allodynia After Glutamate-Induced Pain in the Human Masseter Muscle. FRONTIERS IN ORAL HEALTH 2020; 1:609082. [PMID: 35047987 PMCID: PMC8757840 DOI: 10.3389/froh.2020.609082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Glutamate, as well as nerve growth factor (NGF), is involved in nociception from peripheral tissues, such as muscles. However, the potential interaction between glutamate and NGF still remains unclear. This study investigated the interaction between glutamate-induced masseter muscle pain and NGF-induced allodynia on pain perception and jaw function in healthy individuals, and any possible sex differences in the response. Materials and Methods: Thirty pain-free adult participants (15 men and 15 women, mean age ± SD: 24 ± 4 years) participated in this study consisting of three sessions (Day 0, Day 3, and Day 4). NGF (5 μg/mL, 1.0 mL) was injected into the masseter muscle on Day 0 to induce muscle allodynia. On Day 3, glutamate (1M, 0.2 mL) was injected into the same masseter muscle. Before and after injections on Day 0 and 3, and post-injection (Day 4), spontaneous pain, temporal summation pain, as well as functional pain and fatigue in response to chewing were assessed with validated scales, and the pressure pain threshold (PPT) was recorded. Results: Spontaneous pain intensity was significantly higher after glutamate than NGF (P < 0.001). PPTs, temporal summation pain and functional measures were all reduced 3 days after NGF injection (P's < 0.001). Injection of glutamate on Day 3 did not further affect PPTs or temporal summation pain and there were no sex differences in the effects (P > 0.189). Chewing pain (P = 0.022) and fatigue increased after glutamate injection to a higher degree in the women than men (P = 0.037). Conclusion: Taken together, while glutamate injected into the NGF-sensitized muscle was painful, it did not alter muscle tenderness in women vs. men. However, pain and fatigue evoked by jaw function were higher in women after glutamate injection. This suggest that sex differences reported for masseter myalgia, mimicked by glutamate and NGF mediated pain in this study, may be greater for measures of perceived jaw function, which should be considered in a clinical evaluation.
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Affiliation(s)
- Akiko Shimada
- Department of Geriatric Dentistry, Osaka Dental University, Osaka, Japan
| | - Abdelrahman M Alhilou
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden.,Department of Restorative Dentistry, College of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Malin Ernberg
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
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11
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Local anaesthesia decreases nerve growth factor induced masseter hyperalgesia. Sci Rep 2020; 10:15458. [PMID: 32963266 PMCID: PMC7508842 DOI: 10.1038/s41598-020-71620-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/13/2020] [Indexed: 11/08/2022] Open
Abstract
The aim of this investigation was to evaluate the effects of local anaesthesia on nerve growth factor (NGF) induced masseter hyperalgesia. Healthy participants randomly received an injection into the right masseter muscle of either isotonic saline (IS) given as a single injection (n = 15) or an injection of NGF (n = 30) followed by a second injection of lidocaine (NGF + lidocaine; n = 15) or IS (NGF + IS; n = 15) in the same muscle 48 h later. Mechanical sensitivity scores of the right and left masseter, referred sensations and jaw pain intensity and jaw function were assessed at baseline, 48 h after the first injection, 5 min after the second injection and 72 h after the first injection. NGF caused significant jaw pain evoked by chewing at 48 and 72 h after the first injection when compared to the IS group, but without significant differences between the NGF + lidocaine and NGF + IS groups. However, the mechanical sensitivity of the right masseter 5 min after the second injection in the NGF + lidocaine group was significantly lower than the second injection in the NGF + IS and was similar to the IS group. There were no significant differences for the referred sensations. Local anaesthetics may provide relevant information regarding the contribution of peripheral mechanisms in the maintenance of persistent musculoskeletal pain.
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Mai L, Huang F, Zhu X, He H, Fan W. Role of Nerve Growth Factor in Orofacial Pain. J Pain Res 2020; 13:1875-1882. [PMID: 32801845 PMCID: PMC7399448 DOI: 10.2147/jpr.s250030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/06/2020] [Indexed: 12/18/2022] Open
Abstract
Some chronic pain conditions in the orofacial region are common and the mechanisms underlying orofacial pain are unresolved. Nerve growth factor (NGF) is a member of a family of neurotrophins and regulates the growth, maintenance and development of neurons. Increasing evidence suggests that NGF plays a crucial role in the generation of pain and hyperalgesia in different pain states. This review investigates the role of NGF in orofacial pain and their underlying cellular mechanisms, which may provide essential guidance to drug-discovery programmes. A systemic literature search was conducted in Pubmed focusing on NGF and orofacial pain. Articles were reviewed, and those discussing in vitro studies, animal evidence, clinical course, and possible mechanisms were summarized. We found a hyperalgesic effect of NGF in peripheral sensitization in orofacial pain models. We also summarize the current knowledge regarding NGF-dependent pain mechanism, which is initiated by retrograde transport of the ligand-receptor complex, ensuing transcriptional regulation of many important nociceptor genes involved in nociceptive processing. Phase III trials suggest that anti-NGF drug is endorsed with anti-inflammatory and pain-relieving effects with good tolerance in a variety of pain conditions, including pain associated with osteoarthritis and chronic lower back pain. Based on the data reviewed herein, NGF is believed to be an important hyperalgesic mediator in orofacial pain. The identification of underlying mechanisms and pathways of orofacial pain opens new frontiers for pain management.
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Affiliation(s)
- Lijia Mai
- Department of Anesthesiology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, 510080, People's Republic of China
| | - Fang Huang
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, 510080, People's Republic of China
| | - Xiao Zhu
- The Marine Biomedical Research Institute, Guangdong Medical University, Zhanjiang 524023, People's Republic of China
| | - Hongwen He
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, 510080, People's Republic of China
| | - Wenguo Fan
- Department of Anesthesiology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, 510080, People's Republic of China
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13
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Herrero Babiloni A, Lam JTAT, Exposto FG, Beetz G, Provost C, Gagnon DH, Lavigne GJ. Interprofessional Collaboration in Dentistry: Role of physiotherapists to improve care and outcomes for chronic pain conditions and sleep disorders. J Oral Pathol Med 2020; 49:529-537. [PMID: 32531851 DOI: 10.1111/jop.13068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 01/10/2023]
Abstract
Physiotherapists can manage chronic pain patients by using technical interventions such as mobility, strengthening, manual therapy, or flexibility in a specific and functional manner, being a key component of a multidisciplinary team. Dentists are involved in the management of different chronic pain conditions such as temporomandibular disorders and sleep disorders such as obstructive sleep apnea. However, they are frequently unaware of the benefits of collaborating with physical therapists. In this review, the collaboration of physical therapists and dentists will be explored when managing orofacial pain, headaches, and sleep disorders. The physical therapist is important in the management of these disorders and also in the screening of risk factors.
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Affiliation(s)
- Alberto Herrero Babiloni
- Sacre-Cœur Hospital, CIUSS du Nord-de-l'île-de-Montréal, Montreal, Canada.,Faculté de Medicine Dentaire, Université de Montréal, Montreal, Canada.,Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Jacqueline T A T Lam
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Fernando G Exposto
- Section of Orofacial Pain and Jaw Function, Department of Dentistry, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Gabrielle Beetz
- Sacre-Cœur Hospital, CIUSS du Nord-de-l'île-de-Montréal, Montreal, Canada
| | - Catherine Provost
- Sacre-Cœur Hospital, CIUSS du Nord-de-l'île-de-Montréal, Montreal, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Gilles J Lavigne
- Sacre-Cœur Hospital, CIUSS du Nord-de-l'île-de-Montréal, Montreal, Canada.,Faculté de Medicine Dentaire, Université de Montréal, Montreal, Canada.,Division of Experimental Medicine, McGill University, Montreal, Canada
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14
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Chung MK, Wang S, Yang J, Alshanqiti I, Wei F, Ro JY. Neural Pathways of Craniofacial Muscle Pain: Implications for Novel Treatments. J Dent Res 2020; 99:1004-1012. [PMID: 32374638 DOI: 10.1177/0022034520919384] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Craniofacial muscle pain is highly prevalent in temporomandibular disorders but is difficult to treat. Enhanced understanding of neurobiology unique to craniofacial muscle pain should lead to the development of novel mechanism-based treatments. Herein, we review recent studies to summarize neural pathways of craniofacial muscle pain. Nociceptive afferents in craniofacial muscles are predominantly peptidergic afferents enriched with TRPV1. Signals from peripheral glutamate receptors converge onto TRPV1, leading to mechanical hyperalgesia. Further studies are needed to clarify whether hyperalgesic priming in nonpeptidergic afferents or repeated acid injections also affect craniofacial muscle pain. Within trigeminal ganglia, afferents innervating craniofacial muscles interact with surrounding satellite glia, which enhances the sensitivity of the inflamed neurons as well as nearby uninjured afferents, resulting in hyperalgesia and ectopic pain originating from adjacent orofacial tissues. Craniofacial muscle afferents project to a wide area within the trigeminal nucleus complex, and central sensitization of medullary dorsal horn neurons is a critical factor in muscle hyperalgesia related to ectopic pain and emotional stress. Second-order neurons project rostrally to pathways associated with affective pain, such as parabrachial nucleus and medial thalamic nucleus, as well as sensory-discriminative pain, such as ventral posteromedial thalamic nuclei. Abnormal endogenous pain modulation can also contribute to chronic muscle pain. Descending serotonergic circuits from the rostral ventromedial medulla facilitate activation of second-order neurons in the trigeminal nucleus complex, which leads to the maintenance of mechanical hyperalgesia of inflamed masseter muscle. Patients with temporomandibular disorders exhibit altered brain networks in widespread cortical and subcortical regions. Recent development of methods for neural circuit manipulation allows silencing of specific hyperactive neural circuits. Chemogenetic silencing of TRPV1-expressing afferents or rostral ventromedial medulla neurons attenuates hyperalgesia during masseter inflammation. It is likely, therefore, that further delineation of neural circuits mediating craniofacial muscle hyperalgesia potentially enhances treatment of chronic muscle pain conditions.
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Affiliation(s)
- M K Chung
- Department of Neural and Pain Sciences, School of Dentistry, Program in Neuroscience, Center to Advance Chronic Pain Research, The University of Maryland, Baltimore, MD, USA
| | - S Wang
- Department of Neural and Pain Sciences, School of Dentistry, Program in Neuroscience, Center to Advance Chronic Pain Research, The University of Maryland, Baltimore, MD, USA
| | - J Yang
- Department of Neural and Pain Sciences, School of Dentistry, Program in Neuroscience, Center to Advance Chronic Pain Research, The University of Maryland, Baltimore, MD, USA
| | - I Alshanqiti
- Department of Neural and Pain Sciences, School of Dentistry, Program in Neuroscience, Center to Advance Chronic Pain Research, The University of Maryland, Baltimore, MD, USA
| | - F Wei
- Department of Neural and Pain Sciences, School of Dentistry, Program in Neuroscience, Center to Advance Chronic Pain Research, The University of Maryland, Baltimore, MD, USA
| | - J Y Ro
- Department of Neural and Pain Sciences, School of Dentistry, Program in Neuroscience, Center to Advance Chronic Pain Research, The University of Maryland, Baltimore, MD, USA
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15
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Exposto FG, Bendixen KH, Ernberg M, Bach FW, Svensson P. Characterization and predictive mechanisms of experimentally induced tension-type headache. Cephalalgia 2019; 39:1207-1218. [DOI: 10.1177/0333102419840779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective Studies have shown it is possible to elicit a tension-type headache episode in 15 to 30% of healthy individuals following a tooth-clenching or stress-inducing task. Despite this, no studies have attempted to understand why some healthy individuals develop a headache episode while others do not. Methods The present randomized, single-blind, controlled study recruited 60 healthy participants who participated in a 30-minute tooth-clenching task and 10 participants who participated in a control task. Before the tasks, participants had their pericranial tenderness and pain modulation profiles (wind-up ratio and conditioned pain modulation) assessed. Two hours later, pericranial tenderness and pressure pain thresholds were assessed as well as any developing temporomandibular disorders. Pain diaries were kept for 24 hours to register any developing pain or headache. Results Participants with a decrease in pericranial tenderness after the tooth-clenching task were less likely to develop headache when compared to participants without. Pain modulation profiles could not predict who developed headache and who did not. Finally, no difference was found between groups for developing temporomandibular disorders. No difference in frequency of participants who developed headache was found between the tooth-clenching and the control task. Conclusions In conclusion, it was shown that increased pericranial tenderness was not required to trigger an episode of tension-type headache in healthy participants. Furthermore, pain modulation profiles could not predict who developed headache and who did not. Finally, activation of descending inhibitory pathways, as assessed by decreases in pericranial tenderness, was protective against the development of headache. These findings provide new insights into the pathophysiology of experimentally-induced tension-type headache.
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Affiliation(s)
- Fernando Gustavo Exposto
- Section of Orofacial Pain and Jaw Function, Department of Dentistry, Aarhus University, Aarhus, Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Karina H Bendixen
- Section of Orofacial Pain and Jaw Function, Department of Dentistry, Aarhus University, Aarhus, Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Malin Ernberg
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | | | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry, Aarhus University, Aarhus, Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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Comparison of masseter muscle referred sensations after mechanical and glutamate stimulation: a randomized, double-blind, controlled, cross-over study. Pain 2019; 159:2649-2657. [PMID: 30180087 DOI: 10.1097/j.pain.0000000000001379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Referred sensations (RS) are commonly found in various musculoskeletal pain conditions. Experimental studies have shown that RS can be elicited through glutamate injection and mechanical stimulation. Despite this, differences and similarities between these modalities in RS outcomes remain unclear. The aim of this study was to assess differences between mechanical-induced and glutamate injection-induced RS in the trigeminal region. The present randomized, double-blind, controlled, cross-over study recruited 60 healthy participants who were assessed in 2 different sessions. In both sessions, pressure was applied to the masseter muscle with 4 different forces (0.5, 1, 2, and 4 kg), and glutamate (1 mol/L or 0.25 mol/L) was injected into the same area. Participants rated their perceived masseter sensations and rated and drew any RS they experienced. No difference was found in number of participants reporting RS after glutamate injection compared with mechanical stimulation. More participants reported RS when the stimulus was painful compared with a nonpainful stimulus. Furthermore, it was shown that the more intense the stimulus, the higher the frequency of RS. Finally, RS centre-of-gravity location was similar between the 2 sessions. In summary, RS was elicited in healthy individuals through both modalities, and no differences in frequency of RS were observed in the orofacial region. Hence, RS does not seem to be modality-dependent, and only the painfulness of the stimulus caused an increase in frequency of RS. Finally, RS location for each participant was similar in both sessions possibly indicating a preferred location of referral. These findings may have implications for our understanding of RS in craniofacial pain conditions.
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