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Quantitative sensory testing in classical trigeminal neuralgia-a blinded study in patients with and without concomitant persistent pain
- Source :
- Pain. 157(7)
- Publication Year :
- 2016
-
Abstract
- The diagnostic criteria of the third International Classification of Headache Disorders state that there should be no neurological deficits in patients with classical trigeminal neuralgia (TN) at clinical examination. However, studies demonstrating sensory abnormalities at bedside examination in TN patients have questioned this. Our aim was to examine whether TN patients without sensory abnormalities at neurological examination have sensory abnormalities at quantitative sensory testing (QST) and whether there were any QST differences between TN with and without concomitant persistent pain. Thirty-six TN patients were investigated with the standardized QST protocol by the German Research Network on Neuropathic Pain. The investigators were blinded to presence of concomitant persistent pain and symptomatic side. Based on comparison to the German Research Network on Neuropathic Pain controls, z scores were calculated to process frequency analyses and Z-profiles. We found increased mechanical detection threshold on the symptomatic side (47.2% vs 0%, P = 0.008), asymptomatic side (33.3% vs 0%, P = 0.011), and hand (36% vs 0%, P < 0.001) in TN compared with controls. The Z-profiles demonstrated increased mechanical detection threshold on the symptomatic side compared with the asymptomatic side (-2.980 vs -2.166, P = 0.040). Thermal and mechanical hyperalgesia was detected bilaterally in the face and the hand. Trigeminal neuralgia patients with concomitant persistent pain tended to have higher mean z score values compared to TN with purely paroxysmal pain indicative of decreased detection thresholds. Trigeminal neuralgia patients with no sensory abnormalities at neurological examination had generalized subclinical hypoesthesia, which was more pronounced on the symptomatic side, and thermal and mechanical hyperalgesia. This could indicate pain-induced hypoesthesia and sensitization induced by central mechanisms.
- Subjects :
- Adult
Male
Pain Threshold
Physical examination
Neurological examination
Asymptomatic
Article
03 medical and health sciences
0302 clinical medicine
Trigeminal neuralgia
Physical Stimulation
Threshold of pain
medicine
Humans
Single-Blind Method
030212 general & internal medicine
Aged
Pain Measurement
Neurologic Examination
medicine.diagnostic_test
business.industry
Hypoesthesia
Middle Aged
Trigeminal Neuralgia
medicine.disease
Anesthesiology and Pain Medicine
Neurology
Hyperalgesia
Anesthesia
Neuropathic pain
Female
Neurology (clinical)
medicine.symptom
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 18726623
- Volume :
- 157
- Issue :
- 7
- Database :
- OpenAIRE
- Journal :
- Pain
- Accession number :
- edsair.doi.dedup.....4492442e82f30f97387103e83c571459