Effect of pinching-evoked pain on jaw-stretch reflexes and exteroceptive suppression periods in healthy subjects

Guidelines and recommendations for assessment of somatosensory function in oro-facial pain conditions--a taskforce report

The goals of an international taskforce on somatosensory testing established by the Special Interest Group of Oro-facial Pain (SIG-OFP) under the International Association for the Study of Pain (IASP) were to (i) review the literature concerning assessment of somatosensory function in the oro-facial region in terms of techniques and test performance, (ii) provide guidelines for comprehensive and screening examination procedures, and (iii) give recommendations for future development of somatosensory testing specifically in the oro-facial region. Numerous qualitative and quantitative psychophysical techniques have been proposed and used in the description of oro-facial somatosensory function. The selection of technique includes time considerations because the most reliable and accurate methods require multiple repetitions of stimuli. Multiple-stimulus modalities (mechanical, thermal, electrical, chemical) have been applied to study oro-facial somatosensory function. A battery of different test stimuli is needed to obtain comprehensive information about the functional integrity of the various types of afferent nerve fibres. Based on the available literature, the German Neuropathic Pain Network test battery appears suitable for the study of somatosensory function within the oro-facial area as it is based on a wide variety of both qualitative and quantitative assessments of all cutaneous somatosensory modalities. Furthermore, these protocols have been thoroughly described and tested on multiple sites including the facial skin and intra-oral mucosa. Standardisation of both comprehensive and screening examination techniques is likely to improve the diagnostic accuracy and facilitate the understanding of neural mechanisms and somatosensory changes in different oro-facial pain conditions and may help to guide management.

Modulation of exteroceptive suppression periods in human jaw-closing muscles by subanaesthetic dose of propofol

Exteroceptive suppression (ES) periods in human jaw-closing muscles can be conditioned by a wide range of somatosensory stimuli and cognitive states. The aim of this study was to examine the effects of subanaesthetic doses of midazolam, ketamine and propofol on the short latency (ES1) and long latency (ES2) reflex in the jaw-closing muscles. First, we tried to evaluate the various methodological criteria for ES recording. We then examined the effect of subanaesthetic doses of midazolam (0·035 mg kg(-1)), ketamine (0·30 mg kg(-1)) and propofol (0·35 mg kg(-1)) on these reflexes of recording left masseter and temporalis muscle. ES duration did not differ greatly in the present study, recorded with the correct adjustment of stimulating and recording conditions. None of the subanaesthetic doses of the agents influenced ES1, and no significant effects on ES2 were observed with midazolam and ketamine. However, significant inhibitory change was observed in ES2 with propofol. ES2 is thought to be mediated by afferents, which descend in the spinal trigeminal tract and connect with a polysynaptic chain of excitatory interneurones located in the lateral reticular formation. Our observations indicate that propofol is uniquely effective not only through involvement of the gamma-aminobutyric acid type A receptor, but also through a range of other effects.

Hand and hand preferences in use of a visual analogue scale

Visual analogue scales are commonly used to measure the intensity of sensations, and their validity and reliability have been reported. However, biases similar to those found in visual line bisection have not been investigated. 23 right-handed and 19 left-handed participants, with a mean age of 30.1 yr., marked three points on a visual analogue scale representing imagined pain, using both the left and right hands, corresponding to 1/4, 1/2, and 3/4 of the way across the scale. In keeping with visual line bisection literature, both right- and left-handed participants marked the scale with the left hand significantly leftward of the point marked with the right hand, thereby underreporting the intensity. Right-handed participants marked 1/4 significantly leftward and 3/4 significantly rightward of veridical points, thereby underreporting and overreporting, respectively, the intensity. However, left-handed participants did not display this bias and consistently erred leftward for 1/4, 1/2, and 3/4 positions, underreporting intensity. These findings were explained in terms of hemispheric specialisation and activation for a manual response to a visuospatial task, with the conclusion that scoring the visual analogue scale to millimetre accuracy is subject to a potential confound of these factors.