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Chen Y, Chen L, Ji T, Yu Y, Zhang T, Wang L. The purinergic receptor P2X3 promotes facial pain by activating neurons and cytokines in the trigeminal ganglion. Int Immunopharmacol 2024; 130:111801. [PMID: 38442578 DOI: 10.1016/j.intimp.2024.111801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/18/2024] [Accepted: 03/02/2024] [Indexed: 03/07/2024]
Abstract
The mechanism underlying allodynia/hyperalgesia caused by dental pulpitis has remained enigmatic. This investigation endeavored to characterize the influence of the purinergic receptor P2X3 on pain caused by experimental pulpitis and the mechanism involved. An experimental model of irreversible pulpitis was produced by the drilling and exposure of the dental pulp of the left upper first and second molars in rats, followed by measuring nociceptive responses in the oral and maxillofacial regions. Subsequently, neuronal activity and the expression of P2X3 and pertinent cytokines in the trigeminal ganglion (TG) were meticulously examined and analyzed. Histological evidence corroborated that significant pulpitis was produced in this model, which led to a distinct escalation in nociceptive responses in rats. The activation of neurons, coupled with the upregulated expression of c-fos, P2X3, p-p38, TNF-α and IL-1β, was identified subsequent to the pulpitis surgery within the TG. The selective inhibition of P2X3 with A-317491 effectively restrained the abnormal allodynia/hyperalgesia following the pulpitis surgery and concurrently inhibited the upregulation of p-p38, TNF-α and IL-1β within the TG. These findings suggest that the P2X3 signaling pathway plays a pivotal role in instigating and perpetuating pain subsequent to the induction of pulpitis in rats, implicating its association with the p38 MAPK signaling pathway and inflammatory factors.
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Affiliation(s)
- Yangxi Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China; Department of Emergency and General Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - Liangyu Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China; Department of Anesthesiology, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - Tuo Ji
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China; Department of Anesthesiology, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - Yuan Yu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China; Department of Anesthesiology, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - Tiejun Zhang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China; Department of Anesthesiology, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - Li Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China; Department of Anesthesiology, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China.
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Soma C, Hitomi S, Oshima E, Hayashi Y, Soma K, Shibuta I, Tsuboi Y, Shirakawa T, Kikuiri T, Iwata K, Shinoda M. Involvement of oxidative stress in orofacial mechanical pain hypersensitivity following neonatal maternal separation in rats. Sci Rep 2023; 13:22760. [PMID: 38123836 PMCID: PMC10733350 DOI: 10.1038/s41598-023-50116-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
Patients with persistent pain have sometimes history of physical abuse or neglect during infancy. However, the pathogenic mechanisms underlying orofacial pain hypersensitivity associated with early-life stress remain unclear. The present study focused on oxidative stress and investigated its role in pain hypersensitivity in adulthood following early-life stress. To establish an early-life stress model, neonatal pups were separated with their mother in isolated cages for 2 weeks. The mechanical head-withdrawal threshold (MHWT) in the whisker pad skin of rats received maternal separation (MS) was lower than that of non-MS rats at postnatal week 7. In MS rats, the expression of 8-hydroxy-deoxyguanosine, a marker of DNA oxidative damage, was enhanced, and plasma antioxidant capacity, but not mitochondrial complex I activity, decreased compared with that in non-MS rats. Reactive oxygen species (ROS) inactivation and ROS-sensitive transient receptor potential ankyrin 1 (TRPA1) antagonism in the whisker pad skin at week 7 suppressed the decrease of MHWT. Corticosterone levels on day 14 increased in MS rats. Corticosterone receptor antagonism during MS periods suppressed the reduction in antioxidant capacity and MHWT. The findings suggest that early-life stress potentially induces orofacial mechanical pain hypersensitivity via peripheral nociceptor TRPA1 hyperactivation induced by oxidative stress in the orofacial region.
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Affiliation(s)
- Chihiro Soma
- Department of Pediatric Dentistry, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Suzuro Hitomi
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan.
| | - Eri Oshima
- Department of Oral and Maxillofacial Surgery, Showa University School of Dentistry, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Yoshinori Hayashi
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Kumi Soma
- Department of Pediatric Dentistry, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Ikuko Shibuta
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Yoshiyuki Tsuboi
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Tetsuo Shirakawa
- Department of Pediatric Dentistry, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Takashi Kikuiri
- Department of Pediatric Dentistry, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Koichi Iwata
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Masamichi Shinoda
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
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Chen Q, Yi DI, Perez JNJ, Liu M, Chang SD, Barad MJ, Lim M, Qian X. The Molecular Basis and Pathophysiology of Trigeminal Neuralgia. Int J Mol Sci 2022; 23:ijms23073604. [PMID: 35408959 PMCID: PMC8998776 DOI: 10.3390/ijms23073604] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
Trigeminal neuralgia (TN) is a complex orofacial pain syndrome characterized by the paroxysmal onset of pain attacks in the trigeminal distribution. The underlying mechanism for this debilitating condition is still not clearly understood. Decades of basic and clinical evidence support the demyelination hypothesis, where demyelination along the trigeminal afferent pathway is a major driver for TN pathogenesis and pathophysiology. Such pathological demyelination can be triggered by physical compression of the trigeminal ganglion or another primary demyelinating disease, such as multiple sclerosis. Further examination of TN patients and animal models has revealed significant molecular changes, channelopathies, and electrophysiological abnormalities in the affected trigeminal nerve. Interestingly, recent electrophysiological recordings and advanced functional neuroimaging data have shed new light on the global structural changes and the altered connectivity in the central pain-related circuits in TN patients. The current article aims to review the latest findings on the pathophysiology of TN and cross-examining them with the current surgical and pharmacologic management for TN patients. Understanding the underlying biology of TN could help scientists and clinicians to identify novel targets and improve treatments for this complex, debilitating disease.
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Affiliation(s)
- QiLiang Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (Q.C.); (D.I.Y.); (J.N.J.P.); (M.L.); (M.J.B.)
| | - Dae Ik Yi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (Q.C.); (D.I.Y.); (J.N.J.P.); (M.L.); (M.J.B.)
| | - Josiah Nathan Joco Perez
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (Q.C.); (D.I.Y.); (J.N.J.P.); (M.L.); (M.J.B.)
| | - Monica Liu
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (Q.C.); (D.I.Y.); (J.N.J.P.); (M.L.); (M.J.B.)
| | - Steven D. Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.D.C.); (M.L.)
| | - Meredith J. Barad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (Q.C.); (D.I.Y.); (J.N.J.P.); (M.L.); (M.J.B.)
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.D.C.); (M.L.)
| | - Xiang Qian
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (Q.C.); (D.I.Y.); (J.N.J.P.); (M.L.); (M.J.B.)
- Correspondence:
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Berke MS, Fensholdt LKD, Hestehave S, Kalliokoski O, Abelson KSP. Effects of buprenorphine on model development in an adjuvant-induced monoarthritis rat model. PLoS One 2022; 17:e0260356. [PMID: 35025864 PMCID: PMC8757907 DOI: 10.1371/journal.pone.0260356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
Complete Freund’s adjuvant (CFA)-induced arthritis in rats is a common animal model for studying chronic inflammatory pain. However, modelling of the disease is associated with unnecessary pain and impaired animal wellbeing, particularly in the immediate post-induction phase. Few attempts have been made to counteract these adverse effects with analgesics. The present study investigated the effect of buprenorphine on animal welfare, pain-related behaviour and model-specific parameters during the disease progression in a rat model of CFA-induced monoarthritis. The aim was to reduce or eliminate unnecessary pain in this model, in order to improve animal welfare and to avoid suffering, without compromising the quality of the model. Twenty-four male Sprague Dawley rats were injected with 20 μl of CFA into the left tibio-tarsal joint to induce monoarthritis. Rats were treated with either buprenorphine or carprofen for 15 days during the disease development, and were compared to a saline-treated CFA-injected group or a negative control group. Measurements of welfare, pain-related behaviour and clinical model-specific parameters were collected. The study was terminated after 3 weeks, ending with a histopathologic analysis. Regardless of treatment, CFA-injected rats displayed mechanical hyperalgesia and developed severe histopathological changes associated with arthritis. However, no severe effects on general welfare were found at any time. Buprenorphine treatment reduced facial pain expression scores, improved mobility, stance and lameness scores and it did not supress the CFA-induced ankle swelling, contrary to carprofen. Although buprenorphine failed to demonstrate a robust analgesic effect on the mechanical hyperalgesia in this study, it did not interfere with the development of the intended pathology.
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Affiliation(s)
- Mie S Berke
- Dept. of Experimental Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Louise K D Fensholdt
- Dept. of Experimental Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sara Hestehave
- Dept. of Cell and Developmental Biology, University College London, London, United Kingdom
| | - Otto Kalliokoski
- Dept. of Experimental Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klas S P Abelson
- Dept. of Experimental Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Nagakura Y, Nagaoka S, Kurose T. Potential Molecular Targets for Treating Neuropathic Orofacial Pain Based on Current Findings in Animal Models. Int J Mol Sci 2021; 22:ijms22126406. [PMID: 34203854 PMCID: PMC8232571 DOI: 10.3390/ijms22126406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 01/25/2023] Open
Abstract
This review highlights potential molecular targets for treating neuropathic orofacial pain based on current findings in animal models. Preclinical research is currently elucidating the pathophysiology of the disease and identifying the molecular targets for better therapies using animal models that mimic this category of orofacial pain, especially post-traumatic trigeminal neuropathic pain (PTNP) and primary trigeminal neuralgia (PTN). Animal models of PTNP and PTN simulate their etiologies, that is, trauma to the trigeminal nerve branch and compression of the trigeminal root entry zone, respectively. Investigations in these animal models have suggested that biological processes, including inflammation, enhanced neuropeptide-mediated pain signal transmission, axonal ectopic discharges, and enhancement of interactions between neurons and glial cells in the trigeminal pathway, are underlying orofacial pain phenotypes. The molecules associated with biological processes, whose expressions are substantially altered following trigeminal nerve damage or compression of the trigeminal nerve root, are potentially involved in the generation and/or exacerbation of neuropathic orofacial pain and can be potential molecular targets for the discovery of better therapies. Application of therapeutic candidates, which act on the molecular targets and modulate biological processes, attenuates pain-associated behaviors in animal models. Such therapeutic candidates including calcitonin gene-related peptide receptor antagonists that have a reasonable mechanism for ameliorating neuropathic orofacial pain and meet the requirements for safe administration to humans seem worth to be evaluated in clinical trials. Such prospective translation of the efficacy of therapeutic candidates from animal models to human patients would help develop better therapies for neuropathic orofacial pain.
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Affiliation(s)
- Yukinori Nagakura
- School of Pharmacy at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa-city, Fukuoka 831-8501, Japan
- Correspondence:
| | - Shogo Nagaoka
- Basic Research Development Division, Rohto Pharmaceutical Co., Ltd., 6-5-4 Kunimidai, Kizugawa, Kyoto 619-0216, Japan; (S.N.); (T.K.)
| | - Takahiro Kurose
- Basic Research Development Division, Rohto Pharmaceutical Co., Ltd., 6-5-4 Kunimidai, Kizugawa, Kyoto 619-0216, Japan; (S.N.); (T.K.)
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Wahlund K, Larsson B. The course of pain intensity and frequency of adolescents treated because of temporomandibular disorders: A long-term follow-up. Clin Exp Dent Res 2020; 6:407-414. [PMID: 32304185 PMCID: PMC7453768 DOI: 10.1002/cre2.289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/31/2020] [Accepted: 03/06/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To evaluate the course of pain intensity and frequency related to temporomandibular disorders (TMDs) 15 years (range 5-21 years) after having received TMD treatment as adolescents due to frequent (at least once a week) TMD pain in two controlled trials. MATERIALS AND METHODS In the first trial, subjects (n = 122) were randomly allocated to either information only, received in a control condition (Co), or information and an occlusal appliance (OA) versus relaxation therapy (RT). In the second trial, including 64 subjects, nonresponders to OA or RT were subsequently allocated to the alternate treatment (ST). All study participants having completed the trials (n = 167) were invited to a long-term follow-up evaluations, with a response rate of 69.5% (n = 116). Patient-reported outcomes of TMD-related frequency and intensity were appraised relative to baseline data and short-term outcomes as observed in the two trials by use of general linear mixed model and generalized estimation equation statistics. RESULTS A significantly higher proportion of participants treated with OA and in the combined RT/Co condition than those in the ST group, reported a frequency level of TMD pain less than once week at post-treatment and the long-term follow-up. Adolescents treated with OA showed significantly lower TMD pain intensity levels post-treatment than those in the other two treatment conditions. While no difference between the OA and the RT/Co conditions was found in the long-term follow-up, participants in these two conditions were significantly more improved than those in the ST group. CONCLUSION Adolescents treated with an OA clearly showed better outcome with regard to intensity and frequency in a long-term follow-up of TMD pain than those treated with RT and ST for nonresponders. These latter individuals need special clinical attention and more effective supplementary treatment methods to be developed.
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Affiliation(s)
- Kerstin Wahlund
- Department of Stomatognathic PhysiologyKalmar County HospitalKalmarSweden
| | - Bo Larsson
- Regional Center for Child and Youth Mental Health and Child Welfare – Central NorwayNorwegian University of Science and TechnologyTrondheimNorway
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Ferreira NR, Junqueira YN, Corrêa NB, Fonseca EO, Brito NBM, Menezes TA, Magini M, Fidalgo TKS, Ferreira DMTP, de Lima RL, Carvalho AC, DosSantos MF. The efficacy of transcranial direct current stimulation and transcranial magnetic stimulation for chronic orofacial pain: A systematic review. PLoS One 2019; 14:e0221110. [PMID: 31415654 PMCID: PMC6695170 DOI: 10.1371/journal.pone.0221110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/30/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Transcranial Direct Current Stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS) have been described as promising alternatives to treat different pain syndromes. This study evaluated the effects of TMS and tDCS in the treatment of chronic orofacial pain, through a systematic review. METHODS An electronic search was performed in major databases: MEDLINE, Scopus, Web of Science, Cochrane, Embase, LILACS, BBO, Open Gray and CINAHL. The eligibility criteria comprised randomized clinical trials (RCTs) that applied TMS or tDCS to treat chronic orofacial pain. The variables analyzed were pain, functional limitation, quality of life, tolerance to treatment, somatosensory changes, and adverse effects. The risk of bias was assessed through the Cochrane Collaboration tool, and the certainty of evidence was evaluated through GRADE. The protocol was registered in the PROSPERO database (CRD42018090774). RESULTS The electronic search resulted in 636 studies. Thereafter, the eligibility criteria were applied and the duplicates removed, resulting in eight RCTs (four TMS and four tDCS). The findings of these studies suggest that rTMS applied to the Motor cortex (M1), the dorsolateral prefrontal cortex (DLPFC) and the secondary somatosensory cortex (S2) provide adequate orofacial pain relief. Two studies reported significant pain improvement with tDCS applied over M1 while the other two failed to demonstrate significant effects compared to placebo. CONCLUSIONS rTMS, applied to M1, DLPFC or S2, is a promising approach for the treatment of chronic orofacial pain. Moreover, tDCS targeting M1 seems to be also effective in chronic orofacial pain treatment. The included studies used a wide variety of therapeutic protocols. In addition, most of them used small sample sizes, with a high risk of biases in their methodologies, thus producing a low quality of evidence. The results indicate that further research should be carried out with caution and with better-standardized therapeutic protocols.
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Affiliation(s)
- Natália R. Ferreira
- Laboratório de Morfogênese Celular (LMC), Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ygor N. Junqueira
- Campus Macaé, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
| | - Nathália B. Corrêa
- Campus Macaé, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
| | - Estevão O. Fonseca
- Laboratório de Morfogênese Celular (LMC), Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Campus Macaé, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
| | - Nathália B. M. Brito
- Campus Macaé, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
| | - Thayná A. Menezes
- Campus Macaé, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
| | - Márcio Magini
- Laboratório de Análise e Processamento de Sinais, Universidade Federal do Rio de Janeiro, Campus Macaé, Macaé, Rio de Janeiro, Brazil
| | - Tatiana K. S. Fidalgo
- Departamento de Odontologia Preventiva e Comunitária, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniele M. T. P. Ferreira
- Biblioteca do Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo L. de Lima
- Departamento de Ortodontia e Odontopediatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antônio C. Carvalho
- Laboratório de Morfogênese Celular (LMC), Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcos F. DosSantos
- Laboratório de Morfogênese Celular (LMC), Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
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Abstract
Sleep and pain share a bidirectional relationship. Therefore, it is important for practitioners managing patients experiencing either sleep and/or pain issues to recognize and understand this complex association from a neurobiological perspective involving neuroanatomic and neurochemical processes. Accounting for the influence of pain on the various aspects of sleep and understanding its impact on various orofacial pain disorders assists in developing a prudent management approach. Screening for sleep disorders benefits practitioners in identifying these individuals. Instituting evidence-based multidisciplinary management strategies using both behavioral and pharmacologic strategies enhances the delivery of appropriate care.
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Affiliation(s)
- Gary D Klasser
- Department of Diagnostic Sciences, Louisiana State University Health Sciences Center, School of Dentistry, 1100 Florida Avenue, Box 140, New Orleans, LA 70119, USA.
| | - Galit Almoznino
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Orofacial Sensory Clinic, Hebrew University-Hadassah School of Dental Medicine, PO Box 91120, Jerusalem, Israel; Division of Big Data, Department of Community Dentistry, Orofacial Sensory Clinic, Hebrew University-Hadassah School of Dental Medicine, PO Box 91120, Jerusalem, Israel
| | - Giulio Fortuna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Via Pansini, 5, Naples 80131, Italy
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Tournavitis A, Tortopidis D, Fountoulakis K, Menexes G, Koidis P. Psychopathologic Profiles of TMD Patients with Different Pain Locations. INT J PROSTHODONT 2017; 30:251-257. [PMID: 28453000 DOI: 10.11607/ijp.5155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE The aim of this study was to examine whether psychopathologic profile is related to the location of pain in temporomandibular disorder (TMD) patients with myofascial and/or temporomandibular joint pain. MATERIALS AND METHODS A total of 75 painful TMD patients (39 women and 36 men) participated in the study. Participants were divided into three groups (myogenous, arthrogenous, and mixed) using the Research Diagnostic Criteria for TMD (RDC/TMD) Axis I guidelines for assessment of TMD signs and symptoms. Three psychometric instruments were used to assess the psychopathologic profile of the TMD subgroups. Patients' state and trait anxiety were assessed using the State-Trait Anxiety Inventory (STAI-S, STAI-T), depression was measured with the Center for Epidemiological Studies Depression Scale (CES-D), and psychosocial functioning was evaluated using the Global Disability Scale (Glo.Di.S). The three TMD groups were compared with Kruskal-Wallis test followed by pairwise Mann-Whitney tests relative to the psychometric scores. Statistical analyses were performed with SPSS 15.0 software. RESULTS No significant differences were detected among the different TMD groups in the three psychometric scales; STAI-T, CES-D, Glo.Di.S (P > .05). When the psychometric scale of state anxiety (STAI-S) was considered, significant differences were revealed between the myogenous and the arthrogenous pain groups (P = .008) and also between the mixed and the arthrogenous groups (P < .001). CONCLUSION These findings suggest that the psychopathologic profile is not related to the location of pain in TMD patients. However, anxiety was found to be higher in TMD patients with myogenous pain alone or combined with arthrogenous pain compared to those with only arthrogenous pain.
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Jing L, Liu XD, Yang HX, Zhang M, Wang Y, Duan L, Zhang J, Lu L, Yang T, Wang DM, Chen LW, Wang MQ. ERK potentiates p38 in central sensitization induced by traumatic occlusion. Neuroscience 2016; 340:445-454. [PMID: 27865869 DOI: 10.1016/j.neuroscience.2016.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 10/22/2016] [Accepted: 11/08/2016] [Indexed: 12/28/2022]
Abstract
This study was to investigate the role of p38 activation via ERK1/2 phosphorylation in neurons and microglia of the spinal trigeminal subnucleus caudalis (Vc) in the promotion of orofacial hyperalgesia induced by unilateral anterior crossbite (UAC) traumatic occlusion in adult rats. U0126, a p-ERK1/2 inhibitor, was injected intracisternally before UAC implant. The effects of the U0126 injection were compared to those following the injection of SB203580, a p-p38 inhibitor. Mechanical hyperalgesia was evaluated via pressure pain threshold measurements. Brain stem tissues were processed for a Western blot analysis to evaluate the activation of ERK1/2 and p38. Double immunofluorescence was also performed to observe the expression of p-ERK1/2 and p-p38 in neurons (labeled by NeuN) and microglia (labeled by OX42). The data showed that UAC caused orofacial hyperalgia ipsilaterally on d1 to d7, peaking on d3 (P<0.05). An upregulation of p-ERK1/2 was observed in the ipsilateral Vc on d1 to d3, peaking on d1. An upregulation of p-p38 was also observed on d1 to d7, peaking on d3 (P<0.05). p-ERK1/2 primarily co-localized with NeuN and, to a lesser extent, with OX42, while p-p38 co-localized with both NeuN and OX42. Pretreatment with U0126 prevented the upregulation of both p-ERK1/2 and p-p38. Similarly to an intracisternal injection of SB203580, U0126 pretreatment attenuated the UAC-induced orofacial hyperalgesia. These data indicate that UAC caused orofacial hyperalgesia by inducing central sensitization via the activation of ERK1/2 and p38 in both neurons and microglia in the Vc, potentially impacting the effects of p-ERK1/2 during p38 activation.
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Affiliation(s)
- Lei Jing
- State Key Laboratory of Military Stomatology, Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, The Fourth Military Medical University, 145 Changlexi Road, Xi'an 710032, China
| | - Xiao-Dong Liu
- State Key Laboratory of Military Stomatology, Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, The Fourth Military Medical University, 145 Changlexi Road, Xi'an 710032, China
| | - Hong-Xu Yang
- State Key Laboratory of Military Stomatology, Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, The Fourth Military Medical University, 145 Changlexi Road, Xi'an 710032, China
| | - Mian Zhang
- State Key Laboratory of Military Stomatology, Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, The Fourth Military Medical University, 145 Changlexi Road, Xi'an 710032, China
| | - Ying Wang
- State Key Laboratory of Military Stomatology, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Periodontal Disease, School of Stomatology, The Fourth Military Medical University, 145 Changlexi Road, Xi'an 710032, China
| | - Li Duan
- Institute of Neurosciences, Fourth Military Medical University, 169 Changlexi Road, Xi'an 710032, China
| | - Jing Zhang
- State Key Laboratory of Military Stomatology, Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, The Fourth Military Medical University, 145 Changlexi Road, Xi'an 710032, China
| | - Lei Lu
- State Key Laboratory of Military Stomatology, Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, The Fourth Military Medical University, 145 Changlexi Road, Xi'an 710032, China
| | - Ting Yang
- State Key Laboratory of Military Stomatology, Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, The Fourth Military Medical University, 145 Changlexi Road, Xi'an 710032, China
| | - Dong-Mei Wang
- State Key Laboratory of Military Stomatology, Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, The Fourth Military Medical University, 145 Changlexi Road, Xi'an 710032, China
| | - Liang-Wei Chen
- Institute of Neurosciences, Fourth Military Medical University, 169 Changlexi Road, Xi'an 710032, China.
| | - Mei-Qing Wang
- State Key Laboratory of Military Stomatology, Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, The Fourth Military Medical University, 145 Changlexi Road, Xi'an 710032, China.
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Cornelison LE, Hawkins JL, Durham PL. Elevated levels of calcitonin gene-related peptide in upper spinal cord promotes sensitization of primary trigeminal nociceptive neurons. Neuroscience 2016; 339:491-501. [PMID: 27746346 DOI: 10.1016/j.neuroscience.2016.10.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 01/08/2023]
Abstract
Orofacial pain conditions including temporomandibular disorder (TMD) and migraine are characterized by peripheral and central sensitization of trigeminal nociceptive neurons. The goal of this study was to investigate the role of calcitonin gene-related peptide (CGRP) in promoting bidirectional signaling within the trigeminal system to mediate sensitization of primary nociceptive neurons. Adult male Sprague-Dawley rats were injected intercisternally with CGRP or co-injected with the receptor antagonist CGRP8-37 or KT 5720, a protein kinase A (PKA) inhibitor. Nocifensive head withdrawal response to mechanical stimulation was investigated using von Frey filaments. Expression of PKA, glial fibrillary acidic protein (GFAP), and ionized calcium-binding adapter molecule 1 (Iba1) in the spinal cord and phosphorylated extracellular signal-regulated kinase (P-ERK) in the ganglion was studied using immunohistochemistry. Some animals were co-injected with CGRP and Fast Blue dye and the ganglion was imaged using fluorescent microscopy. CGRP increased nocifensive responses to mechanical stimulation when compared to control. Co-injection of CGRP8-37 or KT 5720 with CGRP inhibited the nocifensive response. CGRP stimulated PKA and GFAP expression in the spinal cord, and P-ERK in ganglion neurons. Seven days post injection, Fast Blue was observed in ganglion neurons and satellite glial cells. Our results demonstrate that elevated levels of CGRP in the upper spinal cord promote sensitization of primary nociceptive neurons via a mechanism that involves activation of PKA centrally and P-ERK in ganglion neurons. Our findings provide evidence of bidirectional signaling within the trigeminal system that facilitate increased neuron-glia communication within the ganglion associated with trigeminal sensitization.
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Affiliation(s)
- Lauren E Cornelison
- Center for Biomedical and Life Sciences, Missouri State University, Springfield, MO, USA
| | - Jordan L Hawkins
- Center for Biomedical and Life Sciences, Missouri State University, Springfield, MO, USA
| | - Paul L Durham
- Center for Biomedical and Life Sciences, Missouri State University, Springfield, MO, USA.
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Thibault K, Rivière S, Lenkei Z, Férézou I, Pezet S. Orofacial Neuropathic Pain Leads to a Hyporesponsive Barrel Cortex with Enhanced Structural Synaptic Plasticity. PLoS One 2016; 11:e0160786. [PMID: 27548330 PMCID: PMC4993517 DOI: 10.1371/journal.pone.0160786] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 07/25/2016] [Indexed: 12/30/2022] Open
Abstract
Chronic pain is a long-lasting debilitating condition that is particularly difficult to treat due to the lack of identified underlying mechanisms. Although several key contributing processes have been described at the level of the spinal cord, very few studies have investigated the supraspinal mechanisms underlying chronic pain. Using a combination of approaches (cortical intrinsic imaging, immunohistochemical and behavioural analysis), our study aimed to decipher the nature of functional and structural changes in a mouse model of orofacial neuropathic pain, focusing on cortical areas involved in various pain components. Our results show that chronic neuropathic orofacial pain is associated with decreased haemodynamic responsiveness to whisker stimulation in the barrel field cortex. This reduced functional activation is likely due to the increased basal neuronal activity (measured indirectly using cFos and phospho-ERK immunoreactivity) observed in several cortical areas, including the contralateral barrel field, motor and cingulate cortices. In the same animals, immunohistochemical analysis of markers for active pre- or postsynaptic elements (Piccolo and phospho-Cofilin, respectively) revealed an increased immunofluorescence in deep cortical layers of the contralateral barrel field, motor and cingulate cortices. These results suggest that long-lasting orofacial neuropathic pain is associated with exacerbated neuronal activity and synaptic plasticity at the cortical level.
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Affiliation(s)
- Karine Thibault
- Brain Plasticity Unit, ESPCI, PSL Research University, 10 rue Vauquelin, 75005, Paris, France
- Centre National de la Recherche Scientifique, UMR 8249, 75005, Paris, France
| | - Sébastien Rivière
- Brain Plasticity Unit, ESPCI, PSL Research University, 10 rue Vauquelin, 75005, Paris, France
- Centre National de la Recherche Scientifique, UMR 8249, 75005, Paris, France
| | - Zsolt Lenkei
- Brain Plasticity Unit, ESPCI, PSL Research University, 10 rue Vauquelin, 75005, Paris, France
- Centre National de la Recherche Scientifique, UMR 8249, 75005, Paris, France
| | - Isabelle Férézou
- Brain Plasticity Unit, ESPCI, PSL Research University, 10 rue Vauquelin, 75005, Paris, France
- Centre National de la Recherche Scientifique, UMR 8249, 75005, Paris, France
| | - Sophie Pezet
- Brain Plasticity Unit, ESPCI, PSL Research University, 10 rue Vauquelin, 75005, Paris, France
- Centre National de la Recherche Scientifique, UMR 8249, 75005, Paris, France
- * E-mail:
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Henderson SE, Tudares MA, Gold MS, Almarza AJ. Analysis of pain in the rabbit temporomandibular joint after unilateral splint placement. J Oral Facial Pain Headache 2015; 29:193-202. [PMID: 25905538 DOI: 10.11607/ofph.1371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To determine whether behavioral, anatomical, and physiologic endpoints widely used to infer the presence of pain in rodent models of temporomandibular disorders (TMD) were applicable to the rabbit model of TMD associated with altered joint loading. METHODS Unilateral molar dental splints were used to alter temporomandibular joint (TMJ) loading. Changes in nociceptive threshold were assessed with a mechanical probing of the TMJ region on nine splinted and three control rabbits. Fos-like immunoreacitivty in the trigeminal subnucleus caudalis was assessed with standard immunohistochemical techniques from three splinted and six control animals. Retrogradely labeled TMJ afferents were studied with patch-clamp electrophysiologic techniques from three splinted and three control animals. Remodeling of TMJ condyles was assessed by histologic investigations of three splinted and three control animals. A Student t test or a Mann-Whitney U test was used with significance set at P < .05 to compare splinted to control samples. RESULTS While variable, there was an increase in mechanical sensitivity in splinted rabbits relative to controls. The increase in Fos+ cells in splinted rabbits was also significant relative to naïve controls (86 ± 8 vs 64 ± 15 cells/section, P < .05). The rheobase (364 ± 80 pA) and action potential threshold (-31.2 ± 2.0 mV) were higher in TMJ afferents from splinted rabbits compared to controls (99 ± 22 pA and -38.0 ± 2.0 mV, P < .05). There was significant remodeling in the condylar fibrocartilage layers as manifested by a change in glycosaminoglycan distribution and a loss of defined cell layers. CONCLUSION Behavioral and anatomical results were consistent with an increase in nociceptive signaling in concert with condylar remodeling driven by altered TMJ loading. Changes in excitability and action potential waveform were consistent with possible compensatory changes of TMJ afferents for an overall increase in afferent drive associated with joint degeneration. These compensatory changes may reflect pain-adaption processes that many patients with TMJ disorders experience.
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Zubrzycki M, Janecka A, Zubrzycka M. Trigemino-hypoglossal somatic reflex in the pharmacological studies of nociception in orofacial area. Acta Neurobiol Exp (Wars) 2015; 75:253-63. [PMID: 26581382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Disorders involving the orofacial area represent a major medical and social problem. They are a consequence of central nociceptive processes associated with stimulation of the trigeminal nerve nucleus. A rat model of trigeminal pain, utilizing tongue jerks evoked by electrical tooth pulp stimulation during perfusion of the cerebral ventricles with various neuropeptide solutions, can be used in the pharmacological studies of nociception in orofacial area. The investigated neuropeptides diffuse through the cerebroventricular lining producing an analgesic effect either directly, through the trigemino-hypoglossal reflex arc neurons or indirectly through the periaqueductal central gray, raphe nuclei or locus coeruleus neurons. The aim of this review is to present the effect of pharmacological activity of various neuropeptides affecting the transmission of the sensory information from the orofacial area on the example of trigemino-hypoglossal reflex in rats.
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Affiliation(s)
- Marek Zubrzycki
- Department of Cardiovascular and Thoracic Surgery, University of Ulm, Ulm, Germany
| | - Anna Janecka
- Department of Biomolecular Chemistry, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | - Maria Zubrzycka
- Department of Experimental Physiology, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland;
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Dong Y, Li P, Ni Y, Zhao J, Liu Z. Decreased microRNA-125a-3p contributes to upregulation of p38 MAPK in rat trigeminal ganglions with orofacial inflammatory pain. PLoS One 2014; 9:e111594. [PMID: 25380251 PMCID: PMC4224409 DOI: 10.1371/journal.pone.0111594] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 10/03/2014] [Indexed: 11/23/2022] Open
Abstract
Orofacial inflammatory pain is a difficult clinical problem, and the specific molecular mechanisms for this pain remain largely unexplained. The present study aimed to determine the differential expression of microRNAs (miRNAs) and disclose the underlying role of miR-125a-3p in orofacial inflammatory pain induced by complete Freund's adjuvant (CFA). Thirty-two differentially expressed miRNAs were first screened using a microarray chip in ipsilateral trigeminal ganglions (TGs) following CFA injection into the orofacial skin innervated by trigeminal nerve, and a portion of them, including miR-23a*, -24-2*, -26a, -92a, -125a-3p, -183 and -299 were subsequently selected and validated by qPCR. The target genes were predicted based on the miRWalk website and were further analyzed by gene ontology (GO). Further studies revealed miR-125a-3p expression was down-regulated, whereas both the expression of p38 MAPK (mitogen-activated protein kinase) alpha and CGRP (calcitonin gene-related peptide) were up-regulated in ipsilateral TGs at different time points after CFA injection compared with control. Furthermore, mechanistic study revealed that miR-125a-3p negatively regulates p38 alpha gene expression and is positively correlated with the head withdrawal threshold reflecting pain. Luciferase assay showed that binding of miR-125a-3p to the 3′UTR of p38 alpha gene suppressed the transcriptional activity, and overexpression of miR-125a-3p significantly inhibited the p38 alpha mRNA level in ND8/34 cells. Taken together, our results show that miR-125a-3p is negatively correlated with the development and maintenance of orofacial inflammatory pain via regulating p38 MAPK.
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Affiliation(s)
- Yingchun Dong
- Department of Anesthesiology, Institute and Hospital of Stomatology, Nanjing University Medical School, Nanjing, China
- * E-mail: (YD); (ZL)
| | - Pengfei Li
- Department of Laboratory, Jiangsu Province Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Yanhong Ni
- Central Laboratory, Institute and Hospital of Stomatology, Nanjing University Medical School, Nanjing, China
| | - Junjie Zhao
- Department of Periodontics, Institute and Hospital of Stomatology, Nanjing University Medical School, Nanjing, China
| | - Zhiqiang Liu
- Department of Lymphoma and Myeloma, the University of Texas MD Anderson Cancer Center, Houston, United States of America
- * E-mail: (YD); (ZL)
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Quintans JSS, Brito RG, Aquino PGV, França PHB, Siqueira-Lima PS, Santana AEG, Ribeiro EAN, Salvador MJ, Araújo-Júnior JX, Quintans-Júnior LJ. Antinociceptive activity of Syzygium cumini leaves ethanol extract on orofacial nociception protocols in rodents. Pharm Biol 2014; 52:762-766. [PMID: 24559393 DOI: 10.3109/13880209.2013.870582] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
CONTEXT Syzygium cumini (L.) Skeels (Myrtaceae) is a tree with dark purple fruits, popularly known as "jambolão" or "jambolan". In folk medicine, this plant is used for the treatment of diabetes and inflammatory conditions. OBJECTIVE We investigated the antinociceptive effect of ethanol extract (EE) from S. cumini leaves on orofacial nociception. MATERIAL AND METHODS The antinociceptive effects of the EE obtained from the leaves of S. cumini were evaluated in mice using formalin- and glutamate-induced orofacial nociception. RESULTS ESI-MS/MS analyses demonstrated that major constituents in the analyzed samples coincided with the mass of the phenolic acids and flavonoids. In pharmacological approach, pre-treatment with EE (100, 200, or 400 mg/kg, p.o.) significantly reduced (p<0.05 or p<0.01) the percentage of paw licks time during phase 2 (43.2, 47.1, and 57.4%, respectively) of a formalin pain test when compared to control group animals. This effect was prevented by pretreatment with glibenclamide and N(G)-nitro-l-arginine (l-NOARG). The extract, all doses, also caused a marked inhibition (p<0.01 or p<0.001) of glutamate-induced orofacial nociception (38.8, 51.7, and 54.7%) when compared with the control group. No effect was observed with the rota-rod model. CONCLUSIONS We can suggest that the antinociceptive effect of the EE is mediated by peripheral mechanisms, possibly involving KATP channels and the nitric oxide pathways. These effects appear to be related to the presence of flavonoids compounds, such as quercetin.
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Affiliation(s)
- Jullyana S S Quintans
- Departamento de Fisiologia, Universidade Federal de Sergipe , São Cristóvão, Sergipe , Brazil
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Wang H, Cao Y, Chiang CY, Dostrovsky JO, Sessle BJ. The gap junction blocker carbenoxolone attenuates nociceptive behavior and medullary dorsal horn central sensitization induced by partial infraorbital nerve transection in rats. Pain 2013; 155:429-435. [PMID: 24239671 DOI: 10.1016/j.pain.2013.11.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 11/01/2013] [Accepted: 11/06/2013] [Indexed: 12/15/2022]
Abstract
Glial cells are being increasingly implicated in mechanisms underlying pathological pain, and recent studies suggest glial gap junctions involving astrocytes may contribute. The aim of this study was to examine the effect of a gap junction blocker, carbenoxolone (CBX), on medullary dorsal horn (MDH) nociceptive neuronal properties and facial mechanical nociceptive behavior in a rat trigeminal neuropathic pain model involving partial transection of the infraorbital nerve (p-IONX). p-IONX produced facial mechanical hypersensitivity reflected in significantly reduced head withdrawal thresholds that lasted for more than 3weeks. p-IONX also produced central sensitization in MDH nociceptive neurons that was reflected in significantly increased receptive field size, reduction of mechanical activation threshold, and increases in noxious stimulation-evoked responses. Intrathecal CBX treatment significantly attenuated the p-IONX-induced mechanical hypersensitivity and the MDH central sensitization parameters, compared to intrathecal vehicle treatment. These results provide the first documentation that gap junctions may be critically involved in orofacial neuropathic pain mechanisms.
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Affiliation(s)
- Hua Wang
- Department of Oral Physiology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Dugashvili G, Menabde G, Janelidze M, Chichua Z, Amiranashvili I. Temporomandibular joint disorder (review). Georgian Med News 2013:17-21. [PMID: 23482357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Etiopathogenesis and clinical management of TMJD integrates a number of medical disciplines. In particular, dentistry, oral - facial surgery, neurology, rheumatology and so on. Nowadays there is no unified strategy for the management of this disease. Most cases of temporomandibular disorder (TMD) respond to simple treatment and the prognosis is good. Symptoms usually remit with simple care. In cases of secondary involvement of temporomandibular joint (TMJ), the prognosis depends on the primary disease. A comprehensive, chronological history and physical and examination of the patient, including dental history and examination, is essential to diagnose the specific condition to decide further investigations, if any, and to provide specific treatment. in severe cases, a joint consultation of a dentist, neurologist and rheumatologist is needed.
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Affiliation(s)
- G Dugashvili
- Ilia State University, Scientific Research Institute of Medicine, Tbilisi, Georgia
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Kostrzewa-Janicka J, Pietrzak B, Jurkowski P, Wielgos M, Binkowska M, Mierzwinska-Nastalska E. Effects of oral contraceptives on the treatment for internal derangements in temporomandibular joints in women. Neuro Endocrinol Lett 2013; 34:566-572. [PMID: 24378447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/05/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The prevalence of signs and symptoms of temporomandibular disorders (TMD) is the highest among women of reproductive age. Estrogens are the major contributor to the regulation of bone growth and development. They also influence peripheral and central mechanism of pain. The aim of this study was to evaluate the efficacy of conservative treatment of temporomandibular joint (TMJ) internal derangements in regular cycling women with and without use of oral contraceptives (OCs). MATERIAL & METHODS The study included 229 women with TMJ disk displacement with and without reduction (DDwR and DDw/oR). The study group consisted of 191 normally cycling women and 38 women using combined OCs (COCs). The conservative TMD treatment was applied and its efficacy was rated during check-up visits. RESULTS The decreased odds of obtaining any or sufficient improvement during control visits were observed in women treated for DDwR and taking COCs for less than 3 years (p=0.01). There was a 2.7-fold higher risk for the failure of treatment in women taking COCs for less than 3 years during control visits in both diagnoses, DDwR or DDw/oR (p=0.082). There was investigated an increase in the risk for the lack of sufficient post-treatment improvement in diagnosed DDwR or DDw/oR in women with co-occurrence general osteoarticular lesions (p=0.07, p=0.04). CONCLUSIONS A worse TMJ internal derangements treatment efficacy was observed in women taking COCs for rather short time (less than 3 years) and in women with disorders in the osteoarticular system, what indicates modification of therapeutic procedures in that groups of patients.
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Affiliation(s)
| | - Bronislawa Pietrzak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Piotr Jurkowski
- Department of Prosthodontics, Medical University of Warsaw, Poland
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
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Matijević M, Uzarević Z, Gvozdić V, Leović D, Ivanisević Z, Matijević-Mikelić V, Bogut I, Vcev A, Macan D. Does body mass index and position of impacted lower third molar affect the postoperative pain intensity? Coll Antropol 2012; 36:1279-1285. [PMID: 23390822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The main objective of this study was to determine to which extent body mass index and position of impacted lower third molar was affecting the pain intensity in the first seven postoperative days. The study was conducted following the extraction of the lower third molar in 108 patients. Depending on the type of information given to each particular patient, the patients were divided in two groups: the test group where patients were given detailed standard written and verbal instructions and the control group which received only standard written instructions about treatment after surgery. Using canonical discriminant analysis we investigated the influence of body mass index and the position of impacted lower third molar on postoperative pain intensity in two groups of patients. Results of this study showed that the body mass index or the tooth position did not have influence on intensity of postoperative pain. The body mass index and the position of impacted lower third molar do not affect the postoperative pain intensity.
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Affiliation(s)
- Marko Matijević
- "J. J. Strossmayer University, School of Medicine, Osijek, Croatia
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Chai B, Guo W, Wei F, Dubner R, Ren K. Trigeminal-rostral ventromedial medulla circuitry is involved in orofacial hyperalgesia contralateral to tissue injury. Mol Pain 2012; 8:78. [PMID: 23092240 PMCID: PMC3484042 DOI: 10.1186/1744-8069-8-78] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/16/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Our previous studies have shown that complete Freund's adjuvant (CFA)-induced masseter inflammation and microinjection of the pro-inflammatory cytokine interleukin-1β (IL-1β) into the subnucleus interpolaris/subnucleus caudalis transition zone of the spinal trigeminal nucleus (Vi/Vc) can induce contralateral orofacial hyperalgesia in rat models. We have also shown that contralateral hyperalgesia is attenuated with a lesion of the rostral ventromedial medulla (RVM), a critical site of descending pain modulation. Here we investigated the involvement of the RVM-Vi/Vc circuitry in mediating contralateral orofacial hyperalgesia after an injection of CFA into the masseter muscle. RESULTS Microinjection of the IL-1 receptor antagonist (5 nmol, n=6) into the ipsilateral Vi/Vc attenuated the CFA-induced contralateral hyperalgesia but not the ipsilateral hyperalgesia. Intra-RVM post-treatment injection of the NK1 receptor antagonists, RP67580 (0.5-11.4 nmol) and L-733,060 (0.5-11.4 nmol), attenuated CFA-induced bilateral hyperalgesia and IL-1β induced bilateral hyperalgesia. Serotonin depletion in RVM neurons prior to intra-masseter CFA injection prevented the development of contralateral hyperalgesia 1-3 days after CFA injection. Inhibition of 5-HT(3) receptors in the contralateral Vi/Vc with direct microinjection of the select 5-HT(3) receptor antagonist, Y-25130 (2.6-12.9 nmol), attenuated CFA-induced contralateral hyperalgesia. Lesions to the ipsilateral Vc prevented the development of ipsilateral hyperalgesia but did not prevent the development of contralateral hyperalgesia. CONCLUSIONS These results suggest that the development of CFA-induced contralateral orofacial hyperalgesia is mediated through descending facilitatory mechanisms of the RVM-Vi/Vc circuitry.
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Affiliation(s)
- Bryan Chai
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD, 21201, USA
- Program in Neuroscience, University of Maryland, Baltimore, MD, 21201, USA
| | - Wei Guo
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD, 21201, USA
- Program in Neuroscience, University of Maryland, Baltimore, MD, 21201, USA
| | - Feng Wei
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD, 21201, USA
- Program in Neuroscience, University of Maryland, Baltimore, MD, 21201, USA
| | - Ronald Dubner
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD, 21201, USA
- Program in Neuroscience, University of Maryland, Baltimore, MD, 21201, USA
| | - Ke Ren
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD, 21201, USA
- Program in Neuroscience, University of Maryland, Baltimore, MD, 21201, USA
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Peñarrocha-Oltra D, Ata-Ali J, Ata-Ali F, Peñarrocha-Diago MA, Peñarrocha M. Treatment of orofacial pain in patients with stylomandibular ligament syndrome (Ernest Syndrome). Neurologia 2012; 28:294-8. [PMID: 22898469 DOI: 10.1016/j.nrl.2012.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 05/23/2012] [Accepted: 06/30/2012] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Ernest syndrome involves the stylomandibular ligament. It is characterised by pain in the preauricular area and mandibular angle, radiating to the neck, shoulder, and eye on the same side, and associated with pain during palpation of that ligament. The purpose of this study is to describe the clinical characteristics, treatment, and course of the disease in a series of patients with Ernest syndrome. METHODS Retrospective observational study covering the period from 1998 to 2008. We recorded patients' age, sex, duration of the disorder, and pain characteristics. All patients were injected with 40mg triamcinolone acetonide at the mandibular insertion of the stylomandibular ligament. RESULTS The study included a total of 6 patients. Mean age was 40.3 years (range, 35-51). All of the subjects were women. Four patients had undergone lengthy dental treatments in the month prior to onset of the pain. The mean time between pain onset and first consultation was 23 months. The syndrome resolved completely in all cases after treatment, with a minimum follow-up period of 12 months. CONCLUSIONS We analysed the clinical characteristics, treatment, and course of disease in 6 patients with Ernest syndrome. Correct diagnosis is the key to being able to provide proper treatment. This disorder is sometimes confused with other types of orofacial pain, and may therefore be more prevalent than the literature would indicate.
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Affiliation(s)
- D Peñarrocha-Oltra
- Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain
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23
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Dong L, Guarino BB, Jordan-Sciutto KL, Winkelstein BA. Activating transcription factor 4, a mediator of the integrated stress response, is increased in the dorsal root ganglia following painful facet joint distraction. Neuroscience 2011; 193:377-86. [PMID: 21821103 PMCID: PMC3171593 DOI: 10.1016/j.neuroscience.2011.07.059] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 07/01/2011] [Accepted: 07/24/2011] [Indexed: 02/06/2023]
Abstract
Chronic neck pain is one of the most common musculoskeletal disorders in the US. Although biomechanical and clinical studies have implicated the facet joint as a primary source of neck pain, specific cellular mechanisms still remain speculative. The purpose of this study was to investigate whether a mediator (activating transcription factor; 4ATF4) of the integrated stress response (ISR) is involved in facet-mediated pain. Holtzman rats underwent C6/C7 facet joint loading that produces either painful (n=16) or nonpainful (n=8) responses. A sham group (n=9) was also included as surgical controls. Behavioral sensitivity was measured and the C6 dorsal root ganglia (DRGs) were harvested on day 7 to evaluate the total and neuronal ATF4 expression. In separate groups, an intra-articular ketorolac injection was administered either immediately (D0 ketorolac) or 1 day (D1 ketorolac) after painful facet joint loading. Allodynia was measured at days 1 and 7 after injury to assess the effects on behavioral responses. ATF4 and BiP (an indicator of ISR activation) were separately quantified at day 7. Facet joint loading sufficient to elicit behavioral hypersensitivity produced a threefold increase in total and neuronal ATF4 expression in the DRG. After ketorolac treatment at the time of injury, ATF4 expression was significantly (P<0.01) reduced despite not producing any attenuation of behavioral responses. Interestingly, ketorolac treatment at day 1 significantly (P<0.001) alleviated behavioral sensitivity at day 7, but did not modify ATF4 expression. BiP expression was unchanged after either intervention time. Results suggest that ATF4-dependent activation of the ISR does not directly contribute to persistent pain, but it may sensitize neurons responsible for pain initiation. These behavioral and immunohistochemical findings imply that facet-mediated pain may be sustained through other pathways of the ISR.
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Affiliation(s)
- Ling Dong
- Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104, USA
| | - Benjamin B. Guarino
- Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104, USA
| | | | - Beth A. Winkelstein
- Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104, USA
- Department of Neurosurgery University of Pennsylvania Philadelphia, PA 19104, USA
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Abstract
Contrary to a clinical aphorism that early head and neck cancer is painless, we show that patients who develop head and neck cancer experience significant pain at the time of initial diagnosis. We compared orofacial pain sensitivity in groups of patients with normal oral mucosa, oral precancer, and newly diagnosed oral cancer. The University of California San Francisco Oral Cancer Pain Questionnaire was administered to these patients at their initial visit, before being prescribed analgesics for pain and before any treatment. In contrast to those with biopsy-proven normal oral mucosa and oral precancer, only oral cancer patients reported significant levels of spontaneous pain and functional restriction from pain. Moreover, oral cancer patients experienced significantly higher function-related, rather than spontaneous, pain qualities. These findings suggest an important predictor for the transition from oral precancer to cancer may be the onset of orofacial pain that is exacerbated during function. Screening patients who have new-onset orofacial pain may lead to a diagnosis of early resectable head and neck cancer and may improve quality of life and survival for head and neck cancer patients.
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Affiliation(s)
- David K Lam
- Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, USA Bluestone Center for Clinical Research, New York University, New York, NY, USA Department of Oral and Maxillofacial Surgery, New York University, New York, NY, USA
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25
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Gerstner G, Ichesco E, Quintero A, Schmidt-Wilcke T. Changes in regional gray and white matter volume in patients with myofascial-type temporomandibular disorders: a voxel-based morphometry study. J Orofac Pain 2011; 25:99-106. [PMID: 21528116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIMS To use magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) to search for evidence of altered brain morphology in patients with temporomandibular disorders (TMD). METHODS Using VBM, regional gray and white matter volume was investigated in nine TMD patients and nine carefully matched healthy controls. RESULTS A decrease in gray matter volume occurred in the left anterior cingulate gyrus, in the right posterior cingulate gyrus, the right anterior insular cortex, left inferior frontal gyrus, as well as the superior temporal gyrus bilaterally in the TMD patients. Also, white matter analyses revealed decreases in regional white matter volume in the medial prefrontal cortex bilaterally in TMD patients. CONCLUSION These data support previous findings by showing that TMD, like other chronic pain states, is associated with changes in brain morphology in brain regions known to be part of the central pain system.
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Affiliation(s)
- Geoffrey Gerstner
- Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA
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Lee S, Zhao YQ, Ribeiro-da-Silva A, Zhang J. Distinctive response of CNS glial cells in oro-facial pain associated with injury, infection and inflammation. Mol Pain 2010; 6:79. [PMID: 21067602 PMCID: PMC2992508 DOI: 10.1186/1744-8069-6-79] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 11/10/2010] [Indexed: 11/10/2022] Open
Abstract
Oro-facial pain following injury and infection is frequently observed in dental clinics. While neuropathic pain evoked by injury associated with nerve lesion has an involvement of glia/immune cells, inflammatory hyperalgesia has an exaggerated sensitization mediated by local and circulating immune mediators. To better understand the contribution of central nervous system (CNS) glial cells in these different pathological conditions, in this study we sought to characterize functional phenotypes of glial cells in response to trigeminal nerve injury (loose ligation of the mental branch), infection (subcutaneous injection of lipopolysaccharide--LPS) and to sterile inflammation (subcutaneous injection of complete Freund's adjuvant--CFA) on the lower lip. Each of the three insults triggered a specific pattern of mechanical allodynia. In parallel with changes in sensory response, CNS glial cells reacted distinctively to the challenges. Following ligation of the mental nerve, both microglia and astrocytes in the trigeminal nuclear complex were highly activated, more prominent in the principal sensory nucleus (Pr5) and subnucleus caudalis (Sp5C) area. Microglial response was initiated early (days 3-14), followed by delayed astrocytes activation (days 7-28). Although the temporal profile of microglial and astrocyte reaction corresponded respectively to the initiation and chronic stage of neuropathic pain, these activated glial cells exhibited a low profile of cytokine expression. Local injection of LPS in the lower lip skin also triggered a microglial reaction in the brain, which started in the circumventricular organs (CVOs) at 5 hours post-injection and diffused progressively into the brain parenchyma at 48 hours. This LPS-induced microglial reaction was accompanied by a robust induction of IκB-α mRNA and pro-inflammatory cytokines within the CVOs. However, LPS induced microglial activation did not specifically occur along the pain signaling pathway. In contrast, CFA injection led to minor microglial morphological changes and an induction of IκB-α mRNA in the CVO regions; a significant increase in IL-1β and IL-6 mRNA started only at 48 hours post-injection, when the induced pain-related behavior started to resolve. Our detailed analysis of CNS glial response clearly revealed that both nerve injury and oro-facial infection/inflammation induced CNS glial activation, but in a completely different pattern, which suggests a remarkable plasticity of glial cells in response to dynamic changes in their microenvironment and different potential involvement of this non-neuronal cell population in pathological pain development.
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Affiliation(s)
- SeungHwan Lee
- The Alan Edwards Centre for Research on Pain, McGill University, 740, Dr. Penfield Ave. Montreal, Quebec, H3A 2B2, Canada
- Faculty of Dentistry; McGill University, Quebec, Canada
| | - Yuan Qing Zhao
- The Alan Edwards Centre for Research on Pain, McGill University, 740, Dr. Penfield Ave. Montreal, Quebec, H3A 2B2, Canada
- Faculty of Dentistry; McGill University, Quebec, Canada
| | - Alfredo Ribeiro-da-Silva
- The Alan Edwards Centre for Research on Pain, McGill University, 740, Dr. Penfield Ave. Montreal, Quebec, H3A 2B2, Canada
- Department of Pharmacology, Faculty of Medicine, McGill University, Quebec, Canada
| | - Ji Zhang
- The Alan Edwards Centre for Research on Pain, McGill University, 740, Dr. Penfield Ave. Montreal, Quebec, H3A 2B2, Canada
- Faculty of Dentistry; McGill University, Quebec, Canada
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Quebec, Canada
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Volkov AG, Stagnieva IV, Eroshenko AI. [Significance of local pain syndrome in patients with frontitis]. Vestn Otorinolaringol 2010:38-40. [PMID: 21105344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The diagnostic value of local pain symptom as a key sign of frontitis is currently regarded as rather low. It occurred only in 69 (14%) of the 487 patients with this disease examined in the present study. Patients presenting with ambiguous symptoms of uncomplicated unilateral frontitis were studied by rheofrontography using coefficient of asymmetry as a diagnostic criterion (its value in excess of 24% indicates the presence of exudate in the sinus cavity. The electron microscopic study demonstrated the presence of morphologically different cells in frontal sinus mucosa of patients with uncomplicated frontitis with and without local pain symptom. These findings are in excellent agreement with the data on the relationship between immunological and neurogenic components of the inflammatory reaction in patients with diseases of the upper respiratory tract.
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Maitra S, Gupta D, Radojkovic M, Sood S. Osseous metaplasia of the maxillary sinus with formation of a well-developed haversian system and bone marrow. Ear Nose Throat J 2009; 88:1115-1120. [PMID: 19750475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Osteogenesis in the maxillary sinus is a lesser known entity in otolaryngology, although it is put to good therapeutic use by maxillofacial surgeons. We present a case of postoperative osseous metaplasia in the maxillary sinus that led to the formation of mature bone with a well-developed haversian system and bone marrow. Such a finding has not been previously reported as a complication of endoscopic sinus surgery. This case highlights the importance of keeping in mind the possibility of osteogenesis within the maxillary sinus in patients who experience a recurrence of symptoms following sinus surgery.
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Affiliation(s)
- Suchir Maitra
- Department of Otorhinolaryngology, Great Western Hospital, Swindon, Wiltshire, UK
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29
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van Selms MKA, Naeije M, van der Zaag J, Lobbezoo F. [Myogenous temporomandibular pain: treat with care!]. Ned Tijdschr Tandheelkd 2009; 116:260-265. [PMID: 19507420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
For the treatment of myogenous temporomandibular pain, a clinician can choose from among a wide variety of possibilities. Unfortunately, a paper summarizing the effectiveness of all these forms of treatment does not yet exist. The aim of this paper is to provide specific advice for dentists concerning the treatment of patients with myogenous temporomandibular pain by means of a systematic review of the relevant literature. The results of this review of the literature suggest that all forms of treatment selected, including treatment with placeboes, are equally effective in reducing myogenous temporomandibular pain. In order to avoid liability issues, it is advisable to choose for a restrained, reversible form of treatment. The dentist and the patient must, in this respect, be aware that the pain can continue after treatment (albeit at a reduced level) or can return after a period of time.
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Affiliation(s)
- M K A van Selms
- Afdeling Functieleer en Restauratieve Tandheelkunde, sectie Orale Kinesiologie, van het Academisch Centrum Tandheelkunde Amsterdam (ACTA).
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Caminero AB, Mateos V. [A clinical approach to cranial neuralgias]. Rev Neurol 2009; 48:365-373. [PMID: 19319818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The International Association for the Study of Pain defines neuralgia as the pain that is felt in the distribution of a nerve or nerve root. Although the most important criterion for its diagnosis is spatial, distinguishing between neuralgia and other types of pain in the craniofacial area will only be possible by looking at a set of many clinical characteristics as a whole. DEVELOPMENT Knowledge of the territories of sensory distribution of the nerves or roots is essential to be able to define the location of the pain in neuralgias. Other attributes are also useful for diagnosing them: the quality of the pain (paroxysmal, stinging-burning, dull), the time profile (seconds-minutes versus hours-days), the absence of accompanying phenomena other than certain manifestations of sensory dysfunction, especially in the symptomatic forms (hypoanaesthesia, paresthesias, dysesthesias, allodynia, hyperalgesia, hyperpathy), pain triggered by tactile or mechanical stimuli in the painful territory ('trigger' zones) or a positive Tinel's sign, the response to anaesthetic blockade of the nerve or root, and the response to certain drugs. CONCLUSIONS Although trigeminal neuralgia is the most frequent, there are many other kinds of craniofacial neuralgias, in fact, theoretically, the total number is the same as the number of nerve roots and nerves responsible for the sensory innervation of these anatomical regions. It is essential to be familiar with them to obtain a correct diagnosis.
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Affiliation(s)
- A B Caminero
- Servicio de Neurología, Clínica Santa Teresa, Avila, España.
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31
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Lima SM, de Souza Maliska MC, Dimitroulis G, Modolo F, Nazareno Gil J. Painful deviation of the mandible. ACTA ACUST UNITED AC 2009; 107:749-53. [PMID: 19230727 DOI: 10.1016/j.tripleo.2009.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 12/25/2008] [Accepted: 01/03/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Sergio Monteiro Lima
- Department of Oral and Maxillofacial Surgery, Federal University of Santa Catarina, Florianópolis, Brazil.
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Friedrich RE. Long-term follow-up control of pedunculated orbital floor osteoma becoming symptomatic by atypical facial pain. In Vivo 2009; 23:117-121. [PMID: 19368135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This report describes the clinical course of a female who developed an osteoma of the orbital floor. Initially, the patient noticed a pain in the left periorbital region, in particular in the region of the lower eyelid and the upper cheek. A radiograph of the midfacial region was taken that depicted a mushroom-like tumor of the orbital floor. The tumor was surgically removed. The follow-up over a period of 13 years revealed no recurrence of the osteoma.
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Affiliation(s)
- Reinhard E Friedrich
- Oral and Maxillofacial Surgery (Nordwestdeutsche Kieferklinik), Eppendorf Medical Center, University of Hamburg, Germany.
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Sands NB, Tewfik MA, Hwang SY, Desrosiers M. Extranodal T-cell lymphoma of the sinonasal tract presenting as severe rhinitis: case series. J Otolaryngol Head Neck Surg 2008; 37:528-533. [PMID: 19128588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Systemic diseases such as Wegener granulomatosis, Churg-Strauss syndrome, and sarcoidosis can present initially as severe rhinitis alone. One clinical entity that mimics severe rhinitis and thus poses a particular challenge in this regard is extranodal T-cell lymphoma of the sinonasal tract. Sinonasal lymphoma has a vague initial presentation that masquerades as more common, benign causes of rhinitis but progresses as a "midfacial progressive destructive lesion" and is uniformly fatal if untreated. In the absence of systemic involvement, the precise etiology frequently defies diagnosis. We present a series of illustrative cases to raise awareness of this rare yet lethal disease to help reduce the therapeutic delays that are currently encountered clinically. METHODS A retrospective case series of four patients was reviewed. Each patient presented initially with severe rhinitis but was later diagnosed with extranodal natural killer/T-cell non-Hodgkin lymphoma of the sinonasal tract. RESULTS The predominant presenting symptoms were unilateral nasal obstruction (four patients), rhinitis (three patients), and facial pain (two patients). Only one patient reported systemic B symptoms. Initial management of all four patients included repeated biopsies revealing nonspecific inflammation, which resulted in extensive therapeutic delays (mean time until diagnosis 21.5 months). The primary outcomes were two deaths and two complete remissions. CONCLUSION The challenge in making an early diagnosis of T-cell lymphoma of the sinonasal tract has been reaffirmed in our case series. We emphasize that diagnosis requires a high index of clinical suspicion in combination with multiple deep and appropriately processed biopsies that are submitted for immunohistochemistry and molecular studies.
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Affiliation(s)
- Noah B Sands
- Department of Otolaryngology, Montreal General Hospital, McGill University, Montreal, Quebec
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Walters H, Lewis E, Wolper R, Yachnis AT, Green J, Lewis S. Neurotropic melanoma of the trigeminal nerve: a case of atypical facial pain. J Oral Maxillofac Surg 2008; 66:547-50. [PMID: 18280392 DOI: 10.1016/j.joms.2006.11.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 10/11/2006] [Accepted: 11/17/2006] [Indexed: 11/18/2022]
Affiliation(s)
- Hugh Walters
- General Surgery, University of Florida College of Medicine, Gainesville, FL, USA
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Abstract
OBJECTIVE To describe the clinical and laboratory features of a painful non-length dependent, small fibre ganglionopathy (SFG). BACKGROUND The syndrome of generalised SFG with early involvement of the face, trunk or proximal limbs is not well recognised and contrasts with the burning feet syndrome of small fibre neuropathy (SFN) and classical large fibre features of sensory ganglionopathy. METHODS Retrospective case review including skin biopsies from four neuromuscular centres. Patients with pre-existing diseases associated with ganglionopathies were excluded. RESULTS 12 men and 11 women, with an average age of 50 years, were studied. Neuropathic pain developed over days in eight and over months in the other patients. The face (n = 12), scalp (n = 10), tongue (n = 6), trunk (n = 15) and acral extremities (n = 21) were involved. Symptoms began in the hands or face before the legs in 10. The pain was characterised as burning (n = 22), prickling (n = 13), shooting (n = 13) or allodynic (n = 11). There was loss of pinprick sensation in affected regions in 19, with minimal or no loss of large fibre sensibility. Laboratory findings included abnormal glucose metabolism in six patients, Sjögren syndrome in three and monoclonal gammopathy, sprue and hepatitis C infection in one each, with the remainder idiopathic. Sensory nerve action potentials were normal in 12 and were reduced in the hands but normal in the legs in six. Skin biopsy in 14 of 17 showed reduced nerve fibre density in the thigh equal to or more prominent than in the calf. Two of seven patients improved with immune therapies, 13 symptomatically with analgesic medications and the remainder had little improvement. Ten considered the pain disabling at the last follow-up (mean 2 years). CONCLUSION The pattern of symmetric, non-length dependent neuropathic pain with face and trunk involvement suggests a selective disorder of the dorsal ganglia cells subserving small nerve fibres. It can be distinguished from distal SFN. A potential metabolic or immune process was detected in half of the cases and the disorder was often refractory to treatment.
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Affiliation(s)
- K C Gorson
- Department of Neurology, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02135, USA.
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Deodato F, Cristiano S, Giorgetti R. Disc-temporal adhesion and conservative functional approach: clinical evidence. Prog Orthod 2008; 9:48-61. [PMID: 19294240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
The Authors show the formative mechanism of disco-temporal adhesion which is a frequent disorder difficult to detect. The mechanisms of articular tension and compression are possible, possible etiopathogenetic factors. In order to point out as the integration of diagnostic and therapeutic methods can frequently provide satisfactory results in the conservative ambit, two clinical cases are described. Diagnostic-therapy iter must be individually planned according to the anatomo-functional situation and to the requests of the patient. Clinical monitoring, diagnostic and therapeutic attention and refinement are the rudiments in the approach to these problems.
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Abstract
Idiopathic trigeminal neuralgia is almost always associated with pathological nerve/vessel contact. Symptomatic forms of trigeminal neuralgia include cases of multiple sclerosis, infratentorial tumours and postherpetic neuralgia. Vascular malformations causing neuralgia have rarely been reported. We present the case of a 55-year old woman, who suffered from facial pain and ptosis on her left side. Repeated neurological examinations as well as repeated magnetic resonance imaging did not lead to a definite diagnosis or therapy. The pain suddenly stopped three weeks before admission and only a slight left sided facial hypaesthesia persisted. Reevaluating the older MRI we found a small signal alteration of 2 mm in the caudal part of the left trigeminal nucleus. A new MRI showed a subacute haemorrhage into a small brainstem cavernoma, which must have caused the pain and later on the hypaesthesia. Small vascular malformations are a rare cause of neuropathic facial pain.
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Affiliation(s)
- J-P Stellmann
- Asklepios Klinik Harburg-Neurologie, Eissendorfer Pferdeweg 52, 21075 Hamburg.
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Chiba M, Kumagai M, Echigo S. Association between high signal intensity in the posterior disc attachment seen on T2 weighted fat-suppressed images and temporomandibular joint pain. Dentomaxillofac Radiol 2007; 36:187-91. [PMID: 17536084 DOI: 10.1259/dmfr/86899638] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We sought to determine whether high signal intensity in the posterior disc attachment (PDA) seen on T2 weighted fat-suppressed MRI is associated with temporomandibular joint (TMJ) pain and joint pathology. METHODS This study was based on 283 TMJs of 177 patients (31 males and 146 females, mean age 32.7 years) with TMJ disorders showing anterior disc displacement. MRI evaluation included assessment of signal intensity in the PDA and TMJ status (disc displacement with reduction, disc displacement without reduction and disc displacement with bone changes). Clinical criteria that were considered positive indicators of TMJ pain included the presence of pre-auricular pain during palpation, jaw function and assisted or unassisted mandibular opening. Association of signal intensity in the PDA with joint pain and TMJ status was analysed using chi2 test. RESULTS Joint pain was reported in 47 (77.0%) out of 61 joints with high signal intensity in the PDA and in 97 (43.7%) out of 222 joints with low signal intensity in the PDA (P<0.0001). High signal intensity in the PDA correlated closely with more advanced joint pathology. In joints with anterior disc displacement with bone changes, TMJ pain was more commonly reported in joints with high signal intensity in the PDA than with low signal intensity in the PDA (P<0.0001). CONCLUSIONS High signal intensity in the PDA on T2 weighted fat-suppressed MRI is associated with TMJ pain in TMJ disorders with anterior disc displacement with bone changes in the mandibular condyles.
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Affiliation(s)
- M Chiba
- Division of Oral Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Sendai 980-8575, Japan.
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Dessem D, Moritani M, Ambalavanar R. Nociceptive craniofacial muscle primary afferent neurons synapse in both the rostral and caudal brain stem. J Neurophysiol 2007; 98:214-23. [PMID: 17493918 DOI: 10.1152/jn.00990.2006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Limited information is available on muscle afferent neurons with fine fibers despite their presumed participation in musculoskeletal disorders, including temporomandibular disorders. To study these neurons, intracellular recordings were made from the central axons of slowly conducting muscle afferent neurons in anesthetized rats. After intraaxonal impalement, axons were characterized by masseter nerve stimulation, receptive field testing, muscle stretching and intramuscular injection of hypertonic saline. Intracellular recordings were made from 310 axons (conduction velocity: 6.5-60(M)/s, mean = 27.3(M)/s; following frequency: 27-250 Hz, mean = 110Hz). No neurons responded to cutaneous palpation or muscle stretching. Some axons (n = 34) were intracellularly stained with biotinamide. These neurons were classified as group II/III noxious mechanoreceptors because their mechanical threshold exceeded 15 mN, and conduction velocities ranged from 12 to 40.2(M)/s (mean = 25.3(M)/s). Two morphological types were recognized by using an object-based, three-dimensional colocalization methodology to locate synapses. One type (IIIHTM(Vp-Vc)) possessed axon collaterals that emerged along the entire main axon and synapsed in the trigeminal principal sensory nucleus and spinal trigeminal subnuclei oralis (Vo), interpolaris (Vi), and caudalis (Vc). A second type (IIIHTM(Vo-Vc)) possessed axon collaterals that synapsed only in caudal Vo, Vi, and Vc. Our previous studies show that muscle spindle afferent neurons are activated by innocuous stimuli and synapse in the rostral and caudal brain stem; here we demonstrate that nociceptive muscle mechanoreceptor afferent axons also synapse in rostral and caudal brain stem regions. Traditional dogma asserts that the most rostral trigeminal sensory complex exclusively processes innocuous somatosensory information, whereas caudal portions receive nociceptive sensory input; the data reported here do not support this paradigm.
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Affiliation(s)
- Dean Dessem
- Dept of Biomedical Sciences, University of Maryland, Baltimore, MD 21201, USA.
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Moustapha G, Chidiac JJ. Contribution of sympathetic innervation in orofacial pain: a review. J Med Liban 2007; 55:89-93. [PMID: 17685121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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41
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Stegenga B. [Manifestations of orofacial pain. Preface]. Ned Tijdschr Tandheelkd 2006; 113:430-2. [PMID: 17147022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Pain is possibly the most common reason for patients to seek dental help, and is, therefore, a phenomenon with which dentists are frequently confronted. This special issue of the Dutch Dental Journal considers several aspects of orofacial pain as they are presented by patients. Both common and less frequent disorders causing pain in the orofacial area are described and discussed.
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Affiliation(s)
- B Stegenga
- Universitair Medisch Centrum, Groningen/Rijksuniversiteit, Groningen.
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Abstract
This review deals with the diagnostic usefulness of neurophysiological testing in patients with craniofacial pain. Neurophysiological testing of trigeminal nerve function relies on trigeminal reflexes and laser–evoked potentials (LEPs). This review briefly describes the physiology of trigeminal reflexes and LEPs, reports normal values and highlights the neurophysiological abnormalities in the main clinical conditions.
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Affiliation(s)
- F. Galeotti
- Department of Neurological Sciences, University of Rome “La Sapienza”, Viale Università 30, I-00185 Rome, Italy
| | - A. Truini
- Department of Neurological Sciences, University of Rome “La Sapienza”, Viale Università 30, I-00185 Rome, Italy
| | - G. Cruccu
- Department of Neurological Sciences, University of Rome “La Sapienza”, Viale Università 30, I-00185 Rome, Italy
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Bereiter DA, Cioffi JL, Bereiter DF. Oestrogen receptor-immunoreactive neurons in the trigeminal sensory system of male and cycling female rats. Arch Oral Biol 2006; 50:971-9. [PMID: 15893734 DOI: 10.1016/j.archoralbio.2005.03.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Accepted: 03/04/2005] [Indexed: 12/31/2022]
Abstract
Many common craniofacial pain conditions are more prevalent in women than men and may be related to the phase of the menstrual cycle. Long-term effects of oestrogen in the nervous system are produced by receptor-mediated [oestrogen receptor alpha (ERalpha) and beta (ERbeta) isoforms] mechanisms; however, it is not known if the distribution of ER-positive neurons in the trigeminal system is similar in males and females. Quantitative immunocytochemistry was used to compare the distribution of ERalpha-labelled neurons in the trigeminal brainstem complex (TBC) and ganglion of male and female rats at different stages of the oestrous cycle. A high density of ERalpha-labelled neurons was seen in the superficial laminae (I-III) throughout the trigeminal subnucleus caudalis (Vc) and the upper cervical dorsal horn. Counts of ERalpha-positive neurons in laminae I-III were similar for prooestrous and dioestrous females, while males had fewer cells. The deeper laminae (IV-V) of the Vc and the cervical dorsal horn had few ERalpha-positive neurons in all groups. At the region surrounding the central canal at caudal levels of the Vc, prooestrous females had more ERalpha-positive neurons than dioestrous females or males. Few labelled cells were seen rostral to the trigeminal subnucleus interpolaris/caudalis transition region (Vi/Vc) in any group. In the trigeminal ganglion, prooestrous and dioestrous females had a moderate (8-10%) number of nuclear-labelled small or medium-sized neurons, while males had fewer labelled cells (4.5%). Qualitatively, the pattern of staining for ERbeta was similar, although weaker, than for ERalpha in the trigeminal dorsal horn or ganglion. These results were consistent with the hypothesis that oestrogen acts through trigeminal ganglion cells and caudal portions of the Vc to modulate sensory and autonomic aspects of craniofacial pain in a sex-related manner.
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Affiliation(s)
- D A Bereiter
- Department of Surgery, Rhode Island Hospital/Brown Medical School, 593 Eddy Street 222 Nursing Arts, Providence, RI 02903, USA.
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Liozon E, Ouattara B, Portal MF, Soria P, Loustaud-Ratti V, Vidal E. Head-and-neck swelling: an under-recognized feature of giant cell arteritis. A report of 37 patients. Clin Exp Rheumatol 2006; 24:S20-5. [PMID: 16859591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To describe the frequency of occurrence and characteristics of head-and-neck swelling (HNS) in temporal (giant cell) arteritis (TA). METHODS We analyzed the charts of patients with HNS retrieved from a single department series of 260 consecutive patients with TA and reviewed the published French-English literature. Patients with a swelling limited to the temporal fossa were excluded. RESULTS A history of HNS was elicited in 17 patients in our series (i.e. 6.5%) and in 20 previously published patients. The swelling was an inaugural feature in most cases and was often transient. Ear-nose-and-throat (ENT )symptoms were observed in 80% of the cases, including jaw claudication or pain upon opening mouth in 22, causing trismus in 10. Two patients had permanent visual impairment and 1 had sudden hearing loss. The temporal artery biopsy yielded giant cell arteritis (GCA) in all the patients but 2. The HNS was often painful and mainly involved mainly the orbital region and face, particularly the lower part of the cheeks and maxillae, less often the neck and, rarely, the forehead and tongue. Concurrent localized limb swellings were also observed in 3 patients. The HNS disappeared in all the patients, either spontaneously or under steroid treatment, and recurred only in 6 patients. CONCLUSION HNS is not exceptional in untreated TA and is strongly associated with ENT symptoms and a positive TAB, but not with visual loss or stroke. Such characteristics imply in these cases a prominent, widespread involvement of the external carotid artery system by giant cell arteritis.
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Affiliation(s)
- E Liozon
- Department of Internal Medicine,University Hospital, Limoges, France.
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Affiliation(s)
- Christina K Sun
- Department of Neurology, Centre for Clinical Neurosciences and Neurological Research, St Vincent's Hospital Melbourne, Fitzroy VIC, Australia.
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Grelik C, Allard S, Ribeiro-da-Silva A. Changes in nociceptive sensory innervation in the epidermis of the rat lower lip skin in a model of neuropathic pain. Neurosci Lett 2005; 389:140-5. [PMID: 16139429 DOI: 10.1016/j.neulet.2005.07.056] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Revised: 06/18/2005] [Accepted: 07/20/2005] [Indexed: 12/21/2022]
Abstract
The epidermis is innervated by fine nerve endings that are important in the perception of nociceptive stimuli. However, their role in neuropathic pain is controversial. In this paper, changes in the innervation patterns of epidermal sensory afferent fibres in the rat lower lip have been studied following bilateral chronic constriction injury (CCI) of the mental nerve-a purely sensory branch of the trigeminal nerve. Sections of the lower lip were processed for immunocytochemistry using antibodies against Protein Gene Product (PGP) 9.5 and Calcitonin Gene-Related Peptide (CGRP) to identify the non-peptidergic and the peptidergic populations of nociceptive small diameter primary sensory afferent fibres. Peptidergic fibres co-localised both markers and the non-peptidergic fibres only stained for PGP 9.5 and not for CGRP. We quantified the total fibre length per 6000 microm(2) in the epidermis at several time points following CCI. Our data indicate that both fibre populations were significantly decreased at 2 weeks post-CCI, followed by fibre re-growth at levels above those seen in sham-operated animals at 4 weeks; however, this increase was only statistically significant for the non-peptidergic population. At 8 weeks post-CCI, the fibre lengths of both populations did not differ significantly from shams. This transient hyper-innervation of the epidermis by one subpopulation of nociceptive fibres coincided with the occurrence of spontaneous pain or dysesthetic sensations which we detected in a previous study in the same animal model. Therefore, we speculate that this transient hyper-innervation of the epidermis following injury could play a role in nociception in these animals.
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Affiliation(s)
- C Grelik
- Department of Pharmacology and Therapeutics, 3655 Prom. Sir-William-Osler, Montreal, Que., Canada H3G 1Y6
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Lang E, Naraghi R, Tanrikulu L, Hastreiter P, Fahlbusch R, Neundörfer B, Tröscher-Weber R. Neurovascular relationship at the trigeminal root entry zone in persistent idiopathic facial pain: findings from MRI 3D visualisation. J Neurol Neurosurg Psychiatry 2005; 76:1506-9. [PMID: 16227540 PMCID: PMC1739384 DOI: 10.1136/jnnp.2005.066084] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with atypical neuralgia or atypical facial pain have been surgically treated with microvascular decompression (MVD) of the trigeminal root entry zone (TREZ). There are no data regarding the sensitivity and specificity of a vessel-TREZ relationship as a cause of pain in patients with persistent idiopathic facial pain (PIFP) according to the definition given by the International Headache Society (IHS). METHODS The TREZ was visualised by 3D CISS MRI in 12 patients with unilateral PIFP according to the IHS criteria. RESULTS The frequency of artery-TREZ, vein-TREZ, or vessel (artery/vein)-TREZ contacts on the symptomatic and asymptomatic sides did not differ significantly. On the symptomatic side, vessel-TREZ contact was found in 58% of patients (sensitivity). On the asymptomatic side, vessel-TREZ contact was absent in 33% of patients (specificity). CONCLUSIONS On the basis of the low sensitivity and specificity found in the present study, PIFP cannot be attributed to a vessel-TREZ contact, and therefore, pain relief after MVD cannot be expected.
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Affiliation(s)
- E Lang
- Department of Neurology and Pain Center, University of Erlangen-Nuremberg, D-91054 Erlangen, Germany.
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Shinoda M, Ozaki N, Asai H, Nagamine K, Sugiura Y. Changes in P2X3 receptor expression in the trigeminal ganglion following monoarthritis of the temporomandibular joint in rats. Pain 2005; 116:42-51. [PMID: 15936887 DOI: 10.1016/j.pain.2005.03.042] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Revised: 03/08/2005] [Accepted: 03/29/2005] [Indexed: 11/22/2022]
Abstract
The pathophysiological mechanisms of orofacial deep-tissue pain is still unclear. Previously, P2X receptors (P2XR) in sensory neurons have been shown to play a role in the signal transduction of cutaneous pain. We investigated the functional significance of P2X3R in relation to orofacial deep-tissue pain caused by monoarthritis of the temporomandibular joint (TMJ). Monoarthritis was induced by the injection of complete Freund's adjuvant (CFA) into the unilateral TMJ of the rat. The pain associated with monoarthritis was assessed by the pressure pain threshold (PPT), which was defined as the amount of pressure required to induce vocalization. Fifteen days after CFA-treatment, changes in PPT were examined after injection of P2XR agonists or antagonists into the TMJ. The number of cells expressing P2X3R in trigeminal ganglia (TG) was investigated by immunohistochemistry. Inflamed TMJ showed a continuous decline in PPT during the experimental period (P<0.001). Injection of alpha,beta-meATP, an agonist of P2X1,3,2/3R, dramatically reduced the bilateral PPTs of both inflamed and non-inflamed TMJs (P<0.01) although beta,gamma-me-l-ATP, a selective agonist of P2X1R, did not. The decreased PPTs of inflamed TMJ were reversed either by PPADS, an antagonist of P2X1,2,3,5,1/5,4/5R, or by TNP-ATP, an antagonist of P2X1,3,2/3,1/5R. Immunohistochemically, the number of P2X3R-positive cells increased in the small cell group in TG (P<0.01), whereas there was no change in medium or large cell groups after the CFA-injection. Retrograde tracing confirmed that TMJ neurons in the TG exhibited P2X3R immunoreactivity. Our results suggested that P2X3R plays an important role in orofacial pressure pain caused by monoarthritis of TMJ.
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Affiliation(s)
- Masamichi Shinoda
- Department of Functional Anatomy and Neuroscience, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya 466-8550, Japan
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Abstract
The diagnosis of facial pain has been a source of confusion for neuroscientists and primary care givers alike. The profusion of various subtypes, differential syndromes, and confusing nomenclature is silent testimony to this dilemma. The author presents a simple scheme with which to arrive at the diagnosis. The use of the patient's history, confirmed by the physical examination, can be supplemented with some of the tests described herein.
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Affiliation(s)
- Kenneth F Casey
- Peter J. Jannetta Center for Cranial Nerve Disorders, Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212., USA.
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