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 Table of Contents  
GUEST EDITORIAL
Year : 2016  |  Volume : 16  |  Issue : 2  |  Page : 114-115

Neuropathic pain


Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, C 850, 07103, Newark, NJ, USA

Date of Web Publication28-Mar-2016

Correspondence Address:
Junad Khan
Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, C 850, 07103, Newark, NJ
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4052.179317

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How to cite this article:
Khan J. Neuropathic pain. J Indian Prosthodont Soc 2016;16:114-5

How to cite this URL:
Khan J. Neuropathic pain. J Indian Prosthodont Soc [serial online] 2016 [cited 2019 Apr 25];16:114-5. Available from: http://www.j-ips.org/text.asp?2016/16/2/114/179317

Neuropathic pain (NP) is defined as ''pain arising as a direct consequence of any lesion or disease affecting the somatosensory system." [1],[2] Although NP may be an idiopathic process reflecting abnormal sensory processing in the peripheral or central nervous system, it more often appears following physical insult or disease affecting the peripheral or central nervous system. It is likely that chronic peripheral neuropathy may lead to neuroplastic changes and affect the central nervous system. These functional and anatomical changes can exacerbate the overall experience of pain. As the changes become more chronic, co-morbid conditions such as sleep disorders, anxiety and depression can accompany the chronic pain, and further complicate treatment.

The prevalence of NP conditions is difficult to establish. There are many confounding factors that may lead to under-reporting of NP. In primary medical care settings, the prevalence has been reported to be between 2 and 11%. [3],[4] Studies have focused on specific NP conditions, secondary to other pathological conditions. It has been shown that the about 26% of patients with type 2 diabetes can experience neuropathy. Cancer patients indicate a prevalence of 19-39. About 1% and 37% of chronic low back pain patients may have a neuropathic component related to it. [5],[6],[7] Even with high prevalence in chronic conditions, the overall numbers of NP conditions tends to be small. One of the reasons is the lack of identification, diagnosis, and treatment. There is no standard approach between health care providers for NP. NP can be localized to the craniofacial region such as in trigeminal and glossopharyngeal neuralgia, painful traumatic trigeminal neuropathy (PTTN), burning mouth syndrome, or may affect other areas of the body such as in case of diabetic neuropathy. In the orofacial region, NP mainly affects the trigeminal nerve and can be referred to as Neuropathic Orofacial Pain (NOP).

Peripheral NP can be a result of nerve damage. Different types of nerve damage such as crush, transection, partial transection, and inflammatory insult can induce various clinical pain presentations and further complicate the process of diagnosis and management. In the orofacial region, development of pain following nerve damage (i.e., PTTN) is around 3-5%, which is low when compared to other parts of the body, where an incidence of painful traumatic neuropathy is 5-17%. [8],[9],[10],[11] PTTN secondary to dental procedures can be a major complication. Third molar extractions have been reported to cause altered sensations in 0.3-1% of cases. [12],[13],[14] Persistent pain after successful endodontics has been found to occur in 3-13% of the patients. [15],[16],[17] The incidence of neurosensory disturbance post implant can range anywhere from 0.6 to 36%. [18],[19],[20],[21]

Causes of central pain may include trauma, cerebrovascular injuries, tumors, multiple sclerosis, and Parkinson's disease. NP can also be classified based on frequency into continuous or episodic. Episodic neuropathies are usually characterized by short, sudden, sharp, or electrical like paroxysmal pain. The pain is usually severe and sporadic in nature. Continuous NP is usually characterized by continuous dull pain of mild to moderate intensity with occasional paroxysms of pain.

There is presently no definitive cure to this condition, and the available treatment requires long-term prescription medications with significant side effects. In some cases, surgical procedures and adjunctive therapy are also recommended. Evaluation of sensory alterations can be performed using quantitative sensory testing which is a noninvasive assessment of normal and abnormal responses of the nervous system to various stimuli. Mapping and sketches of the affected area can help treatment decisions and management. The medications used for NP can include antidepressants, anticonvulsants, antiarrhythmics, opioids and nonopioid analgesics, and topical medications. [22] Adjunctive treatment can include but is not limited to a variety of options which include physical therapy, acupuncture, hypnosis, counseling, biofeedback, massage, relaxation, pressure, herbs, yoga, exercise, and electrotherapy. The prevailing "trial and error" approach to NP treatment includes a titration regimen of 3-8 weeks which is very often repeated several times before an effective medication for the individual patient is identified. As health care providers it is important to recognize NOP conditions to avoid unnecessary treatment and suffering.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Haanpää M, Attal N, Backonja M, Baron R, Bennett M, Bouhassira D, et al. NeuPSIG guidelines on neuropathic pain assessment. Pain 2011;152:14-27.  Back to cited text no. 1
    
2.
Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, et al. Neuropathic pain: Redefinition and a grading system for clinical and research purposes. Neurology 2008;70:1630-5.  Back to cited text no. 2
    
3.
Clark JD. Chronic pain prevalence and analgesic prescribing in a general medical population. J Pain Symptom Manage 2002;23:131-7.  Back to cited text no. 3
    
4.
Koleva D, Krulichova I, Bertolini G, Caimi V, Garattini L. Pain in primary care: An Italian survey. Eur J Public Health 2005;15:475-9.  Back to cited text no. 4
    
5.
Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care 2006;29:1518-22.  Back to cited text no. 5
    
6.
Freynhagen R, Baron R, Tölle T, Stemmler E, Gockel U, Stevens M, et al. Screening of neuropathic pain components in patients with chronic back pain associated with nerve root compression: A prospective observational pilot study (MIPORT). Curr Med Res Opin 2006;22:529-37.  Back to cited text no. 6
    
7.
Bennett MI, Rayment C, Hjermstad M, Aass N, Caraceni A, Kaasa S. Prevalence and aetiology of neuropathic pain in cancer patients: A systematic review. Pain 2012;153:359-65.  Back to cited text no. 7
    
8.
Jääskeläinen SK, Teerijoki-Oksa T, Virtanen A, Tenovuo O, Forssell H. Sensory regeneration following intraoperatively verified trigeminal nerve injury. Neurology 2004;62:1951-7.  Back to cited text no. 8
    
9.
Macrae WA. Chronic pain after surgery. Br J Anaesth 2001;87:88-98.  Back to cited text no. 9
    
10.
Beniczky S, Tajti J, Tímea Varga E, Vécsei L. Evidence-based pharmacological treatment of neuropathic pain syndromes. J Neural Transm (Vienna) 2005;112:735-49.  Back to cited text no. 10
    
11.
Benoliel R, Birenboim R, Regev E, Eliav E. Neurosensory changes in the infraorbital nerve following zygomatic fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:657-65.  Back to cited text no. 11
    
12.
Carmichael FA, McGowan DA. Incidence of nerve damage following third molar removal: A West of Scotland Oral Surgery Research Group study. Br J Oral Maxillofac Surg 1992;30:78-82.  Back to cited text no. 12
    
13.
Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Inferior alveolar nerve damage after lower third molar surgical extraction: A prospective study of 1117 surgical extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:377-83.  Back to cited text no. 13
    
14.
Robinson PP, Smith KG. Lingual nerve damage during lower third molar removal: A comparison of two surgical methods. Br Dent J 1996;180:456-61.  Back to cited text no. 14
    
15.
Lobb WK, Zakariasen KL, McGrath PJ. Endodontic treatment outcomes: Do patients perceive problems? J Am Dent Assoc 1996;127:597-600.  Back to cited text no. 15
    
16.
Polycarpou N, Ng YL, Canavan D, Moles DR, Gulabivala K. Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing. Int Endod J 2005;38:169-78.  Back to cited text no. 16
    
17.
Campbell RL, Parks KW, Dodds RN. Chronic facial pain associated with endodontic therapy. Oral Surg Oral Med Oral Pathol 1990;69:287-90.  Back to cited text no. 17
    
18.
Albrektsson T. A multicenter report on osseointegrated oral implants. J Prosthet Dent 1988;60:75-84.  Back to cited text no. 18
    
19.
Haas DA, Lennon D. A 21 year retrospective study of reports of paresthesia following local anesthetic administration. J Can Dent Assoc 1995;61:319-20, 323-6, 329-30.  Back to cited text no. 19
    
20.
Higuchi KW, Folmer T, Kultje C. Implant survival rates in partially edentulous patients: A 3-year prospective multicenter study. J Oral Maxillofac Surg 1995;53:264-8.  Back to cited text no. 20
    
21.
Gregg JM. Neuropathic complications of mandibular implant surgery: Review and case presentations. Ann R Australas Coll Dent Surg 2000;15:176-80.  Back to cited text no. 21
    
22.
Mendell JR, Sahenk Z. Clinical practice. Painful sensory neuropathy. N Engl J Med 2003;348:1243-55.  Back to cited text no. 22
    




 

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