Altered cortical excitability in persistent idiopathic facial pain

Galhardoni, Ricardo; Andrade, Daniel Ciampi de; Puerta, Mariana Yumi Takahashi; Brunoni, André R.; Varotto, Bruna Luiza Roim; Siqueira, José Tadeu Tesseroli de; Teixeira, Manoel Jacobsen; Siqueira, Sílvia Regina Dowgan Tesseroli de

doi:10.1177/0333102418780426

Cited by 11 publications

(8 citation statements)

References 33 publications

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“…15 Recently, it was also suggested that PIFP might be associated with alterations in intracortical GABAergic modulation. 11 In line with the pathophysiological concept of a central pain component in patients with PIFP, we hypothesized that they would show alterations in trigeminal pain processing when contrasted against healthy controls (HC) and performed event-related brainstem functional magnetic resonance imaging (fMRI) using a wellestablished trigeminal nociceptive test paradigm. 24,26 It is noteworthy that intranasal ammonia as used in this experiment has an olfactory component shown in mice and that intranasal trigeminal stimulation…”

Section: (Criterion C 2 Of Pifp)mentioning

confidence: 99%

Altered trigeminal pain processing on brainstem level in persistent idiopathic facial pain

Ziegeler

Schulte

May

2020

Pain

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Persistent idiopathic facial pain (PIFP) is a poorly understood chronic pain syndrome of the face, formerly known as atypical facial pain. It is characterized by a constant painful sensation without neurological abnormalities and without clinically objectifiable cause. Similarities to neuropathic pain conditions have been discussed and are currently thought to be relevant for the pathophysiology of this disease. In this study, we aim to characterize the trigeminal pain processing in PIFP using functional magnetic resonance imaging of the brainstem. Twenty-five patients suffering from PIFP and 25 healthy controls underwent a standardized and well-established paradigm of painful stimulation of the trigeminal nerve using gaseous ammonia. Functional images were acquired within a 3T magnetic resonance imaging scanner using an optimized protocol for high-resolution echo planar brainstem imaging. Patients with PIFP show exclusively a stronger activation to painful stimulation in the spinal trigeminal nucleus when contrasted against healthy controls. Our data suggest that abnormal central pain processing plays a role in the pathophysiology of PIFP. An integration of these findings into neuropathic pain models might help to gain a better general understanding of the pathophysiology of PIFP.

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Section: (Criterion C 2 Of Pifp)mentioning

confidence: 99%

Altered trigeminal pain processing on brainstem level in persistent idiopathic facial pain

Ziegeler

Schulte

May

2020

Pain

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“…A recent study on PIFP patients using cortical excitability measurements by transcranial magnetic stimulation applied to the cortical representation of the masseter muscle of both hemispheres showed changes in in-tracortical modulation involving GABAergic mechanisms, which may be related to certain aspects of the pathophysiology of this chronic pain condition [12]. Significant disturbances in somatosensory function, also called "central sensitization", may explain the generalized dysfunction of the nociceptive system with imbalance between descending inhibitory and facilitatory mechanisms or deficiencies related to diffuse noxious control system [13]. Finally, some observations postulate that PIFP may involve a disproportionate response to mild injury, as occurs in patients with CRPS (Complex Regional Pain Syndrome), affected by traumatic injury and neuropathic response [14].…”

Section: Discussionmentioning

confidence: 99%

Persistent Idiopathic Facial Pain (PIFP) in Patients Referred to a Multidisciplinary Centre in Italy: A Retrospective Observational Study

Schweiger

Nocini

Santis

et al. 2022

JCM

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Background: Persistent Idiopathic Facial Pain (PIFP), previously named Atypical Facial Pain (AFP) is a poorly understood condition, often diagnosed after several inconclusive investigations. The aim of this retrospective study was to evaluate the demographic and clinical characteristics of patients with PIFP referred to a Facial Pain Center. Methods: Between May 2011 and September 2014, data on 41 PIFP patients were analyzed regarding temporal, topographical and descriptive pain features, including onset, localization, pain descriptors and intensity. Pharmacological pain treatments were also registered. Finally, the presence and type of previous minor oro-surgery procedures in the painful area were investigated. Results: Demographic and clinical characterization were similar to PIFP patients reported in literature. The presence of previous minor oro-surgery procedures in the painful area was reported in most of these patients, in particular endodontic treatments and tooth extractions. Conclusions: This retrospective analysis showed a high prevalence of minor oro-surgery procedures in our population, while its role in PIFP pathophysiology remains unknown. A new classification of PIFP built around the main discriminant factor of presence of these procedures in the painful area could be considered while available data were still insufficient to define specific diagnostic criteria.

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“…Of those, chronic pain has been one of the most debilitating conditions and appears to be inseparable for those who were diagnosed with Gulf War Illness 3 – 5 . While the pathophysiology underlying pain symptomology has not been well defined, it is well known that chronic pain states are associated with diminished intrinsic supraspinal pain modulatory function which often presents as reduced motor cortical excitability 6 – 10 . On the other hand, increased motor cortical excitability is known to be associated with enhanced pain inhibition 11 .…”

Section: Introductionmentioning

confidence: 99%

“…Thus, assessing the underlying motor cortical excitability in patients with GWI related diffuse body pain including headaches, muscle, and joint pain can offer a new level of understanding in the illness and potentially provide guidance for therapeutic intervention for this patient population. While it is widely accepted that chronic pain states can be associated with impaired corticomotor excitability represented by a diminished supraspinal modulatory state from traumatic or non-traumatic causes 6 – 8 , 12 – 14 , to the authors’ best knowledge, no study has been conducted to assess the corticomotor excitability in patients with GWI related chronic diffuse body pain including headaches, joint, and muscle pain.…”

Section: Introductionmentioning

confidence: 99%

Diminished corticomotor excitability in Gulf War Illness related chronic pain symptoms; evidence from TMS study

Lei

Kunnel

Metzger-Smith

et al. 2020

Sci Rep

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Chronic diffuse body pain is unequivocally highly prevalent in Veterans who served in the 1990–91 Persian Gulf War and diagnosed with Gulf War Illness (GWI). Diminished motor cortical excitability, as a measurement of increased resting motor threshold (RMT) with transcranial magnetic stimulation (TMS), is known to be associated with chronic pain conditions. This study compared RMT in Veterans with GWI related diffuse body pain including headache, muscle and joint pain with their military counterparts without GWI related diffuse body pain. Single pulse TMS was administered over the left motor cortex, using anatomical scans of each subject to guide the TMS coil, starting at 25% of maximum stimulator output (MSO) and increasing in steps of 2% until a motor response with a 50 µV peak to peak amplitude, defined as the RMT, was evoked at the contralateral flexor pollicis brevis muscle. RMT was then analyzed using Repeated Measures Analysis of Variance (RM-ANOVA). Veterans with GWI related chronic headaches and body pain (N = 20, all males) had a significantly (P < 0.001) higher average RMT (% ± SD) of 77.2% ± 16.7% compared to age and gender matched military controls (N = 20, all males), whose average was 55.6% ± 8.8%. Veterans with GWI related diffuse body pain demonstrated a state of diminished corticomotor excitability, suggesting a maladaptive supraspinal pain modulatory state. The impact of this observed supraspinal functional impairment on other GWI related symptoms and the potential use of TMS in rectifying this abnormality and providing relief for pain and co-morbid symptoms requires further investigation. Trial registration: This study was registered on January 25, 2017, on ClinicalTrials.gov with the identifier: NCT03030794. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03030794.

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Altered cortical excitability in persistent idiopathic facial pain

Abstract: NTC01746355.

Cited by 11 publications

References 33 publications

Altered trigeminal pain processing on brainstem level in persistent idiopathic facial pain

Altered trigeminal pain processing on brainstem level in persistent idiopathic facial pain

Persistent Idiopathic Facial Pain (PIFP) in Patients Referred to a Multidisciplinary Centre in Italy: A Retrospective Observational Study

Diminished corticomotor excitability in Gulf War Illness related chronic pain symptoms; evidence from TMS study

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