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Evidence of descending inhibition deficits in atypical but not classical trigeminal neuralgia

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Article de périodique (512.0Kb)
Publication date
2009
Author(s)
Léonard, Guillaume; Goffaux, Philippe; Mathieu, David; Blanchard, Jocelyn; Kenny, Brendan; Marchand, Serge
Editor(s)
Université de Sherbrooke. Faculté de médecine
Moncton Hospital
Subject
Trigeminal neuralgia
 
Diffuse noxious inhibitory controls (DNIC)
 
Descending inhibition
 
Pain modulation
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Abstract
Abstract : Trigeminal neuralgia (TN) is a rare neuropathic facial pain disorder. Two forms of TN, classical TN (CTN) and atypical TN (ATN), are reported and probably have different aetiologies. The aim of the present study was to evaluate the functional integrity of the diffuse noxious inhibitory controls (DNIC) in (1) a group of patients with classical trigeminal neuralgia (CTN), (2) a group of patients with atypical trigeminal neuralgia (ATN), and (3) a group of healthy controls in order to determine if a descending pain modulation deficit could participate in the pathophysiology of TN pain. DNIC responses of 14 CTN patients, 14 ATN patients and 14 healthy controls were obtained by comparing thermode-induced facial heat pain scores before and after activating DNIC. DNIC was triggered using a standard counter-irritation paradigm (i.e., immersion of the arm in painfully cold water). General sensitivity to pain was also evaluated by measuring mechanical pain thresholds over 18 points located outside the trigeminal territory. Healthy participants and CTN patients showed a 21% and 16% reduction in thermode-induced pain following the immersion, respectively (all p-values <.01), whereas ATN patients experienced no change (p=.57). ATN patients also had more tender points (mechanical pain thresholds < 4.0 kg) than CTN and healthy controls (all p-values < .05). Taken together, these results suggest that the underlying physiopathology differs between CTN and ATN and that a deficit in descending inhibition may further contribute to the pain experienced by patients with ATN.
URI
http://hdl.handle.net/11143/10170
Collection
  • Médecine et sciences de la santé – Articles de périodiques [143]

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