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Professor of Oral Surgery, King's College London; Honorary Consultant in Oral Surgery, King's College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust, London
Neuropathic pain is a significant social and economic burden. Back pain, joint pain and headaches affect over 30% of the population. Chronic orofacial pain is a common condition and is difficult to diagnose and manage. This two-part paper aims to provide an overview of novel understanding of neuropathic pain, and furnish clinical teams with an update on the less common and less well-recognized chronic orofacial conditions. Headaches and temporomandibular disorders are the most common conditions and are covered in separate papers (6 and 10). Trigeminal neuralgia, burning mouth, and trigeminal autonomic cephalgias are also covered in separate papers (7, 8 and 9). The remaining conditions: post-traumatic neuropathy (nerve injury); and persistent idiopathic facial pain and atypical odontalgia are discussed in this and the following paper.
Clinical Relevance: Neuropathic pain, though rare, is a consequence of dental treatment. Nerve injury in relation to M3M surgery, dental implants, endodontics and local anaesthesia result in 70% of affected patients experiencing chronic neuropathic pain.
Article
Neuropathic pain is defined as ‘pain initiated or caused by a primary lesion or dysfunction in the nervous system’1 and is characterized by intense, chronic pain in the absence of any overt tissue damage or dysfunction. While chronic pain is an umbrella term referring to any type of neuropathic or dysfunctional (Table 1) pain affecting the body, there is evidence to suggest that neuropathic pain affecting the trigeminal nerve, which innervates most of the head and face tissues, is distinct from painful conditions seen elsewhere in the body.
Pain is normally caused by tissue damage of intense noxious stimuli, which activate high threshold receptors that may be pain specific (nociceptors) or polymodal receptors.2 Peripheral nervous system (PNS) neuropathic pain manifests in many ways, however, key signs include:
Mechanisms for the development and perpetuation of chronic pain are discussed earlier in this series.2 See figures illustrating overall central and peripheral mechanisms related to symptoms of neuropathic pain (Figure 1). Peripheral mechanisms related to persistent pain (Figure 2) and central mechanisms of neuropathic pain (Figure 3).
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