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Pathophysiology of Head and Facial Pain

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Diagnosis and Management of Head and Face Pain
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Abstract

A variety of insults and mechanisms cause head and facial pain. Nociceptive pathways carrying the unpleasant physical and emotional perception of pain excite based on actual or impending tissue damage. Facial pain in particular possesses a large differential diagnosis that can be narrowed with historical facts pertinent to the patient. An understanding of the pathophysiology of facial pain will help the practitioner to the correct diagnosis and treatment for the patient. Causes of facial pain include acute insult, neurogenic, inflammatory, post-traumatic, and idiopathic.

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References

  1. Ingram SL. Molecular basis of nociception. In: Winn HR, editor. Youmans and Winn neurological surgery. Philadelphia: Elsevier; 2017. p. 1379.

    Google Scholar 

  2. Julius D, Basbaum AI. Molecular mechanisms of nociception. Nature. 2001;413(6852):203–10.

    Article  CAS  PubMed  Google Scholar 

  3. Reichling DB, Levine JD. Critical role of nociceptor plasticity in chronic pain. Trends Neurosci. 2009;32(12):611–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70(18):1630–5.

    Article  CAS  PubMed  Google Scholar 

  5. Austin PJ, Moalem-Taylor G. The neuro-immune balance in neuropathic pain: involvement of inflammatory immune cells, immune-like glial cells and cytokines. J Neuroimmunol. 2010;229(1–2):26–50.

    Article  CAS  PubMed  Google Scholar 

  6. Parada CA, Reichling DB, Levine JD. Chronic hyperalgesic priming in the rat involves a novel interaction between cAMP and PKCepsilon second messenger pathways. Pain. 2005;113(1–2):185–90.

    Article  CAS  PubMed  Google Scholar 

  7. Hirai T, Mulpuri Y, Cheng Y, et al. Aberrant plasticity of peripheral sensory axons in a painful neuropathy. Sci Rep. 2017;7(1):3407.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cohen SP, Mao J. Neuropathic pain: mechanisms and their clinical implications. BMJ. 2014;348:f7656.

    Article  PubMed  Google Scholar 

  9. Conforti L, Gilley J, Coleman MP. Wallerian degeneration: an emerging axon death pathway linking injury and disease. Nat Rev Neurosci. 2014;15(6):394–409.

    Article  CAS  PubMed  Google Scholar 

  10. Takeda M, Takahashi M, Hara N, Matsumoto S. Glial cell line-derived neurotrophic factor modulates the excitability of nociceptive trigeminal ganglion neurons via a paracrine mechanism following inflammation. Brain Behav Immun. 2013;28:100–7.

    Article  CAS  PubMed  Google Scholar 

  11. Coull JA, Beggs S, Boudreau D, et al. BDNF from microglia causes the shift in neuronal anion gradient underlying neuropathic pain. Nature. 2005;438(7070):1017–21.

    Article  CAS  PubMed  Google Scholar 

  12. Devor M, Amir R, Rappaport ZH. Pathophysiology of trigeminal neuralgia: the ignition hypothesis. Clin J Pain. 2002;18(1):4–13.

    Article  PubMed  Google Scholar 

  13. Campero M, Bostock H, Baumann TK, Ochoa JL. A search for activation of C nociceptors by sympathetic fibers in complex regional pain syndrome. Clin Neurophysiol. 2010;121(7):1072–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Serra J, Solà R, Aleu J, Quiles C, Navarro X, Bostock H. Double and triple spikes in C-nociceptors in neuropathic pain states: an additional peripheral mechanism of hyperalgesia. Pain. 2011;152(2):343–53.

    Article  PubMed  Google Scholar 

  15. Kleggetveit IP, Namer B, Schmidt R, et al. High spontaneous activity of C-nociceptors in painful polyneuropathy. Pain. 2012;153(10):2040–7.

    Article  CAS  PubMed  Google Scholar 

  16. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–15.

    Article  PubMed  Google Scholar 

  17. Basbaum AI, Bautista DM, Scherrer G, Julius D. Cellular and molecular mechanisms of pain. Cell. 2009;139(2):267–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Ji RR, Chamessian A, Zhang YQ. Pain regulation by non-neuronal cells and inflammation. Science. 2016;354(6312):572–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971–9.

    Article  CAS  PubMed  Google Scholar 

  20. Monaco A, Cattaneo R, Marci MC, et al. Central sensitization-based classification for temporomandibular disorders: a pathogenetic hypothesis. Pain Res Manag. 2017;2017:5957076.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kandasamy R, Price TJ. The pharmacology of nociceptor priming. Handb Exp Pharmacol. 2015;227:15–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Nijs J, Torres-Cueco R, Van Wilgen CP, et al. Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain. Pain Physician. 2014;17(5):447–57.

    PubMed  Google Scholar 

  23. Bergouignan M. Successful cure of essential facial neuralgia by sodium diphenylhydantoinate (in French). Rev Larygol Otol Rhinol (Bord). 1942;63:34–41.

    Google Scholar 

  24. Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg. 1967;26(1 Suppl):159–62.

    Article  Google Scholar 

  25. Eller JL, Raslan AM, Burchiel KJ. Trigeminal neuralgia: definition and classification. Neurosurg Focus. 2005;18(5):E3.

    Article  PubMed  Google Scholar 

  26. Cheng J, Meng J, Liu W, et al. Nerve atrophy in trigeminal neuralgia due to neurovascular compression and its association with surgical outcomes after microvascular decompression. Acta Neurochir. 2017;159(9):1699–705.

    Article  PubMed  Google Scholar 

  27. Devor M, Govrin-lippmann R, Rappaport ZH. Mechanism of trigeminal neuralgia: an ultrastructural analysis of trigeminal root specimens obtained during microvascular decompression surgery. J Neurosurg. 2002;96(3):532–43.

    Article  PubMed  Google Scholar 

  28. Lee A, Mccartney S, Burbidge C, et al. Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression. J Neurosurg. 2014;120(5):1048–54.

    Article  PubMed  Google Scholar 

  29. Liao MF, Lee M, Hsieh MJ, et al. Evaluation of the pathophysiology of classical trigeminal neuralgia by blink reflex study and current perception threshold testing. J Headache Pain. 2010;11(3):241–6.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Obermann M, Yoon MS, Ese D, et al. Impaired trigeminal nociceptive processing in patients with trigeminal neuralgia. Neurology. 2007;69(9):835–41.

    Article  CAS  PubMed  Google Scholar 

  31. Burchiel KJ, Slavin KV. On the natural history of trigeminal neuralgia. Neurosurgery. 2000;46(1):152–4.

    Article  CAS  PubMed  Google Scholar 

  32. Dasilva AF, Dossantos MF. The role of sensory fiber demography in trigeminal and postherpetic neuralgias. J Dent Res. 2012;91(1):17–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Shulev Y, Trashin A, Gordienko K. Secondary trigeminal neuralgia in cerebellopontine angle tumors. Skull Base. 2011;21(5):287–94.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Love S, Gradidge T, Coakham HB. Trigeminal neuralgia due to multiple sclerosis: ultrastructural findings in trigeminal rhizotomy specimens. Neuropathol Appl Neurobiol. 2001;27(3):238–44.

    Article  CAS  PubMed  Google Scholar 

  35. Minagar A, Sheremata WA. Glossopharyngeal neuralgia and MS. Neurology. 2000;54(6):1368–70.

    Article  CAS  PubMed  Google Scholar 

  36. Teixeira MJ, De Siqueira SR, Bor-Seng-Shu E. Glossopharyngeal neuralgia: neurosurgical treatment and differential diagnosis. Acta Neurochir. 2008;150(5):471–5.

    Article  CAS  PubMed  Google Scholar 

  37. Khan M, Nishi SE, Hassan SN, et al. Trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome: an update. Pain Res Manag. 2017;2017:7438326.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Choi I, Jeon SR. Neuralgias of the head: occipital neuralgia. J Korean Med Sci. 2016;31(4):479–88.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Mallick-Searle T, Snodgrass B, Brant JM. Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology. J Multidiscip Healthc. 2016;9:447–54.

    Article  PubMed  PubMed Central  Google Scholar 

  40. de Leeuw R, American Academy of Orofacial Pain. Orofacial pain: guideline or assessment, diagnosis, and management. Chicago: Quintessence; 2008.

    Google Scholar 

  41. Rajput K, Reddy S, Shankar H. Painful neuromas. Clin J Pain. 2012;28(7):639–45.

    Article  PubMed  Google Scholar 

  42. Fried K, Govrin-Lippmann R, Devor M. Close apposition among neighbouring axonal endings in a neuroma. J Neurocytol. 1993;22(8):663–81.

    Article  CAS  PubMed  Google Scholar 

  43. Benoliel R, Kahn J, Eliav E. Peripheral painful traumatic trigeminal neuropathies. Oral Dis. 2012;18(4):317–32.

    Article  CAS  PubMed  Google Scholar 

  44. Mantyh P. Bone cancer pain: causes, consequences, and therapeutic opportunities. Pain. 2013;154(Suppl 1):S54–62.

    Article  PubMed  Google Scholar 

  45. Yang Y, Li H, Li TT, et al. Delayed activation of spinal microglia contributes to the maintenance of bone cancer pain in female Wistar rats via P2X7 receptor and IL-18. J Neurosci. 2015;35(20):7950–63.

    Article  CAS  PubMed  Google Scholar 

  46. Chiu IM, Heesters BA, Ghasemlou N, et al. Bacteria activate sensory neurons that modulate pain and inflammation. Nature. 2013;501(7465):52–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Diogenes A, Ferraz CC, Akopian AN, et al. LPS sensitizes TRPV1 via activation of TLR4 in trigeminal sensory neurons. J Dent Res. 2011;90(6):759–64.

    Article  CAS  PubMed  Google Scholar 

  48. Forssell H, Jääskeläinen S, List T, et al. An update on pathophysiological mechanisms related to idiopathic oro-facial pain conditions with implications for management. J Oral Rehabil. 2015;42(4):300–22.

    Article  CAS  PubMed  Google Scholar 

  49. Seccia TM, Rossitto G, Calò LA, Rossi GP. Oral burning with dysphagia and weight loss. Medicine (Baltimore). 2015;94(31):e1163.

    Article  Google Scholar 

  50. Lang E, Kaltenhäuser M, Seidler S, et al. Persistent idiopathic facial pain exists independent of somatosensory input from the painful region: findings from quantitative sensory functions and somatotopy of the primary somatosensory cortex. Pain. 2005;118(1-2):80–91.

    Article  PubMed  Google Scholar 

  51. Takenoshita M, Miura A, Shinohara Y, et al. Clinical features of atypical odontalgia; three cases and literature reviews. Biopsychosoc Med. 2017;11:21.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Rhodus NL, Fricton J, Carlson P, Messner R. Oral symptoms associated with fibromyalgia syndrome. J Rheumatol. 2003;30(8):1841–5.

    PubMed  Google Scholar 

  53. Lauria G, Majorana A, Borgna M, et al. Trigeminal small-fiber sensory neuropathy causes burning mouth syndrome. Pain. 2005;115(3):332–7.

    Article  PubMed  Google Scholar 

  54. Rahman M, Okamoto K, Thompson R, et al. Sensitization of trigeminal brainstem pathways in a model for tear deficient dry eye. Pain. 2015;156(5):942–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Bendtsen L. Central sensitization in tension-type headache–possible pathophysiological mechanisms. Cephalalgia. 2000;20(5):486–508.

    Article  CAS  PubMed  Google Scholar 

  56. Buchgreitz L, Lyngberg AC, Bendtsen L, Jensen R. Frequency of headache is related to sensitization: a population study. Pain. 2006;123(1-2):19–27.

    Article  CAS  PubMed  Google Scholar 

  57. Fernández-de-las-Peñas C, Cuadrado ML, Arendt-Nielsen L, et al. Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia. 2007;27(5):383–93.

    Article  PubMed  Google Scholar 

  58. Sandrini G, Proietti Cecchini A, Milanov I, et al. Electrophysiological evidence for trigeminal neuron sensitization in patients with migraine. Neurosci Lett. 2002;317(3):135–8.

    Article  CAS  PubMed  Google Scholar 

  59. Fernández-de-las-Peñas C, Ortega-Santiago R, Cuadrado ML, et al. Bilateral widespread mechanical pain hypersensitivity as sign of central sensitization in patients with cluster headache. Headache. 2011;51(3):384–91.

    Article  PubMed  Google Scholar 

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Correspondence to Erika A. Petersen .

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Helton, M., Petersen, E.A. (2018). Pathophysiology of Head and Facial Pain. In: Suen, J., Petersen, E. (eds) Diagnosis and Management of Head and Face Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-90999-8_3

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  • DOI: https://doi.org/10.1007/978-3-319-90999-8_3

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