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Comparative evaluation of somatosensory mechanisms involved in orofacial somatic, visceral and neuropathic pain

Porporatti, André Luís

Biblioteca Digital de Teses e Dissertações da USP; Universidade de São Paulo; Faculdade de Odontologia de Bauru 2016-03-08

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  • Título:
    Comparative evaluation of somatosensory mechanisms involved in orofacial somatic, visceral and neuropathic pain
  • Autor: Porporatti, André Luís
  • Orientador: Bonjardim, Leonardo Rigoldi; Conti, Paulo Cesar Rodrigues
  • Assuntos: Acurácia Diagnóstica; Teste Sensorial Quantitativo; Pulpectomia; Implantes Dentários; Dor Visceral; Dor Somática; Dor Neuropática; Doenças Da Polpa Dentária; Distúrbios Somatossensoriais; Dental Implants; Somatosensory Disorders; Somatic Pain; Quantitative Sensory Testing; Pulpectomy; Dental Pulp Diseases; Neuropathic Pain; Diagnostic Accuracy; Visceral Pain
  • Notas: Tese (Doutorado)
  • Descrição: Orofacial pain conditions can be classified into somatic, visceral or neuropathic pain. Somatic pain is triggered by a noxious stimulus generally inducted by peripheral traumas, such as dental implants surgeries (IMP). Visceral pain initiates within internal body tissues and is normally triggered by inflammation, as in inflammatory toothaches (IT). The third condition is neuropathic pain, which results from persistent injury to the peripheral nerve as in Atypical Odontalgia (AO). The aims of this study were: 1- to investigate somatosensory abnormalities, using mechanical, painful, and electrical quantitative sensory testing (QST), in somatic (IMP patients), visceral (IT) and neuropathic pain (AO); 2- to quantify how accurately QST discriminates an IT or AO diagnosis; and 3- to investigate the influence implant surgeries or pulpectomy may have on somatosensory system and sensory nerve fibers. Sixty subjects were divided in three groups: IMP (n = 20), IT (n = 20) and AO group (n = 20). A sequence of five QSTs and the Conditioned Pain Modulation Test (CPM) were performed one month and three months after dental implant surgery (IMP group) or pulpectomy (IT group). AO group was evaluated only at baseline. QST comprehended Mechanical Detection Threshold (MDT), Mechanical Pain Threshold (MPT), Dynamical Mechanical Allodynia (DMA), Current Perception Threshold (CPT) for A-beta (frequency of 2000Hz), A-delta (250Hz) and C fibers (5Hz) and Temporal Summation Test (TS). Z score transformation were applied to the data, and within and between groups were statistically analyzed using two-way ANOVA. In addition, the receiver operating characteristic curve analysis, diagnostic accuracy, sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of QSTs were calculated ( = 5%). The findings of this study proved that: 1- loss of function for touch threshold and electrical threshold of C fibers is present in inflammatory toothache; 2- allodynia, hyperalgesia, gain of function for touch and pain thresholds and impaired pain modulation is detected in atypical odontalgia; 3- some QSTs may be used as complementary tests in the differential diagnosis of atypical odontalgia and inflammatory toothache with strong accuracy; 4- the most accurate QSTs for differential diagnosis between subjects with AO and IT were MDT, MPT and DMA where touch threshold forces > 1 g/mm2 and pain threshold forces > 10g/mm2 can be used to accurately discriminate AO from IT; and 5- no somatosensory modification is found after implant surgery and reduced electrical threshold in C fiber is found for patients with inflammatory toothache after 3 months of pulpectomy.
  • DOI: 10.11606/T.25.2016.tde-10112021-093114
  • Editor: Biblioteca Digital de Teses e Dissertações da USP; Universidade de São Paulo; Faculdade de Odontologia de Bauru
  • Data de criação/publicação: 2016-03-08
  • Formato: Adobe PDF
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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