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      Journal of Pain Research (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on reporting of high-quality laboratory and clinical findings in all fields of pain research and the prevention and management of pain. Sign up for email alerts here.

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      Is Open Access

      Neuropathic Characteristics In Patients With Persistent Idiopathic Facial Pain

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          Abstract

          Background

          Persistent idiopathic facial pain (PIFP) is a subtype of painful cranial neuropathies and other facial pains. The involvement of neuropathic mechanisms in PIFP, however, remains controversial. Using the Douleur Neuropathique 4 (DN4) questionnaire, the present study examined neuropathic characteristics in patients with PIFP.

          Methods

          The multi-institutional retrospective study collected the following clinical data from 205 consecutive patients with adult chronic pain: gender, age, BMI, diseases causing chronic pain, disease duration, visual analogue scale score of pain strength, and DN4 score. To compare neuropathic characteristics between PIFP and postherpetic neuralgia (PHN), we selected patients with PIFP (n=19) and patients with PHN (n=33), and performing a case–control study in which each patient with PHN or PIFP was matched by age and gender (n=16 in each group).

          Results

          DN4 score was significantly lower in the PIFP group than in the PHN group before and after matching. The incidence when DN4 was ≥4 was 10.5% before matching and 12.5% after matching in the PIFP group, both of which were significantly lower than those in the PHN group before and after matching (66.7% and 75.0%).

          Conclusion

          Ten percent of the PIFP patients likely show neuropathic pain characteristics.

          Most cited references13

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          Do we need a third mechanistic descriptor for chronic pain states?

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            New insights into the mechanisms of itch: are pain and itch controlled by distinct mechanisms?

            Itch and pain are closely related but distinct sensations. They share largely overlapping mediators and receptors, and itch-responding neurons are also sensitive to pain stimuli. Itch-mediating primary sensory neurons are equipped with distinct receptors and ion channels for itch transduction, including Mas-related G protein-coupled receptors (Mrgprs), protease-activated receptors, histamine receptors, bile acid receptor, toll-like receptors, and transient receptor potential subfamily V1/A1 (TRPV1/A1). Recent progress has indicated the existence of an itch-specific neuronal circuitry. The MrgprA3-expressing primary sensory neurons exclusively innervate the epidermis of skin, and their central axons connect with gastrin-releasing peptide receptor (GRPR)-expressing neurons in the superficial spinal cord. Notably, ablation of MrgprA3-expressing primary sensory neurons or GRPR-expressing spinal cord neurons results in selective reduction in itch but not pain. Chronic itch results from dysfunction of the immune and nervous system and can manifest as neural plasticity despite the fact that chronic itch is often treated by dermatologists. While differences between acute pain and acute itch are striking, chronic itch and chronic pain share many similar mechanisms, including peripheral sensitization (increased responses of primary sensory neurons to itch and pain mediators), central sensitization (hyperactivity of spinal projection neurons and excitatory interneurons), loss of inhibitory control in the spinal cord, and neuro-immune and neuro-glial interactions. Notably, painful stimuli can elicit itch in some chronic conditions (e.g., atopic dermatitis), and some drugs for treating chronic pain are also effective in chronic itch. Thus, itch and pain have more similarities in pathological and chronic conditions.
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              Clinical presentation, management, and pathophysiology of neuropathic itch

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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                27 September 2019
                2019
                : 12
                : 2801-2805
                Affiliations
                [1 ]Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine , Hyogo, Japan
                [2 ]Department of Anesthesiology and Reanimatology, Faculty of Medicine Sciences, University of Fukui , Fukui, Japan
                [3 ]Department of Anesthesiology and Pain Management, Nishinomiya Municipal Central Hospital , Hyogo, Japan
                Author notes
                Correspondence: Munetaka Hirose Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine , 1-1 Mukogawa-cho, Nishinomiya, Hyogo663-8501, JapanTel +81-798-45-6392 Email mhirose@hyo-med.ac.jp
                Author information
                http://orcid.org/0000-0003-2949-2574
                http://orcid.org/0000-0003-1291-2827
                Article
                218332
                10.2147/JPR.S218332
                6776287
                bd6ca0b0-a956-4440-afc5-3d3a2698c5b9
                © 2019 Sukenaga et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 04 June 2019
                : 17 September 2019
                Page count
                Figures: 3, Tables: 2, References: 17, Pages: 5
                Categories
                Original Research

                Anesthesiology & Pain management
                dn4,neuropathic pain,orofacial pain
                Anesthesiology & Pain management
                dn4, neuropathic pain, orofacial pain

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