Altered pain modulation in patients with persistent postendodontic pain

Cibele Nasri-Heir, Junad Khan, Rafael Benoliel, Changyong Feng, David Yarnitsky, Fengshen Kuo, Craig Hirschberg, Gary Hartwell, Ching Yu Huang, Gary Heir, Olga Korczeniewska, Scott R. Diehl, Eli Eliav

Research output: Contribution to journalArticlepeer-review

50 Scopus citations


Persistent pain may follow nerve injuries associated with invasive therapeutic interventions. About 3% to 7% of the patients remain with chronic pain after endodontic treatment, and these are described as suffering from painful posttraumatic trigeminal neuropathy (PTTN). Unfortunately, we are unable to identify which patients undergoing such procedures are at increased risk of developing PTTN. Recent findings suggest that impaired endogenous analgesia may be associated with the development of postsurgical chronic pain. We hypothesized that patients with PTTN display pronociceptive pain modulation, in line with other chronic pain disorders. Dynamic (conditioned pain modulation, temporal summation) and static (response to mechanical and cold stimulation) psychophysical tests were performed intraorally and in the forearm of 27 patients with PTTN and 27 sex-And age-matched controls. The dynamic sensory testing demonstrated less efficient conditioned pain modulation, suggesting reduced function of the inhibitory endogenous pain-modulatory system, in patients with PTTN, mainly in those suffering from the condition for more than a year. The static sensory testing of patients with PTTN demonstrated forearm hyperalgesia to mechanical stimulation mainly in patients suffering from the condition for less than a year and prolonged painful sensation after intraoral cold stimulus mainly in patients suffering from the condition for more than a year. These findings suggest that PTTN is associated more with the inhibitory rather than the facilitatory arm of pain modulation and that the central nervous system has a role in PTTN pathophysiology, possibly in a timedependent fashion.

Original languageEnglish (US)
Pages (from-to)2032-2041
Number of pages10
Issue number10
StatePublished - Oct 2015

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


  • Conditioned pain modulation
  • Neuropathic pain
  • Orofacial pain
  • Pain modulation
  • Postendodontic pain
  • Posttraumatic trigeminal neuropathy
  • Temporal summation


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