Abstract
Comprehensive neurophysiologic and psychophysical examination provides unique, sensitive, and specific information about an underlying neuropathy in patients presenting with orofacial pain symptoms. These tests consist of special electroneuromyography techniques, brainstem reflex examinations, sensory and motor evoked potential recordings, as well as quantitative sensory testing of different sensory modalities (tactile, thermal, vibratory). The neurophysiologic diagnostic biomarkers for large and small nerve fiber systems can confirm definite diagnosis of neuropathic pain, also within the trigeminal distribution with up to 95–100% accuracy. They thus provide valuable differential diagnostic markers of neuropathic vs. musculoskeletal pain within the orofacial area. When used in appropriate combinations, these neurophysiologic markers allow accurate topographic-level diagnosis along the neuraxis from peripheral nerves to the cortex and help in guiding further imaging studies to the most likely region of underlying pathology. These tests have already elucidated neural mechanisms of various orofacial pain conditions including trigeminal neuropathic pain, trigeminal neuralgia, persistent idiopathic orofacial pain, primary burning mouth syndrome, and atypical odontalgia (or persistent dentoalveolar pain). In the future, neurophysiologic markers will hopefully open a way for individually tailored, mechanism-based treatment approaches. In addition, recent research indicates that neurophysiologic and psychophysical markers can provide invaluable prognostic information as regards, e.g., recovery and individual risk for persistent pain after nerve injury.
Published Version
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