Department of Endodontics, New York University College of Dentistry, New York, New York.
Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
Eur J Pain. 2019 Oct;23(9):1701-1711. doi: 10.1002/ejp.1447. Epub 2019 Jul 22.
Pain descriptors capture the multidimensional nature of pain and can elucidate underlying pathophysiological mechanisms. This study determined whether the pain descriptors chosen by subjects experiencing acute dental pain associate with the outcomes of two commonly performed dental sensory tests. The goal of the study is to clarify whether pain descriptors are useful in discriminating the underlying biological processes contributing to dental pain.
Participants (n = 228) presenting with acute toothache underwent standardized clinical dental sensory testing and described their pain in reference to 22 pain quality descriptors. Univariate and two-way ANOVA determined the relationship between groups defined by cold detection (positive or negative) and percussion hypersensitivity (painful or not) on the affected tooth, and pain descriptor reporting.
Subjects experiencing painful toothache most frequently reported evoked pain to temperature and chewing, and pain descriptors such as "throbbing" and "aching." They also reported neuropathic pain descriptors such as "tingling" and "electric shock." Subjects who detected a cold stimulus (thermal) on the affected tooth, frequently reported high intensity paroxysmal shooting pain compared to those that did not detect cold. By contrast, patients with percussion (mechanical) hypersensitivity on the affected tooth, reported higher levels of global pain intensity at rest and in function, and reported significantly higher intensity "radiating" and "throbbing" pain, than subjects with non-painful percussion.
The reporting of neuropathic pain descriptors by subjects experiencing acute toothache was more frequent than expected, suggesting that neuropathic mechanisms could contribute to typical toothache pain. Subjects experiencing toothache with mechanical hypersensitivity experience more intense pain overall.
In subjects experiencing acute toothache, specific pain descriptors associate with the responses to routine clinical sensory tests performed on the injured tooth. The frequent reporting of neuropathic pain descriptors suggests that neuropathic mechanisms could create a diagnostic challenge to differentiate toothache from intraoral neuropathic conditions. Persons experiencing toothache with mechanical hypersensitivity experience more intense pain overall, suggesting patients with this clinical feature will have distinct clinical pain management needs.
疼痛描述符捕捉疼痛的多维性质，并阐明潜在的病理生理机制。本研究旨在确定经历急性牙痛的受试者选择的疼痛描述符是否与两种常用的牙科感觉测试的结果相关。该研究的目的是阐明疼痛描述符是否有助于区分导致牙痛的潜在生物学过程。
出现急性牙痛的参与者（n=228）接受了标准化的临床牙科感觉测试，并参照 22 种疼痛质量描述符来描述他们的疼痛。单变量和双向方差分析确定了在受影响牙齿上冷探测（阳性或阴性）和叩诊敏感（疼痛或不疼痛）以及疼痛描述符报告的组之间的关系。
经历牙痛的受试者最常报告温度和咀嚼引起的诱发疼痛，以及“悸动”和“酸痛”等疼痛描述符。他们还报告了“刺痛”和“电击”等神经性疼痛描述符。在受影响的牙齿上检测到冷刺激（冷觉）的受试者，与未检测到冷觉的受试者相比，经常报告高强度阵发性射击痛。相比之下，在受影响的牙齿上有叩诊敏感（叩诊觉）的患者在休息和功能时报告的总体疼痛强度更高，并且报告的“辐射”和“悸动”疼痛强度显著更高，而叩诊觉不痛的患者则没有。
经历急性牙痛的受试者报告的神经性疼痛描述符比预期的更频繁，这表明神经性机制可能导致典型的牙痛。机械性敏感性的牙痛患者总体上经历更剧烈的疼痛。
在经历急性牙痛的受试者中，特定的疼痛描述符与受伤牙齿上进行的常规临床感觉测试的反应相关。神经性疼痛描述符的频繁报告表明，神经性机制可能对区分牙痛与口腔内神经性疾病构成诊断挑战。机械性敏感性的牙痛患者总体上经历更剧烈的疼痛，这表明具有这种临床特征的患者将有独特的临床疼痛管理需求。
