Blink reflexes in patients with atypical odontalgia and matched healthy controls

Atypical odontalgia (AO) is an orofacial pain condition which has been suggested to involve neuropathic pain mechanisms. The aim of this study was to use a brain stem reflex to investigate craniofacial nociceptive mechanisms in AO. In 38 AO patients and 27 matched healthy controls, the R2 component of the blink reflex (BR) was elicited using a "nociceptive-specific" electrode and recorded with surface electromyography electrodes on both orbicularis oculi muscles. The BR was tested by stimulation of both sides of the face of the participants before, during, and after an intraoral pain provocation test with capsaicin. The data were analyzed with three- and four-way mixed-model analyses of variance. The root mean square value of the ipsilateral R2 (R2i) was significantly reduced in patients compared with controls (P=0.046). No differences in R2 between stimulation sides were detected in either group (P>0.757). In all participants, R2 responses and the intensity of the pain evoked by the electrical stimulus were decreased during and after application of capsaicin compared with baseline (P<0.001). In patients, R2i onset latencies were significantly prolonged compared with controls (P=0.031). The present data show disturbances in the central processing of craniofacial information and that endogenous pain inhibitory systems in AO patients and healthy controls were activated to a similar degree by an acute intraoral nociceptive input. Additional clinical research with AO patients will be needed to determine to what extent neuropathic pain mechanisms are involved in this pain condition.