Peripheral/central neural microstructural alterations in persistent idiopathic dentoalveolar pain: a case-comparative...

Area of Science:

• Neurology
• Pain Medicine
• Neuroimaging

Background:

• Persistent idiopathic dentoalveolar pain (PIDAP) mechanisms are unclear, with theories suggesting peripheral or central nervous system involvement.
• Understanding these mechanisms is crucial for effective PIDAP diagnosis and treatment.

Purpose of the Study:

• To investigate differences in clinical characteristics and white matter integrity in PIDAP patients.
• To compare neural integrity at the peripheral trigeminal nerve and central white matter based on the presence or absence of neurovascular compression (NVC).

Main Methods:

• Retrospective case-comparative study of PIDAP patients undergoing diffusion tensor imaging (DTI).
• Fractional anisotropy (FA) assessed trigeminal nerve integrity at the root entry zone (REZ) and central white matter integrity.
• Clinical characteristics including pain intensity, pain catastrophizing, and Somatic Symptoms Scale-8 (SSS-8) were analyzed.

Main Results:

• Patients without NVC reported significantly higher pain intensity compared to those with NVC.
• NVC presence correlated with reduced FA in the trigeminal nerve, while absence showed a trend toward reduced FA in white matter.
• Asymmetric FA patterns in pain-related brain regions were observed in all PIDAP patients, irrespective of NVC.
• Correlations between FA, clinical scores, and NVC status varied, suggesting distinct pathophysiological pathways.

Conclusions:

• PIDAP may comprise subgroups with predominantly peripheral (with NVC) or central (without NVC) mechanisms.
• PIDAP with NVC is linked to peripheral trigeminal nerve changes and central alterations related to somatic burden.
• PIDAP without NVC appears associated with central white matter alterations in pain-related regions, correlating with pain severity.
• Asymmetric FA patterns in specific brain regions may represent a common feature of PIDAP.