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Evidence of descending inhibition deficits in atypical but not classical trigeminal neuralgia
Pain, 10/20/09

Leonard G et al. – The aim of the present study was to evaluate the functional integrity of the diffuse noxious inhibitory controls (DNIC) in (1) a group of patients with classical trigeminal neuralgia (CTN), (2) a group of patients with atypical trigeminal neuralgia (ATN), and (3) a group of healthy controls in order to determine if a descending pain modulation deficit could participate in the pathophysiology of TN pain...Taken together, these results suggest that the underlying physiopathology differs between classical TN (CTN) and atypical TN (ATN) and that a deficit in descending inhibition may further contribute to the pain experienced by patients with ATN.

Exclusive Author Commentary
Serge Marchand, 11/11/09

Trigeminal neuralgia (TN) is a complex and poorly understood neuropathic facial pain disorder. In the present study, we tested the hypothesis that a deficit in descending inhibition deficit could be associated with TN. We observed that the analgesic efficacy of a counter-irritation paradigm (known to recruit descending pain modulating mechanisms originating in the brainstem) was preserved in classical TN patients but almost absent in atypical TN patients, hence suggesting that a deficit in descending pain modulating mechanisms could contribute to the constant and diffuse pain experienced by atypical TN patients. Clinically, these observations could explain why the efficacy of many surgical interventions (e.g. MVD and GKS) is decreased in atypical TN patients when compared with classical TN patients. They could also open new therapeutic avenues for atypical TN patients (e.g. use of serotonine and noradrenaline reuptake inhibitors to rekindle inhibitory responses).

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