A Case of Nociplastic Pain Following Extraction of Painful Tooth Attribute to Myofascial Pain: A Case Report

Author(s): Itabashi, I1) , Fushimi, S2), Fushimi, T2),Tanahara, J3), Tanahara, H3)、 Wajima, K4)

Affiliations:
1)Itabashi Dental Clinic
2)Fushimi Dental Office
3)Tanahara Dental Clinic
4) School Medicine, Keio University Japan,

Aim of investigation:
In this report, we describe a case in which nociplastic pain developed at the referred pain area from recurrent myofascial pain one year after extraction of painful tooth. Nociplastic pain is defined as the following by IASP, Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.

Methods:
56 years old, female. In May 2013, she was diagnosed with myofascial pain in the left masseter and temporalis muscles and related pain in the #27 area at our clinic and started treatment. In March 2018, #27 tooth was extracted due to root fracture. About one year later, she returned to our clinic with hypersensitive myalgia of the left masseter and temporal muscles.

Results:
Clinical initial diagnosis: Myofascial pain The treatment for myofascial pain was not effective.

Clinical re-evaluation:
Combined myofascial pain and nociplastic pain. Since there were no findings of neuropathic pain such as sensory disturbance, nociplastic pain due to persistent myofascial pain was suspected. The concomitant prescribing of pregabalin 50mg/day was initiated, and the pain disappeared after 20 days.

Conclusions:
Clinically, the patient had overlapping myofascial pain and neuropathic pain. Persistent myofascial pain was considered to cause central sensitization, resulting in a condition similar to neuropathic pain in the absence of neurological damage. This was considered to be one of the developmental processes of the nociplastic pain.

Acknowledgements and/or Funding Source: None