Sinus Pain
Patients with facial pain that has been attributed to potential nasal or sinus pathology present frequently to otolaryngologists. An otolaryngologist, who wishes to comprehensively diagnose and treat these patients, has to also integrate neurological, rhe
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Sinus Pain James Bartley
Keywords
Migraine • Tension headache • Temporomandibular joint disease • Sinus pain • Medication overuse headache • Central sensitisation • Glial activation
Abbreviations CNS CRS MOH TMJ TLR
Central nervous system Chronic rhinosinusitis Medication overuse headache Temporomandibular joint Toll-like receptor
J. Bartley, MB, ChB, FRACS, FFPMANZCA Department of Otolaryngology – Head and Neck Surgery, Counties Manukau District Health Board, 19 Lambie Drive, Manukau, Auckland, New Zealand e-mail: [email protected]
Core Messages
• The functional state of the central nervous system as well as the site and intensity of peripheral noxious stimuli is important in pain perception. • The glia, their receptors and their secreted signalling factors have a major influence on neural function. • Migraine, tension headache and temporomandibular joint pain are manifestations of central sensitisation. • While many patients with “sinus headache” may fulfil the criteria for tension headache, this does not exclude sinus infection contributing to central sensitisation. • Sinus infection does not cause pain by itself; it simply influences sensory thresholds. • Around the head and neck other pathologies apart from sinus infection can also be related to facial pain.
T.M. Önerci (ed.), Nasal Physiology and Pathophysiology of Nasal Disorders, DOI 10.1007/978-3-642-37250-6_18, © Springer-Verlag Berlin Heidelberg 2013
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18.1
Introduction
Patients with facial pain that has been attributed to potential nasal or sinus pathology present frequently to otolaryngologists. As well as considering the nose and sinuses as a potential cause, neurological, dental, rheumatological and musculoskeletal conditions need inclusion in a differential diagnosis. An otolaryngologist, who wishes to understand, diagnose and treat patients presenting with “sinus pain”, has to move away from a simplistic “cause and effect” pain model to a central sensitisation model. Central sensitisation introduces the concept that the central nervous system (CNS) is continually modifying the degree, duration and spatial extent of pain in a way that reflects the functional state of the CNS, rather than the site or intensity of peripheral noxious stimuli (Woolf 2011). As well as a sensory pain component, many facial pain patients have associated anxiety and depression issues, which may also need to be addressed (Jacobson and Folstein 2003). The central nervous system is continually modifying the degree, duration and spatial extent of pain in a way that reflects the functional state of the central nervous system, rather than the site or intensity of peripheral noxious stimuli.
18.2
(Woolf 1983). Central sensitisation introduces the concept that the CNS modifies the degree, duration and spatial extent of pain in a way that reflects the functional states of the CNS, rather than the site or intensity of peripheral noxious stimuli (Woolf 2011). Central sensitisation is characterised by increased (often exquisite) sensitivity to light
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