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Hormonal Changes and Other Related Factors in Atypical Facial Pain Patients

PI: Linda LeResche, Ph.D., Research Professor, Oral Medicine, School of Dentistry, University of Washington

Over the last few decades, the effects of sex steroids on neurological function in health and disease has become a rich and rapidly expanding area of neuroendocrinology. Estrogen and progestin have potent effects on central serotonergic and opioid neurons, modulating both neuronal activity and receptor density. Evidence from animal experiments supports a role for estrogen in central pain pathways. Several studies have shown differences in the pain neurotransmission and pain modulation systems of male and female rodents. Sex differences in mechanisms of pain modulation have been identified, and estrogen has been found to play a critical role in the pain modulation system of female mice.

Atypical facial pain (AFP) is a chronic facial pain which occurs predominantly in women. The cause and pathophysiology remain enigmatic. To date, no study has explored the effects of female hormones on AFP. The proposed research should shed light on whether such effects occur. AFP is a chronic orofacial pain which is more prevalent in women than in men. In clinical settings, the ratio of females to males presenting with this disorder is as high as 19:1. The mean age of onset is in the 4th or 5th decade of life. Because of this prevalence pattern and because of recent evidence linking other types of chronic facial pain with hormonal changes, we propose an epidemiologic case-control study aimed at determining whether hormonal change influences the risk of AFP in women. We will also explore other potential risk factors for the development of AFP in women, including a history of endogenous and exogenous hormonal changes, trauma and accident history, stress level and daily hassles, and psychological distress (depression, anxiety and somatization). The data will be used to assess whether hormonal changes increase the risk of AFP. Also, other potential confounding factors which have been previously hypothesized as risk factors will be studied for their effect on AFP.

Cases and controls have been identified and questionnaires will be mailed within the next month.

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