Patients with NOP often complain of a constant burning pain starting with a clear traumatic onset. Although burning is a frequent word used to describe the pain, other words like dull aching or sharp and shooting are commonly reported. In addition to the spontaneous pain, there is frequently stimulus-evoked pain triggered mainly by mechanical stimuli, for example touching the skin or oral mucosa or intensified by normal oral functions, such as chewing, talking, and jaw-opening. Unfortunately, there are no universal criteria for NOP which significantly hampers the description of clinical characteristics.84

Clinical findings are rare. There are no visible signs of inflammation and only in very rare cases may there be swelling and reddening of the facial skin or oral mucosa possibly mimicking complex regional pain syndromes.85

One of the hallmark findings in NOP may be changes in somatosensory function. The use of quantitative sensory testing (QST) has revealed a number of somatosensory disturbances with both hypo- and hyperesthesia. According to the criteria suggested, there should be complete or partial sensory loss in the painful area, but these areas could potentially be masked by hyperpheno-mona from the surrounding areas.86 It should be noted that although a number of QST techniques are available for intraoral use, there are no widely accepted guidelines for the standardized assessment of intraoral sensitivity which varies substantially from region to region and with type, thickness, and vascularization of the tissues. However, in the painful facial areas of patients with NOP, increased temperature and tactile thresholds have been demonstrated in addition to abnormal temporal summation of painful stimuli.87 Relatively few QST studies are available,83, 88 but there seems to be a trend that not all NOP patients have sensory disturbances and that there can be modality-specific differences.73 This therefore suggests that a comprehensive battery of QST techniques should be used.89,90

Advanced electrophysiological tests may be of help. For example, the blink reflex and recording of sensory nerve action potentials may provide important diagnostic information about the integrity of the trigeminal nerve fibers83 (Figure 35.1). In addition, laser-evoked potentials and other brain stem reflexes can be used.91

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