Persistent Post-Endodontic Dental Pain and its Relationship to Phantom Limb–Like Neuropathic Pain: A Narrative Review

Review Article

Abstract

Persistent post-endodontic pain affects a clinically significant proportion of patients despite technically successful
root canal treatment. This narrative review examines the biopsychosocial mechanisms underlying this condition
through five interrelated domains: peripheral sensitization, central sensitization, neuroplasticity and cortical
reorganization, psychosocial factors, and the clinical entities of persistent idiopathic dentoalveolar pain and painful
post-traumatic trigeminal neuropathy as classified by the International Classification of Orofacial Pain 2020. A
conceptual parallel with phantom limb pain is explored, highlighting shared mechanisms of deafferentation, ectopic
discharge, and maladaptive cortical remapping, while acknowledging the anatomical and clinical differences inherent
to the trigeminal system. Psychosocial factors including pain catastrophizing, anxiety, and depression are framed as
perpetuating and amplifying elements rather than alternative diagnoses. Evidence-based pharmacological and nonpharmacological
management strategies are reviewed. The review is intended for clinicians in dentistry, orofacial
pain, and pain medicine seeking an integrative reference for this complex condition.