A possible role for saliva as a diagnostic fluid in patients with chronic pain

OBJECTIVES: The focus of this review was on proteins and
peptides found in saliva. Of greatest interest were those
neuropeptides relevant to nociception and to the pathogenesis
of chronic pain syndromes. An additional goal was to develop a
standardized protocol to collect saliva for laboratory
METHODS: Data were obtained through discussion
with experts at the medical schools in San Antonio and
Heidelberg and a Medline literature search involving all
relevant studies from 1966 to 1997. The literature search was
based on the following key terms: saliva, serotonin,
neuropeptide, substance P (SP), calcitonin gene-related
peptide (CGRP), and nerve growth factor (NGF).
mean concentration of SP in the saliva of healthy normal
controls ranged from 9.6 to 220 pg/mL. Generally, the
concentration of SP was approximately three times higher in
saliva than in plasma. In a number of painful conditions,
particularly tension headache, substantial elevations of
salivary SP were found. Mean values for salivary CGRP in
healthy controls were approximately 22 pmol/L and were
significantly elevated in patients with migraine attacks or
cluster headache. There were no data to indicate prior
quantitative determination of NGF in human saliva.
CONCLUSIONS: After sampling and processing techniques have
been standardized, measurement of neuropeptides in human
saliva could provide a valuable tool for study of patients
with chronic painful disorders such as rheumatoid arthritis,
osteoarthritis, and even fibromyalgia syndrome.

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