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Biochem Exam 5 > 11/30: Orofacial Pain > Flashcards

11/30: Orofacial Pain Flashcards

1
Q

What is the most prevalent pain in the facial region?

A

Toothache (odontalgia)

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2
Q

What is included in odontogenic?

A

Pulpal
Periodontal

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3
Q

What is included in non-odontogenic?

A

Sinus/nasal
Myofascial
Neurovascular
Neuropathic
Cardiogenic (rare)
Systemic (rare)
Idiopathic

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4
Q

What is the prevalence of temporomandibular disorders?

A

Females more often than males
Younger adults and older adults
Progression is uncommon

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5
Q

Why do we feel pain?

A

Instills protective behavior but if unabated, pain can be harmful

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6
Q

What are the principles of pain?

A
  • It is always subjective.
  • It may or may not be tied to a stimulus.
  • It is always a consequence of an emotional
    experience and psychological state.
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7
Q

Why do we experience pain?

A
  • Environmental stimulus (thermal, mechanical, chemical, polymodal)
  • Receptor activation
  • Generation of action potential
  • Transmission through primary afferent to dorsal horn (trigeminal spinal track nucleus)
  • Projection from dorsal horn/TSTN to brain for perception and interpretation
  • Pain location, intensity, reflexes, and meaning (supraspinal structures)
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8
Q

Nociception is not pain until…

A

it reaches and is processed
by higher centers (supraspinal structures)

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9
Q

What are the non-opioid inhibitory neurotransmitters?

A

Serotonin
Noradrenaline
GABA
Glycine

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10
Q

What is influenced by psychological factors?

A

Supraspinal

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11
Q

Where do supraspinal neurons come from?

A

The cortex and medulla

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12
Q

Describe the supraspinal medulla

A

Periaqueductal gray and restroventral medulla

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13
Q

Modulation is….

A

Always happening

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14
Q

What aspects are included in supraspinal modulation?

A

Psychological
Emotional
Placebo

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15
Q

What aspects are included in spinal modulation?

A

Neurotransmitters
Neuropeptides
Interneurons
Endogenous opioids
Central sensitization

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16
Q

What aspects are included in peripoheral modulation?

A

Peripheral sensitization
Inflammatory mediators
Intense/repetitive/prolonged noxious stimulus

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17
Q

Pain modulation is a dynamic process which means?

A

Can occur at multiple levels of the ascending and descending pathways

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18
Q

When do neuronal sensitization arise?

A

When neurotransmitters are left to linger in the synapse
- due to failure in diffusion, enzymatic destruction, reuptake

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19
Q

What kind of effects do neuronal sensitization prolong?

A

Effect on the post-synaptic neuron

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20
Q

What does neuronal sensitization allow?

A

Subthreshold input to recruit a response

21
Q

In neuronal sensitization, the normal input creates an increased…

A

responsiveness of nociceptive neurons

22
Q

In neuronal sensitization, the subthreshold input creates a recruitement of a response

A

Subthreshold input

23
Q

What kind of sensitization has Nociceptive neurons at periphery of receptive field?

A

Peripheral sensitization

24
Q

What is an increased pain experience in response to a painful stimulus?

A

Hyperalgesia

25
Q

What are Nociceptive neurons in the central nervous system?

A

Central sensitization

26
Q

What does an Increased responsiveness to normal/subthreshold afferent input?

A

Primary and secondary hyperalgesia
Allodynia

27
Q

What is Pain resulting from a
stimulus that does not
normally provoke pain?

A

Allodynia

28
Q

What is the revised gate control theory?

A
  • Myelinated (fast) non-nociceptive afferent fiber can activate
    inhibitory interneurons modulating nociceptive transmission.
  • Reason you instinctively wave, hold, clench your fingers
    when they burn.
  • Reason why T.E.N.S. helps relieve pain
29
Q

What is diffuse noxious inhibitor control?

A

The threshold for nociception can be raised when another
noxious stimulus is provoked in another area

30
Q

Describe a placebo effect

A

Psychological

31
Q

What does a palcebo effect lead to?

A

Release of endogenous analgesic substances

32
Q

What are the different ways to categorize different pains?

A
  • Neurophysiology
  • Structures involved
  • Timing
33
Q

What is Pain resulting from damage or threatened
damage to non-neural tissue?

A

Nociceptive pain

34
Q

What is Pain resulting from the presence of a lesion or disease of the somatosensory nervous system?

A

Neuropathic pain

35
Q

What is Pain that arises from altered nociception?

A

Nociplastic pain

36
Q

What is Pain with close temporal relationship to a stimulus, injury, or disease?

A

Acute pain

37
Q

Describe chronic pain

A
  • Pain that has lasted >3 months.
  • Does not typically respond to treatment in a linear dose-dependent fashion.
  • Presence of other/multiple ongoing pains is a predictor for transition from acute to chronic.
  • More influence of psychosocial factors.
  • More difficult to treat
38
Q

What are the most common psychosocial disorders?

A

Anxiety
Major depression
Personality disorders
Pain distress

39
Q

What are coping mechanisms for psychosocial disorders?

A
  • Internal locus of control
  • Perceived control
  • Catastrophic thinking
  • Hypervigilance
  • Fear avoidance
40
Q

What are pain assessments?

A
  • Pain intensity
  • Pain distress
  • Pain-related interference
    Functional limitation, disability
  • Oral Habits
41
Q

What is homotopic pain?

A

Site = source
- treat site of pain, effective

41
Q

What is heterotopic pain?

A

Site ≠ source
- treat site of pain, ineffective

41
Q

What are the 3 types of heterotropic pain?

A
  1. Central pain
  2. Projected pain
  3. referred pain
41
Q

What is pain when the Source is central but perceived peripherally?

A

Central pain
Example: Brain tumor (brain does not have nociceptors)

42
Q

What is pain when it follows same nerve distribution as primary source?

A

Projected pain
* Dermatome or motor distribution
* Hyperalgesia may be present
* Example: Post-herpetic neuralgia

43
Q

What is pain when its different nerve than primary source and is spontaneous (non-provoked)?

A

Referred pain
* Not aggravated by palpation
* Does not respond to anesthesia at site of pain –must block source of pain
* Does not typically cross midline (only if generated at midline)
* Can refers upward: cervical to trigeminal, mandibular to maxillary
* Example: Mandibular molar affected, but perceived at maxillary molar
 Same nerve root

44
Q

What kind of intents are used when determining what type of treatment goal is appropriate and achievable?

A
  1. Curative intent
  2. Palliative intent
    - Limit tissue damage
    - Get patient through adaptive phase
    - Manage chronic pain
    - More aggressive care if palliative care is ineffective to control
    symptoms or of there is significantly decreased quality of life
45
Q

What is the main class of drugs used to reduce pain?

A

Opioids
ex: codeine, oxycodone, morphine, hydromorphone, meperidine

46
Q

How long should a patient be treated before being re-evaluated?

A

10-14 days

Biochem Exam 5 (11 decks)

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