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D1 Fall - Biochem > 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
What are Nociceptive neurons in the central nervous system?
Central sensitization
26
What does an Increased responsiveness to normal/subthreshold afferent input?
Primary and secondary hyperalgesia Allodynia
27
What is Pain resulting from a stimulus that does not normally provoke pain?
Allodynia
28
What is the revised gate control theory?
* 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
What is diffuse noxious inhibitor control?
The threshold for nociception can be raised when another noxious stimulus is provoked in another area
30
Describe a placebo effect
Psychological
31
What does a palcebo effect lead to?
Release of endogenous analgesic substances
32
What are the different ways to categorize different pains?
* Neurophysiology * Structures involved * Timing
33
What is Pain resulting from damage or threatened damage to non-neural tissue?
Nociceptive pain
34
What is Pain resulting from the presence of a lesion or disease of the somatosensory nervous system?
Neuropathic pain
35
What is Pain that arises from altered nociception?
Nociplastic pain
36
What is Pain with close temporal relationship to a stimulus, injury, or disease?
Acute pain
37
Describe chronic pain
* 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
What are the most common psychosocial disorders?
Anxiety Major depression Personality disorders Pain distress
39
What are coping mechanisms for psychosocial disorders?
* Internal locus of control * Perceived control * Catastrophic thinking * Hypervigilance * Fear avoidance
40
What are pain assessments?
* Pain intensity * Pain distress * Pain-related interference Functional limitation, disability * Oral Habits
41
What is pain when the Source is central but perceived peripherally?
Central pain Example: Brain tumor (brain does not have nociceptors)
42
What is pain when it follows same nerve distribution as primary source?
Projected pain * Dermatome or motor distribution * Hyperalgesia may be present * Example: Post-herpetic neuralgia
43
What is pain when its different nerve than primary source and is spontaneous (non-provoked)?
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
What kind of intents are used when determining what type of treatment goal is appropriate and achievable?
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
What is the main class of drugs used to reduce pain?
Opioids ex: codeine, oxycodone, morphine, hydromorphone, meperidine
46
How long should a patient be treated before being re-evaluated?
10-14 days
47
What are the 3 types of heterotropic pain?
1. Central pain 2. Projected pain 3. referred pain
48
What is heterotopic pain?
Site ≠ source - treat site of pain, ineffective
49
What is homotopic pain?
Site = source - treat site of pain, effective

D1 Fall - Biochem (29 decks)

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