Adjunct Therapy for Pain

Question 1

What influences the perception of pain?

Answer 1

Mood, Attitude, Exercise

Question 2

What must chronic orofacial pain be differentiated from?

Answer 2

Pain from teeth, gums, sinuses, TMJ, jaw, Neurological Problems (Trigeminal Neuralgia, Trigeminal Nerve Lesions, Post-Herpetic Neuralgia)

Question 3

What are some drugs used as adjunctive therapeutic agents?

Answer 3

1. Anti anxiety and muscle relaxants
2. Antidepressants
3. Anticonvulsants
4. Others

Question 4

What is an example of an anxiolytic?

Answer 4

Benzodiazepines

Question 5

What is an example of an antidepressant?

Answer 5

Amitriptyline (Tricyclic antidepressant)

Question 6

What is the mechanism of action of Amitriptyline (Antidepressant)?

Answer 6

It increases CNS serotonin and norepinephrine levels by blocking the transporter (for reuptake) at the pre-synaptic membrane.

Question 7

Why does Amitriptyline cause sedation if it increases Norepinephrine?

Answer 7

This is because it also has histamine effects which causes drowsiness as it crosses the BBB.
This effect varies from patient to patient.
If the effect is too much, Prozac (Antidepressant) may be used instead.

Question 8

What is Prozac (Antidepressant)?

Answer 8

It is a selective serotonin uptake inhibitor

Question 9

What are the adverse effects of Amitriptyline?

Answer 9

CVS:
Tachycardia, postural hypotension, Cardiac Arrhythmia
Anticholinergic effects:
Dry mouth, blurring of vision, constipation, urinary retention
CNS:
Sedation