Chronic Facial Pain

Question 1

What can be used to assess pain?

Answer 1

McGill pain index - visual analgoue scale

Question 2

Why is assessed in biopsychosocial assessment?

Answer 2

Biological - firing of nerves
Psychological - anxiety/ depression
Social - work/finance/ family

Question 3

Example of oral dysaesthesia?

Answer 3

Burning mouth

Question 4

How to tx burning mouth?

Answer 4

Exclude other causes

CBT

Question 5

Local causes of burning mouth?

Answer 5

Bacteria
Fungus
Allergy
Geographic tongue
Parafunction
Oseophageal reflux 
Xerostomia

Question 6

How to test for bacteria or candida in mouth?

Answer 6

Bacteria - oral swab

Fungal - oral rinse

Question 7

Systemic causes of burning mouth?

Answer 7

Decrease B12
Diabetes
Menopause
Psychogenic

Question 8

Management of oral dysthesa?

Answer 8

Exclude any causes

Manage symtoms

Question 9

What tx have had postive trials in tx of oral dysaesthesia?

Answer 9

Topical clonazepam
Antidepressant
Capsaicin capsules
CBT

Question 10

How can capsaicin capsules help in burning mouth?

Answer 10

Chilli = burning

Deplete substance P from nerve endings giving pain free period

Question 11

How do pt w/ atypical facial pain present?

Answer 11

Daily persistant pain
At onset confined to limited area of face - can spread
No sensory or physical signs

Question 12

Associated features w/ atypical facial pain?

Answer 12

Facial swelling/ flushing
Altered sensation
Lacrimation

Question 13

What will lab investigations reveal in atypical facial pain?

Answer 13

No abnormalities

Question 14

What is atypical odontalgia?

Answer 14

Severe pain in tooth w/o pathology

Constant throb/ache

Question 15

Does dental tx improve atypical odontalgia?

Answer 15

Often no difference

May have improvement short term - week

Question 16

Should consider XLA if atypical pain?

Answer 16

No - pain may remain w/o tooth or move to adjacent teeth/ tissue

Question 17

Aetological features of atypical pain?

Answer 17

Change within CNS/ change neural activity
Psychosocial factors
Sensitisation of nerve - infection, XLA, RCT

Question 18

Examples of abnormal pain response?

Answer 18

Phantom limb pain

Question 19

Difference between hyperalgesia and allodynia?

Answer 19

Hyperalgesia - stimulation more painful

Allodynia - non-painful stimli are painful

Question 20

What is common see abnormal pain response?

Answer 20

Spontaneous pain - in absence of stimuli

Question 21

What is central sensitisaition?

Answer 21

Change in behaviour of central cells
Often induced by tissue injury
Cause spontaneous background firing/ hyperexcitabiltiy low threshold input
Increased size receptive field

Question 22

Why may pain by enhanced?

Answer 22

Wind up

Question 23

What is wind up?

Answer 23

Enhanced responsiveness and increase AP firing = increased perceived pan

Question 24

Possible therapies help deal chronic/ atypical pain?

Answer 24

Stress management
Relaxation/hypnosis
CBT

Question 25

What is CBT?

Answer 25

Talking therapy - can help change how think and what you do

Question 26

What medications can be helpful in chronic/atypical pain?

Answer 26

Analgesic antidepressants

Question 27

Example of med used?

Answer 27

Amitriptyline