Chronic Facial Pain Flashcards
What can be used to assess pain?
McGill pain index - visual analgoue scale
Why is assessed in biopsychosocial assessment?
Biological - firing of nerves
Psychological - anxiety/ depression
Social - work/finance/ family
Example of oral dysaesthesia?
Burning mouth
How to tx burning mouth?
Exclude other causes
CBT
Local causes of burning mouth?
Bacteria Fungus Allergy Geographic tongue Parafunction Oseophageal reflux Xerostomia
How to test for bacteria or candida in mouth?
Bacteria - oral swab
Fungal - oral rinse
Systemic causes of burning mouth?
Decrease B12
Diabetes
Menopause
Psychogenic
Management of oral dysthesa?
Exclude any causes
Manage symtoms
What tx have had postive trials in tx of oral dysaesthesia?
Topical clonazepam
Antidepressant
Capsaicin capsules
CBT
How can capsaicin capsules help in burning mouth?
Chilli = burning
Deplete substance P from nerve endings giving pain free period
How do pt w/ atypical facial pain present?
Daily persistant pain
At onset confined to limited area of face - can spread
No sensory or physical signs
Associated features w/ atypical facial pain?
Facial swelling/ flushing
Altered sensation
Lacrimation
What will lab investigations reveal in atypical facial pain?
No abnormalities
What is atypical odontalgia?
Severe pain in tooth w/o pathology
Constant throb/ache
Does dental tx improve atypical odontalgia?
Often no difference
May have improvement short term - week
Should consider XLA if atypical pain?
No - pain may remain w/o tooth or move to adjacent teeth/ tissue
Aetological features of atypical pain?
Change within CNS/ change neural activity
Psychosocial factors
Sensitisation of nerve - infection, XLA, RCT
Examples of abnormal pain response?
Phantom limb pain
Difference between hyperalgesia and allodynia?
Hyperalgesia - stimulation more painful
Allodynia - non-painful stimli are painful
What is common see abnormal pain response?
Spontaneous pain - in absence of stimuli
What is central sensitisaition?
Change in behaviour of central cells
Often induced by tissue injury
Cause spontaneous background firing/ hyperexcitabiltiy low threshold input
Increased size receptive field
Why may pain by enhanced?
Wind up
What is wind up?
Enhanced responsiveness and increase AP firing = increased perceived pan
Possible therapies help deal chronic/ atypical pain?
Stress management
Relaxation/hypnosis
CBT
What is CBT?
Talking therapy - can help change how think and what you do
What medications can be helpful in chronic/atypical pain?
Analgesic antidepressants
Example of med used?
Amitriptyline
